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Efficacy and predicting factors of multimodal treatment for ruptured intracranial vertebral artery dissecting aneurysms

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Abstract

We aimed to investigate the efficacy of our multimodal strategies and propose a treatment algorithm for ruptured vertebral artery dissecting aneurysms (VADAs). This study included 41 patients treated at a single institution between 2015 and 2022. The treatment modalities were justified based on the collateral circulation and aneurysm location related to the posterior inferior cerebellar artery (PICA). Treatment outcomes and complications of each treatment group were analyzed. The association between the collateral blood flow and the postoperative vertebrobasilar ischemia (VBI) was also investigated. There were 17 post-PICA, 10 PICA-involved, 7 pre-PICA, and 7 non-PICA types. Reconstruction techniques included flow diversion devices (n = 11) and stent-assisted coiling (n = 3). Deconstruction techniques included coil trapping (n=17) and microsurgical parent artery occlusion with (n = 8) or without PICA revascularization (n = 2). Five (18.5%) of the deconstruction group had postoperative VBI. Overall favorable outcomes in both groups were observed in 70.7% of patients with a mean follow-up time of 21.5 months. Poor World Federation of Neurosurgical Societies grade (IV-V) was identified as a predictor of unfavorable outcomes (p = 0.003). In addition, the VA4/BA4 ratio > 0.22, the presence of collateral blood flow from the posterior communicating artery (PcomA), and a contralateral VA diameter > 2.5 mm were associated with a lower risk of postoperative VBI. In summary, the proposed strategic treatment in this study is pragmatic, yielding satisfactory results where a deconstructive technique should be used with caution, particularly when there is a flow mismatch or the absence of collateral PcomA in the vertebrobasilar circulation.

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  1. Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Thammasat University, Thammasat University Hospital, Khlong Nueng, Pathum Thani, 12120, Thailand

    Gahn Duangprasert, Raywat Noiphithak, Sasikan Sukhor & Dilok Tantongtip

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Contributions

Conceptualization: Gahn Duangprasert. Methodology: Gahn Duangprasert, Raywat Noiphithak. Investigation: Gahn Duangprasert, Sasikan Sukhor. Data curation: Gahn Duangprasert. Statistical analysis: Gahn Duangprasert. Writing—original draft: Gahn Duangprasert. Writing—review and editing: Gahn Duangprasert, Raywat Noiphithak. Visualization: all authors. Project administration: Gahn Duangprasert, Raywat Noiphithak. Supervision: Dilok Tantongtip

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Correspondence to Raywat Noiphithak.

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Retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Thammasat University approved this study (MTU-EC-SU-0–055/65).

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Duangprasert, G., Noiphithak, R., Sukhor, S. et al. Efficacy and predicting factors of multimodal treatment for ruptured intracranial vertebral artery dissecting aneurysms. Neurosurg Rev 46, 321 (2023). https://doi.org/10.1007/s10143-023-02226-7

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