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Symptomatic ischemic complications following endovascular treatment of vertebral artery dissecting aneurysms

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Purpose

The aim of this study is to investigate the clinical and radiological features related to the symptomatic ischemic complications of vertebral artery dissecting aneurysm (VADA) following endovascular treatment (EVT).

Methods

The clinical and radiological features of 127 VADAs, which were treated in a single tertiary institute between September 2008 and December 2020, were retrospectively reviewed. We defined a thrombosed aneurysm as being one which the thrombus was in the aneurysm in magnetic resonance imaging (MRI). Symptomatic ischemic complication was defined as a case in which acute infarction was confirmed on diffusion weighted image after EVT with associated clinical symptoms. Univariate and multivariate analyses were executed to demonstrate the associations between symptomatic ischemic complication and characteristics of VADA.

Results

The rate of symptomatic ischemic complication was 13.4% (17 of 127). The thrombosed aneurysms were observed in 24.4% (31 of 127) and posterior inferior cerebellar artery (PICA) involvement was shown in 38.6% (49 of 127). Multivariate logistic regression analysis demonstrated that thrombosed aneurysms (odds ratio [OR] = 8.54, 95% confidence interval [CI] 1.98–36.87, p = 0.004) and PICA involvement (OR = 4.26, 95% CI 1.03–17.68, p = 0.046) were significantly associated with symptomatic ischemic complications following EVT.

Conclusion

This study showed that the VADAs with intra-aneurysmal thrombose and PICA involvement may be independent risk factors for symptomatic ischemic complications following EVT. Therefore, when the thrombosed VADAs with PICA involvement are observed, practitioners may consider close postoperative monitoring for early detection of ischemic complications.

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Abbreviations

VADA :

vertebral artery dissecting aneurysm

VA :

vertebral artery

EVT :

endovascular treatment

PAO :

parent artery occlusion

DSA :

digital subtraction angiography

CTA :

computed tomography angiography

MRA :

magnetic resonance angiography

3DRA :

3D-dimensional rotational angiography

PICA :

posterior inferior cerebellar artery

DWI :

diffusion weighted imaging

MRA :

magnetic resonance imaging

CI :

confidence interval

OR :

odds ratio

WSS :

wall shear stress

References

  1. Aihara M, Naito I, Shimizu T, Matsumoto M, Asakura K, Miyamoto N, Yoshimoto Y (2018) Predictive factors of medullary infarction after endovascular internal trapping using coils for vertebral artery dissecting aneurysms. J Neurosurg 129:107–113. https://doi.org/10.3171/2017.2.JNS162916

    Article  PubMed  Google Scholar 

  2. Chatzizisis YS, Coskun AU, Jonas M, Edelman ER, Feldman CL, Stone PH (2007) Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol 49:2379–2393. https://doi.org/10.1016/j.jacc.2007.02.059

    Article  CAS  PubMed  Google Scholar 

  3. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, Kuhlenbaumer G, Stogbauer F, Ringelstein EB (2003) Cervical artery dissection—clinical features, risk factors, therapy and outcome in 126 patients. J Neurol 250:1179–1184. https://doi.org/10.1007/s00415-003-0174-5

    Article  PubMed  Google Scholar 

  4. Guan J, Li G, Kong X, He C, Long J, Qin H, Zhang H, Wang R (2017) Endovascular treatment for ruptured and unruptured vertebral artery dissecting aneurysms: a meta-analysis. J Neurointerv Surg 9:558–563. https://doi.org/10.1136/neurintsurg-2016-012309

    Article  PubMed  Google Scholar 

  5. Hernandez-Duran S, Ogilvy CS (2014) Clinical outcomes of patients with vertebral artery dissection treated endovascularly: a meta-analysis. Neurosurg Rev 37:569–577. https://doi.org/10.1007/s10143-014-0541-y

    Article  PubMed  Google Scholar 

  6. Hong JM, Chung CS, Bang OY, Yong SW, Joo IS, Huh K (2009) Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry 80:1087–1092. https://doi.org/10.1136/jnnp.2008.169805

    Article  CAS  PubMed  Google Scholar 

  7. Jin SC, Kwon DH, Choi CG, Ahn JS, Kwun BD (2009) Endovascular strategies for vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30:1518–1523. https://doi.org/10.3174/ajnr.A1621

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kim BM, Kim SH, Kim DI, Shin YS, Suh SH, Kim DJ, Park SI, Park KY, Ahn SS (2011) Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 76:1735–1741. https://doi.org/10.1212/WNL.0b013e31821a7d94

    Article  CAS  PubMed  Google Scholar 

  9. Kocaeli H, Chaalala C, Andaluz N, Zuccarello M (2009) Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature. Skull Base 19:209–218. https://doi.org/10.1055/s-0028-1114296

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kong X, Sun Z, Ling C, Xu L, Qian C, Yu J, Xu J (2021) Endovascular treatment for ruptured vertebral dissecting aneurysms involving PICA: reconstruction or deconstruction? Experience from 16 patients. Interv Neuroradiol 27:163–171. https://doi.org/10.1177/1591019920970030

    Article  PubMed  Google Scholar 

  11. Kulcsar Z, Houdart E, Bonafe A, Parker G, Millar J, Goddard AJ, Renowden S, Gal G, Turowski B, Mitchell K, Gray F, Rodriguez M, van den Berg R, Gruber A, Desal H, Wanke I, Rufenacht DA (2011) Intra-aneurysmal thrombosis as a possible cause of delayed aneurysm rupture after flow-diversion treatment. AJNR Am J Neuroradiol 32:20–25. https://doi.org/10.3174/ajnr.A2370

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. McLaughlin N, McArthur DL, Martin NA (2013) Use of stent-assisted coil embolization for the treatment of wide-necked aneurysms: a systematic review. Surg Neurol Int 4:43. https://doi.org/10.4103/2152-7806.109810

    Article  PubMed  PubMed Central  Google Scholar 

  13. Park KW, Park JS, Hwang SC, Im SB, Shin WH, Kim BT (2008) Vertebral artery dissection: natural history, clinical features and therapeutic considerations. J Korean Neurosurg Soc 44:109–115. https://doi.org/10.3340/jkns.2008.44.3.109

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sianos G, Papafaklis MI, Serruys PW (2010) Angiographic thrombus burden classification in patients with ST-segment elevation myocardial infarction treated with percutaneous coronary intervention. J Invasive Cardiol 22:6B–14B

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea

    Hyeong Jin Lee, Jai Ho Choi & Yong Sam Shin

  2. Department of Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea

    Bum Soo Kim

Authors
  1. Hyeong Jin Lee
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  2. Jai Ho Choi
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  4. Yong Sam Shin
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Corresponding author

Correspondence to Jai Ho Choi.

Ethics declarations

Ethics approval

The Ethics Committee of the Seoul St. Mary’s Hospital approved this study (approval no. KC21RISI0565) and waived the need to obtain consent for the collection, analysis, and publication of the retrospectively obtained and anonymized data for this non-interventional study.

Competing interests

The authors declare no competing interests.

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Comments

The authors reported their analysis concerning symptomatic ischemic complications following endovascular treatment of VADAs from their single center experience. They concluded that the thrombosed aneurysm and PICA involvement may be independent risk factors for symptomatic ischemic complications following endovascular treatment. This is interesting and important study and provides useful information to the readers. However, the readers may pay attention to following issues, as the authors mention in the limitation part.

(1) The diversity of VADA was not fully considered in this study. They included acute ruptured VADAs and chronic large or giant partially thrombosed aneurysms. The characteristics of these aneurysms were completely different.

(2) Their endovascular strategy was also variable including deconstructive and reconstructive techniques.

I believe that recent development of stent technology and improvement of anti-thrombotic management played an important role in the treatment of VADAs. Despite these developments of endovascular treatment, there are still several difficult aneurysms including thrombosed giant VADAs. Because these “malignant” aneurysms often have vasa vasorum, endovascular treatment is believed ineffective.

Although they focused on ischemic complications in this paper, I personally would like to know the long-term follow-up result in these patients’ group, especially such “malignant” aneurysms treated by reconstructive technique.

Finally, this paper will contribute endovascular treatment for the VADAs from the viewpoint of preventing ischemic complications. Further extended study will be expected.

Kenji Sugiu,

Okayama, Japan

This article is part of the Topical Collection on Vascular Neurosurgery - Aneurysm

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Lee, H.J., Choi, J.H., Kim, B.S. et al. Symptomatic ischemic complications following endovascular treatment of vertebral artery dissecting aneurysms. Acta Neurochir 164, 1645–1651 (2022). https://doi.org/10.1007/s00701-022-05223-9

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  • DOI: https://doi.org/10.1007/s00701-022-05223-9

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