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Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?

  • Clinical Investigation
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Abstract

Purpose

The treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.

Methods

A retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.

Results

The immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).

Conclusions

Our preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.

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Abbreviations

VA:

Vertebral artery

VADAs:

Vertebral artery dissecting aneurysms

PICA:

Posterior inferior cerebellar artery

supra-PICA VADAs:

VADAs distal to the posterior inferior cerebellar artery

SAH:

Subarachnoid hemorrhage

mRS:

Modified Rankin Scale score

References

  1. Kudo T, Iihara K, Satow T, Murao K, Miyamoto S (2007) Incidence of ischemic complications after endovascular treatment for ruptured dissecting vertebral artery aneurysms. Comparison between those arising proximal to and distal to the origin of the posterior inferior cerebellar artery. Interv Neuroradiol 13(Suppl 1):157–162

    PubMed Central  PubMed  Google Scholar 

  2. Jin SC, Kwon DH, Choi CG, Ahn JS, Kwun BD (2009) Endovascular strategies for vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30(8):1518–1523

    Article  PubMed  Google Scholar 

  3. Kurata A, Ohmomo T, Miyasaka Y, Fujii K, Kan S, Kitahara T (2001) Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22(1):11–18

    CAS  PubMed  Google Scholar 

  4. Peluso JP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB (2008) Endovascular treatment of symptomatic intradural vertebral dissecting aneurysms. AJNR Am J Neuroradiol 29(1):102–106

    Article  CAS  PubMed  Google Scholar 

  5. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94(3):427–432

    Article  CAS  PubMed  Google Scholar 

  6. Park SI, Kim BM, Kim DI, Shin YS, Suh SH, Chung EC et al (2009) Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30(7):1351–1356

    Article  CAS  PubMed  Google Scholar 

  7. Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ et al (2009) Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery clinical article. J Neurosurg 111(1):48–52

    Article  PubMed  Google Scholar 

  8. Zhao KJ, Fang YB, Huang QH, Xu Y, Hong B, Li Q et al (2013) Reconstructive treatment of ruptured intracranial spontaneous vertebral artery dissection aneurysms: long-term results and predictors of unfavorable outcomes. PLoS ONE 8(6):e67169

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36(5):905–911 discussion 912–913

    Article  CAS  PubMed  Google Scholar 

  10. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J et al (2006) Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 37(10):2499–2503

    Article  PubMed  Google Scholar 

  11. Mokri B, Houser OW, Sandok BA, Piepgras DG (1988) Spontaneous dissections of the vertebral arteries. Neurology 38(6):880–885

    Article  CAS  PubMed  Google Scholar 

  12. Wilkinson IM (1972) The vertebral artery extracranial and intracranial structure. Arch Neurol 27(5):392–396

    Article  CAS  PubMed  Google Scholar 

  13. Yoon W, Seo JJ, Kim TS, Do HM, Jayaraman MV, Marks MP (2007) Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment. Eur Radiol 17(4):983–993

    Article  PubMed  Google Scholar 

  14. Durward QJ (1995) Treatment of vertebral artery dissecting aneurysm by aneurysm trapping and posterior inferior cerebellar artery reimplantation: case report. J Neurosurg 82(1):137–139

    Article  CAS  PubMed  Google Scholar 

  15. Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S et al (2002) Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97(2):259–267

    Article  PubMed  Google Scholar 

  16. Yasui T, Yagura H, Komiyama M, Fu Y, Nagata Y, Tamura K (1993) Surgical treatment of ruptured dissecting aneurysms: proximal clipping vs trapping. No Shinkei Geka 21(5):395–401

    CAS  PubMed  Google Scholar 

  17. Shibukawa M, Sakamoto S, Kiura Y, Matsushige T, Kurisu K (2009) Ruptured vertebral artery dissecting aneurysms treated with endovascular treatment. Hiroshima J Med Sci 58(2–3):55–60

    PubMed  Google Scholar 

  18. Ryu CW, Koh JS, Kim EJ (2010) Dissection of the distal vertebral artery treated by modified parent artery trapping and a contralateral stent barricade: a case report. Interv Neuroradiol 16(2):171–174

    PubMed Central  PubMed  Google Scholar 

  19. Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM (2003) Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24(7):1421–1428

    PubMed  Google Scholar 

  20. Krischek O, Miloslavski E, Fischer S, Shrivastava S, Henkes H (2011) A comparison of functional and physical properties of self-expanding intracranial stents [Neuroform3, Wingspan, Solitaire, Leo + , Enterprise]. Minim Invasive Neurosurg 54(1):21–28

    Article  CAS  PubMed  Google Scholar 

  21. Takai N, Ezuka I, Sorimachi T, Kumagai T, Sano K (1993) Vertebral artery dissecting aneurysm rebleeding after proximal occlusion–case report. Neurol Med Chir (Tokyo) 33(11):765–768

    Article  CAS  Google Scholar 

  22. Sugiu K, Tokunaga K, Ono S, Nishida A, Date I (2009) Rebleeding from a vertebral artery dissecting aneurysm after endovascular internal trapping: adverse effect of intrathecal urokinase injection or incomplete occlusion? case report. Neurol Med Chir (Tokyo) 49(12):597–600

    Article  Google Scholar 

  23. Nakatomi H, Nagata K, Kawamoto S (1999) Persistent patent pseudolumen of ruptured dissecting aneurysm involving the posterior inferior cerebellar artery after proximal clipping. Acta Neurochir (Wien) 141(5):533–536

    Article  CAS  Google Scholar 

  24. Chalouhi N, Starke RM, Koltz MT, Jabbour PM, Tjoumakaris SI, Dumont AS et al (2013) Stent-assisted coiling versus balloon remodeling of wide-neck aneurysms: comparison of angiographic outcomes. AJNR Am J Neuroradiol 34(10):1987–1992

    Article  CAS  PubMed  Google Scholar 

  25. Kulcsar Z, Goricke SL, Gizewski ER, Schlamann M, Sure U, Sandalcioglu IE et al (2013) Neuroform stent-assisted treatment of intracranial aneurysms: long-term follow-up study of aneurysm recurrence and in-stent stenosis rates. Neuroradiology 55(4):459–465

    Article  PubMed  Google Scholar 

  26. Chung J, Kim BS, Lee D, Kim TH, Shin YS (2010) Vertebral artery occlusion with vertebral artery-to-posterior inferior cerebellar artery stenting for preservation of the PICA in treating ruptured vertebral artery dissection. Acta Neurochir (Wien) 152(9):1489–1492

    Article  Google Scholar 

  27. Kim MJ, Chung J, Kim SL, Roh HG, Kwon BJ, Kim BS et al (2011) Stenting from the Vertebral Artery to the Posterior Inferior Cerebellar Artery. AJNR Am J Neuroradiol 33(2):348–352

    Article  PubMed  Google Scholar 

  28. Hong B, Wang K, Huang Q, Xu Y, Fang X, Li Z et al (2012) Effects of metal coverage rate of flow diversion device on neointimal growth at side branch ostium and stented artery: an animal experiment in rabbit abdominal aorta. Neuroradiology 54(8):849–855

    Article  PubMed  Google Scholar 

  29. Masuo O, Terada T, Walker G, Tsuura M, Matsumoto H, Tohya K et al (2002) Study of the patency of small arterial branches after stent placement with an experimental in vivo model. AJNR Am J Neuroradiol 23(4):706–710

    PubMed  Google Scholar 

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Acknowledgments

The study was supported by the National Natural Science Foundation of China (No. 81301004, 81271271), the Foundation of Shanghai Public Health Bureau (No. 20114232), and the Shanghai Science and Technology Development Funds (No. 13140903201).

Conflict of interest

Yi-Bin Fang, Kai-Jun Zhao, Yi-Na Wu, Yu Zhou, Qiang Li, Peng-Fei Yang, Qing-Hai Huang, Wen-Yuan Zhao, Yi Xu, and Jian-Min Liu have no conflicts of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China

    Yi-Bin Fang, Kai-Jun Zhao, Yi-Na Wu, Yu Zhou, Qiang Li, Peng-Fei Yang, Qing-Hai Huang, Wen-Yuan Zhao, Yi Xu & Jian-Min Liu

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  1. Yi-Bin Fang
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  2. Kai-Jun Zhao
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  3. Yi-Na Wu
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  8. Wen-Yuan Zhao
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  10. Jian-Min Liu
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Correspondence to Yi Xu or Jian-Min Liu.

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Yi-Bin Fang and Kai-Jun Zhao are co-first authors.

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Fang, YB., Zhao, KJ., Wu, YN. et al. Treatment of Ruptured Vertebral Artery Dissecting Aneurysms Distal to the Posterior Inferior Cerebellar Artery: Stenting or Trapping?. Cardiovasc Intervent Radiol 38, 592–599 (2015). https://doi.org/10.1007/s00270-014-0981-3

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  • DOI: https://doi.org/10.1007/s00270-014-0981-3

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