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Treatment of Intracranial Vertebral Artery Dissecting Aneurysms Using Pipeline Embolization Devices

A Multicenter Cohort Study

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Abstract

Purpose

Intracranial vertebral artery dissecting aneurysm (IVADA) is a rare type of aneurysm with high morbidity and mortality. Recently, the application of pipeline embolization devices (PEDs) has been extended to IVADAs. Here, we aim to investigate the safety and effectiveness of PEDs for IVADAs.

Method

We retrospectively reviewed the PLUS database to identify patients who had IVADAs and were treated with PEDs from 2014 to 2019 at 14 centers across China. Data including patient and aneurysm characteristics, procedure details, angiographic and clinical results, relationship with the ipsilateral posterior inferior cerebellar artery (PICA), and patency of the PICA following PED coverage were analyzed.

Results

In this study 52 consecutive patients with 52 IVADAs were included. The mean age was 52.33 years and 82.7% were male. With a median follow-up of 10.5 months, the complete occlusion rate was 93.8% (45/48) and no recurrence or in-stent stenosis was detected. The total postoperative complication rate and mortality were 11.5% and 1.9%, respectively. Complications occurred in 9.6% (5/52) of patients within 30 days after the operation, including ischemic stroke in 3 and hemorrhagic stroke in 2. Another patient suffered an ischemic stroke at follow-up, 78.8% (41/52) PICAs were covered by PEDs, 1 case (2.4%) had a functional disability due to PICA occlusion, while 39.0% (16/41) had reduced flow during follow-up but hardly caused any obvious neurological deficits. Patients with IVADA involving PICA had a trend towards more complications (66.7% vs. 51.1%; P = 1).

Conclusion

Treating IVADAs with PEDs may be a safe and effective option, with favorable clinical and angiographic outcomes; however, complications associated with this treatment should not be ignored.

Registration

http://www.clinicaltrials.gov. Unique identifier: NCT03831672

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Acknowledgements

The authors acknowledge the 14 centers for their cooperation. Ying Zhang and Fujunhui Zhang share first authorship.

Funding

This work was supported by the National Natural Science Foundation of China (grant numbers: 82072036, 82272092), Research Projects of National Health Commission Capacity Building and Continuing Education Centre in 2021 (grant number: GWJJ2021100103); Capital’s Funds for Health Improvement and Research (grant number: 2022-01-2041); Summit Talent Program (grant number: DFL20220504).

Author information

Authors and Affiliations

  1. Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China

    Ying Zhang, Fujunhui Zhang, Mirzat Turhon, Jiliang Huang, Mengxing Li, Qichen Peng, Zhaoxu Zheng, Jian Liu & Yisen Zhang

  2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Ying Zhang, Fujunhui Zhang, Mirzat Turhon, Jiliang Huang, Mengxing Li, Qichen Peng, Zhaoxu Zheng, Jian Liu & Yisen Zhang

  3. Changhai Hospital Affiliated to Naval Medical University, Shanghai, China

    Jianmin Liu

  4. Xuanwu Hospital, Capital Medical University, Beijing, China

    Hongqi Zhang

  5. Zhengzhou University People’s Hospital, Zhengzhou, China

    Tianxiao Li

  6. Shanghai Donglei Brain Hospital, Shanghai, China

    Donglei Song

  7. Peking University International Hospital, Beijing, China

    Yuanli Zhao

  8. First Affiliated Hospital of Xinjiang Medical University, Urumqi, China

    Maimaitili Aisha

  9. Qilu Hospital of Shandong University, Jinan, China

    Yunyan Wang

  10. Nanfang Hospital, Southern Medical University, Guangzhou, China

    Wenfeng Feng

  11. Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Yang Wang

  12. Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

    Jieqing Wan

  13. Second Affiliated Hospital of Nanchang University, Nanchang, China

    Guohua Mao

  14. First Affiliated Hospital of Harbin Medical University, Harbin, China

    Huaizhang Shi

  15. First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Sheng Guan

Authors
  1. Ying Zhang
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  2. Fujunhui Zhang
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  18. Yang Wang
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Contributions

Ying Zhang: conceptualization, supervision, methodology, writing—revised draft, review and editing; Fujunhui Zhang: writing—original draft, formal analysis, data curation, software; Mizart Turhon: writing—review and editing; Jiliang Huang, Mengxing Li, Qichen Peng, Zhaoxu Zheng: data curation, investigation; Jian Liu: conceptualization, supervision, validation, funding acquisition; Yisen Zhang: conceptualization, supervision, validation; Jianmin Liu, Hongqi Zhang, Tianxiao Li, Donglei Song, Yuanli Zhao, Maimaitili Aisha, Yunyan Wang, Wenfeng Feng, Yang Wang, Jieqing Wan, Guohua Mao, Huaizhang Shi, Sheng Guan: resources, investigation. All authors have read the manuscript and consented to publication.

Corresponding author

Correspondence to Ying Zhang.

Ethics declarations

Conflict of interest

Y. Zhang, F. Zhang, M. Turhon, J. Huang, M. Li, Q. Peng, Z. Zheng, J. Liu, Y. Zhang, J. Liu, H. Zhang, T. Li, D. Song, Y. Zhao, M. Aisha, Y. Wang, W. Feng, Y. Wang, J. Wan, G. Mao, H. Shi and S. Guan declare that they have no relevant financial or non-financial interests to disclose.

Ethical standards

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The institutional review boards and ethics committee of Beijing Tiantan Hospital, Capital Medical University reviewed and approved the study protocol (approval No KY 2018-098-02). Participants gave informed consent to participate in the study before taking part.

Additional information

Ying Zhang and Fujunhui Zhang share first authorship.

Availability of Data and Materials

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Supplementary Information

62_2023_1318_MOESM1_ESM.doc

Supplementary Fig. 1: SAH Case. A Emergency CT showing SAH. B Right vertebral artery angiography showing a dissecting aneurysm located below PICA (pre-PICA) and far away from PICA three months later. C The aneurysm was treated with a PED alone (black arrow). D Right vertebral artery angiography showing complete aneurysm occlusion at 6‑months follow-up.

62_2023_1318_MOESM2_ESM.docx

Supplementary table 1: Comparison of main factors characterizing postoperative complications (one patient with SAH was excluded). Compared to the non-complication group, there were fewer patients underwent platelet function testing (0% vs. 22.2%; P= 0.331) but more patients with aneurysms involving the posterior inferior cerebellar artery (66.7% vs. 51.1%; P=1) in the complication group, but these findings did not achieve statistical significance.

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Zhang, Y., Zhang, F., Turhon, M. et al. Treatment of Intracranial Vertebral Artery Dissecting Aneurysms Using Pipeline Embolization Devices. Clin Neuroradiol 33, 1105–1114 (2023). https://doi.org/10.1007/s00062-023-01318-7

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