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Essibayi MA, Lanzino G, Keser Z. Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis. Interv Neuroradiol 2024; 30:22-30. [PMID: 35450460 PMCID: PMC10956451 DOI: 10.1177/15910199221095789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. METHODS The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. RESULTS Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. CONCLUSIONS IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.
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Affiliation(s)
| | | | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, USA
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Liu XL, Wang B, Zhao LB, Jia ZY, Shi HB, Liu S. Overlapping stents-assisted coiling for vertebral artery dissecting aneurysm: LVIS stent within Neuroform EZ stent. J Korean Neurosurg Soc 2022; 65:523-530. [PMID: 35430791 PMCID: PMC9271808 DOI: 10.3340/jkns.2021.0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Methods Results Conclusion
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Li W, Zhu W, Sun X, Liu J, Wang Y, Wang K, Zhang Y, Yang X, Zhang Y. Retreatment With Flow Diverters and Coiling for Recurrent Aneurysms After Initial Endovascular Treatment: A Propensity Score-Matched Comparative Analysis. Front Neurol 2021; 12:625652. [PMID: 34149588 PMCID: PMC8209336 DOI: 10.3389/fneur.2021.625652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Flow diverters and conventional coiling are established modalities for the retreatment of intracranial recurrent aneurysms after initial endovascular treatment. We aimed to compare the efficacy of these techniques. Methods: We retrospectively analyzed data for patients with recurrent aneurysms after initial endovascular treatment retreated in our center with either a pipeline embolization device (PED) or conventional coil embolization from January 2012 to July 2020. We performed 1:2 propensity score matching (PSM) using the nearest neighbor method. We controlled for: initial treatment strategy, aneurysm size, neck diameter, symptom presentation, history of aneurysm rupture, age, sex, fusiform-dissecting aneurysm, bifurcation aneurysm, and aneurysm location. The clinical and morphological factors of all patients at initial treatment and the angiographic and clinical results at the second treatment were collected and compared between the propensity-matched pairs. Results: A total of 105 intracranial aneurysms were identified; 18 patients (17.1%) were treated with a PED, and 87 (82.9%) were treated via conventional coil embolization. PSM resulted in 12 matched pairs (12 patients in the PED group and 24 in the coiling group). There was no significant difference of ischemic and hemorrhagic complications between the groups, the obliteration rate of branches covered by stent, or modified Rankin Scale scores at the last clinical follow-up. Importantly, the retreatment strategy in the PED group provided significantly different results vs. the coiling group (P < 0.001), with a lower recurrence rate (0.0 vs. 29.2%, respectively; P = 0.037). However, the procedural failure rate and the parent artery stenosis were more frequently in PED group compared with coiling group (both were 16.7 vs. 0.0%; P = 0.040). Conclusions: Endovascular retreatment for recurrent aneurysms after initial endovascular treatment might be safe and effective. Flow diverters might be associated with reduced risk of recanalization and an increased risk of procedural failure and mild parent artery stenosis.
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Affiliation(s)
- Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinguo Sun
- Department of Neurosurgery, Binzhou People's Hospital, Binzhou, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Mamonov NA, Petrov AE, Goroshchenko SA, Rozhchenko LV, Ivanov AA, Samochernykh KA. [Endovascular treatment of extracranial dissecting aneurysms of cervical arteries]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:16-24. [PMID: 34951756 DOI: 10.17116/neiro20218506116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Dissecting aneurysms of extracranial cervical arteries are a rare vascular pathology. To date, there is no consensus on the choice of optimal surgical approach for these aneurysms. OBJECTIVE To evaluate the effectiveness of endovascular treatment of various extracranial dissecting aneurysms. MATERIAL AND METHODS There were 19 patients with 21 extracranial dissecting aneurysms for the period from January 1, 2013 to October 19, 2020. Clinical examination, ultrasound and neuroimaging data were considered to determine surgical intervention. RESULTS Nineteen patients underwent 20 intravascular interventions: aneurysm embolization with detachable coils with stent-assistance (n=9), flow-diverting stent implantation (n=5), arterial reconstruction with a stent for carotid stenting (n=3), aneurysm embolization with balloon assistance (n=1), aneurysm embolization with detachable coils without assistance (n=2). There were no complications. All patients were discharged without neurological impairment after 1-5 days. Long-term results of control angiography were analyzed within 1-19 months in 12 patients. All aneurysms were completely occluded. Asymptomatic occlusion of flow-diverting stent together with aneurysm occurred in 1 patient with low compliance to antiplatelet therapy. Other 6 patients are scheduled for elective angiography. CONCLUSION Extracranial dissecting aneurysms of cervical arteries require vigilance due to their rare occurrence and risk of severe complications. In our opinion, intravascular interventions are advisable for these patients as effective and safe procedures.
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Affiliation(s)
- N A Mamonov
- Polenov Research Neurosurgery Institute, Saint-Petersburg, Russia
| | - A E Petrov
- Polenov Research Neurosurgery Institute, Saint-Petersburg, Russia
| | - S A Goroshchenko
- Polenov Research Neurosurgery Institute, Saint-Petersburg, Russia
| | - L V Rozhchenko
- Polenov Research Neurosurgery Institute, Saint-Petersburg, Russia
| | - A A Ivanov
- Polenov Research Neurosurgery Institute, Saint-Petersburg, Russia
| | - K A Samochernykh
- Polenov Research Neurosurgery Institute, Saint-Petersburg, Russia
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Tian Z, Wang Z, Li W, Zhu W, Liu J, Zhang Y, Yang X, Zhang Y. Dynamic contrast-enhanced MRI analysis for prognosis of intracranial dissecting aneurysm with intramural haematoma after endovascular treatment: an observational registry study. Stroke Vasc Neurol 2020; 6:133-138. [PMID: 32611729 PMCID: PMC8005896 DOI: 10.1136/svn-2020-000326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/07/2020] [Accepted: 05/16/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracranial dissecting aneurysm (IDA) with intramural haematoma (IMH) is an intractable cerebrovascular disease. The outcome of IDA with IMH after endovascular treatment varies across different individuals: some IMHs stop growing after endovascular treatment, while others continue to grow, even after embolisation of the parent artery. Currently, the mechanism for the continuous growth of IMH after endovascular treatment is still unclear. Continuous haemorrhage of the vasa vasorum in the IMH is considered to be associated with continuous enlargement of the IMH; however, this theory has not been proved by in vivo imaging. METHODS AND ANALYSIS This study will establish a prospective cohort of 80 patients who had an IDA with IMH and received endovascular treatment. Demographic characteristics, IDA morphological characteristics and treatment characteristics will be collected prospectively. All patients will undergo dynamic contrast-enhanced MRI (DCE-MRI) before and 6 months after the endovascular treatment. According to the follow-up results of the MRI, the IDAs will be divided into two groups: a haematoma stabilisation group and a haematoma enlargement group. Then, quantitative analysis of the vasa vasorum in the IMH will be performed, and differences between the two groups will be compared with determine the association between DCE-MRI related parameters and the outcomes of IMH changes. ETHICS AND DISSEMINATION The research was approved by the ethics committee of Beijing Tian Tan Hospital (KY 2019-024-03) and written informed consents would be obtained from all patients included in this study. The results of this study will be disseminated in professional printed media. TRIAL REGISTRATION NUMBER NCT03940859. Registered: 7 May, 2019. https://clinicaltrials.gov/ct2/show/NCT03940859.
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Affiliation(s)
- Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Zhongxiao Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Wenqiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Wei Zhu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Beijing, China
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Park KY, Yeon JY, Kim BM, Jeon P, Kim JH, Jang CK, Kim DJ, Lee JW, Kim YB, Chung J, Song DH, Park HG, Park JS. Efficacy and Safety of Flow-Diverter Therapy for Recurrent Aneurysms after Stent-Assisted Coiling. AJNR Am J Neuroradiol 2020; 41:663-668. [PMID: 32165365 DOI: 10.3174/ajnr.a6476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Flow-diverter treatment for previously stented aneurysms has been reported to be less effective and prone to complications. In this study, we evaluated the effectiveness and safety of flow diverters for recurrent aneurysms after stent-assisted coiling. MATERIALS AND METHODS Patients who underwent flow-diverter placement for recurrent aneurysms after stent-assisted coiling between March 2015 and March 2019 were recruited. Clinical and radiographic characteristics and clinical and angiographic outcomes were retrospectively evaluated. RESULTS Among 133 patients who underwent flow-diverter insertion, 17 (male/female ratio = 5:12; mean age, 53.8 years) were treated for recurrent aneurysms after stent placement with (n = 16) or without (n = 1) coiling. Eight patients initially presented with subarachnoid hemorrhage; 7, with headache; and 2, with visual field defects. Angiographic morphology included large/giant saccular in 12 patients, dissecting in 2, fusiform in 1, traumatic pseudoaneurysm in 1, and ruptured blood blister-like aneurysm in 1. The duration between the first treatment and flow-diverter placement ranged from 2 weeks to 15 months (median, 6 months). Flow-diverter placement was successful in all cases without any complications. All patients had favorable outcomes (mRS, 0-2), without any newly appearing symptoms. Aneurysms were followed up with conventional angiography at least once in 6-18 months. Sixteen aneurysms showed complete occlusion, and 1 aneurysm was enlarged. CONCLUSIONS Results from this case series investigating flow-diverter placement for recurrent aneurysms after stent-assisted coiling suggested that the procedure is safe and effective. Further study in a larger population may be warranted.
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Affiliation(s)
- K Y Park
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Y Yeon
- Department of Neurosurgery (J.Y.Y.), Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - B M Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - P Jeon
- Department of Radiology (P.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J-H Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - C K Jang
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D J Kim
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J W Lee
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y B Kim
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J Chung
- From the Department of Neurosurgery (K.Y.P., C.K.J., J.W.L., Y.B.K., J.C.), Yonsei University College of Medicine, Seoul, Republic of Korea
| | - D H Song
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H G Park
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J S Park
- Department of Radiology (B.M.K., J.-H.K., D.J.K., D.H.S., H.G.P., J.S.P.), Severance Stroke Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Hijikata T, Baba E, Shirokane K, Tsuchiya A, Nomura M. Dissecting Vertebral Artery Aneurysm Presenting Regrowth After Stent-Assisted Coil Embolization in Acute Stage. J Clin Med Res 2018; 10:527-530. [PMID: 29707096 PMCID: PMC5916543 DOI: 10.14740/jocmr3397w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 03/19/2018] [Indexed: 02/06/2023] Open
Abstract
For a case of dissecting vertebral artery aneurysm (DVAA) in a dominant vertebral artery (VA) or posterior inferior cerebellar artery (PICA)-involving lesion, stent-assisted coil embolization (SACE) is an effective technique to preserve blood flow of the VA. A 41-year-old man presented with subarachnoid hemorrhage. Angiography demonstrated DVAA on the left VA just distal to the PICA, and the right VA was thinner than the left. For this case, SACE was performed to preserve the left VA and PICA. On the 10th day, angiography showed recurrence of the dissection. The dissected portion had thickened and extended to both distal and proximal sides involving the PICA origin and proximal portion to the PICA. A second endovascular embolization was performed and the recurrent dissecting aneurysm was embolized including the main VA cavity. In cases of DVAA, there is a possibility of recurrence after SACE, if a dissecting cavity remains unembolized. Therefore, total embolization is necessary under close observation from multiple angles, including the down-the-barrel view.
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Affiliation(s)
| | - Eiichi Baba
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
| | | | | | - Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
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Zhang Y, Sui B, Liu J, Wang Y, Tian Z, Chen J, Wu Z, Yang X. Aneurysm wall enhancement on magnetic resonance imaging as a risk factor for progression of unruptured vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment. J Neurosurg 2018; 128:747-755. [DOI: 10.3171/2016.11.jns162433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe recurrence rate of vertebrobasilar dissecting aneurysms (VBDAs) after reconstructive endovascular treatment (EVT) is relatively high. The aneurysm wall enhancement on high-resolution MRI (HRMRI) reportedly predicts an unsteady state of an intracranial aneurysm. The authors used HRMRI to investigate the relationship between wall enhancement on HRMRI and progression of VBDAs after reconstructive EVT.METHODSFrom January 2012 to December 2015, patients with an unruptured VBDA who underwent reconstructive EVT were enrolled in this study. Preoperative enhanced HRMRI was performed to evaluate radiological characteristics. The relationships between aneurysm wall enhancement and various potential risk factors were statistically analyzed. Follow-up angiographic examination was performed with digital subtraction angiography and conventional HRMRI. Cox regression analysis was performed to identify predictors of VBDA progression after reconstructive EVT.RESULTSEighty-two patients (12 women and 70 men, mean age 53.48 ± 9.23 years) with 83 VBDAs were evaluated in the current study. The average maximum diameter of the VBDAs was 11.30 ± 7.90 mm. Wall enhancement occurred in 43 VBDAs (51.81%). Among all 83 VBDAs, 62 (74.70%) were treated by stent-assisted coil embolization and 21 (25.30%) by stenting alone. The mean duration of imaging follow-up among all 82 patients was 10.55 months (range 6–45 months), and 15 aneurysms (18.07%) exhibited progression. The statistical analysis indicated no significant differences in age, sex, risk factors (high blood pressure, smoking, diabetes mellitus, and a high cholesterol level), VBDA stage, or VBDA size between enhanced and unenhanced VBDAs. Univariate Cox regression analysis showed that both the maximum diameter of the VBDAs and wall enhancement were associated with recurrence (p < 0.05). Multivariate Cox proportional hazard regression analysis showed that the maximum diameter of the VBDAs and wall enhancement on HRMRI were independent risk factors for aneurysm progression (p < 0.05).CONCLUSIONSAneurysm size and wall enhancement on HRMRI can predict the progression of VBDAs after reconstructive EVT.
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Affiliation(s)
- Yisen Zhang
- 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Binbin Sui
- 2Department of Neuroimaging, Beijing Tiantan Hospital, Capital Medical University, Beijing; and
| | - Jian Liu
- 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Yang Wang
- 3Department of Neurosurgery, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
| | - Zhongbin Tian
- 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Junfan Chen
- 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Zhongxue Wu
- 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - Xinjian Yang
- 1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing
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Takahashi Y, Endo H, Endo T, Fujimura M, Niizuma K, Tominaga T. Patient with Recurrent Anterior Cerebral Artery Dissecting Aneurysm After Stent-Assisted Coil Embolization Successfully Treated with A3-A3 Anastomosis. World Neurosurg 2018; 109:77-81. [PMID: 28962962 DOI: 10.1016/j.wneu.2017.09.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yoshiharu Takahashi
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Toshiki Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Liu J, Jing L, Zhang Y, Song Y, Wang Y, Li C, Wang Y, Mu S, Paliwal N, Meng H, Linfante I, Yang X. Successful Retreatment of Recurrent Intracranial Vertebral Artery Dissecting Aneurysms After Stent-Assisted Coil Embolization: A Self-Controlled Hemodynamic Analysis. World Neurosurg 2016; 97:344-350. [PMID: 27742509 DOI: 10.1016/j.wneu.2016.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intracranial vertebral artery dissecting aneurysms (VADAs) tend to recur despite successful stent-assisted coil embolization (SACE). Hemodynamics is useful in evaluating aneurysmal formation, growth, and rupture. Our aim was to evaluate the hemodynamic patterns of the recurrence of VADA. METHODS Between September 2009 and November 2013, all consecutive patients with recurrent VADAs after SACE in our institutions were enrolled. Recurrence was defined as recanalization and/or regrowth. We assessed the hemodynamic alterations in wall shear stress (WSS) and velocity after the initial SACE and subsequently after retreatment of the aneurysms that recurred. RESULTS Five patients were included. After the initial treatment, 3 patients showed recanalization and 2 showed regrowth. In the 2 patients with regrowth, the 2 original aneurysms maintained complete occlusion; however, de novo aneurysm regrowth was confirmed near the previous site. Compared with 3 recanalized aneurysms, the completely occluded aneurysms showed high mean reductions in velocity and WSS after initial treatment (velocity, 77.6% vs. 57.7%; WSS, 74.2% vs. 52.4%); however, WSS remained high at the region near the previous lesion where the new aneurysm originated. After the second retreatment, there was no recurrence in any patient. Compared with the 3 aneurysms that recanalized, the 4 aneurysms that maintained complete occlusion showed higher reductions in velocity (62.9%) and WSS (71.1%). CONCLUSIONS Our series indicated that hemodynamics might have an important role in recurrence of VADAs. After endovascular treatment, sufficient hemodynamic reduction in aneurysm dome, orifice, and parent vessel may be one of the key factors for preventing recurrence in VADAs.
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Affiliation(s)
- Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Linkai Jing
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ying Song
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yanmin Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Nikhil Paliwal
- Toshiba Stroke and Vascular Research Center, and Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, and Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Italo Linfante
- Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Baptist Hospital, Miami, Florida, USA.
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
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Magnetic Resonance Imaging Follow-Up of Large or Giant Vertebrobasilar Dissecting Aneurysms After Total Embolization on Angiography. World Neurosurg 2016; 91:218-27. [DOI: 10.1016/j.wneu.2016.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 02/05/2023]
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12
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Daou B, Hammer C, Chalouhi N, Starke RM, Jabbour P, Rosenwasser RH, Tjoumakaris S. Dissecting pseudoaneurysms: predictors of symptom occurrence, enlargement, clinical outcome, and treatment. J Neurosurg 2016; 125:936-942. [PMID: 26824374 DOI: 10.3171/2015.10.jns151846] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dissection of the carotid and vertebral arteries can result in the development of aneurysmal dilations. These dissecting pseudoaneurysms can enlarge and cause symptoms. The objective of this study is to provide insight into the progression of dissecting pseudoaneurysms and the treatments required to manage them. METHODS A review of the electronic medical records was conducted to detect patients with carotid and vertebral artery dissection. An imaging review was conducted to identify patients with dissecting pseudoaneurysms. One hundred twelve patients with 120 dissecting pseudoaneurysms were identified. Univariate and multivariate analyses were conducted to assess the factors associated with undergoing further interventions other than medical treatment, pseudoaneurysm enlargement, pseudoaneurysms resulting in ischemic and nonischemic symptoms, and clinical outcome. RESULTS Overall, 18.3% of pseudoaneurysms were intracranial and 81.7% were extracranial, and the average size was 7.3 mm. The mean follow-up time was 29.3 months; 3.3% of patients had a recurrent transient ischemic attack, no patients had a recurrent stroke, and 14.2% of patients had recurrence of nonischemic symptoms (headache, neck pain, Horner syndrome, or cranial nerve palsy). Follow-up imaging demonstrated that 13.8% of pseudoaneurysms had enlarged, 30.2% had healed, and 56% had remained stable. In total, 20.8% of patients had an intervention other than medical treatment. Interventions included stenting, coiling, flow diversion, and clipping. Predictors of intervention included increasing size, size > 10 mm, location in the C2 (petrous) segment of the internal carotid artery (ICA), younger age, hyperlipidemia, pseudoaneurysm enlargement, and any symptom development. Significant predictors of enlargement included smoking, history of trauma, C2 location, hyperlipidemia, and larger initial pseudoaneurysm size. Predictors of pseudoaneurysm resulting in recurrent ischemic and nonischemic symptoms included increasing size and location in the petrous segment of the ICA. Smoking was a predictor of unfavorable outcome. CONCLUSIONS Dissecting pseudoaneurysms have a benign course and most will not cause symptoms or enlarge on follow-up. Medical treatment can be a sufficient, initial treatment for dissecting pseudoaneurysms.
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Affiliation(s)
- Badih Daou
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Christine Hammer
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert M Starke
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Long-Term Outcome of Tubridge Flow Diverter(S) in Treating Large Vertebral Artery Dissecting Aneurysms-A Pilot Study. Clin Neuroradiol 2016; 27:345-350. [PMID: 26780551 DOI: 10.1007/s00062-015-0494-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The experience of flow diverters (FDs) in treating large vertebral artery-dissecting aneurysms (VADAs) is still limited. This study was conducted to present our long-term outcome of VADAs treated with a Tubridge flow diverter (TFD), a new device developed in China. MATERIALS AND METHODS The clinical and angiographic data of six patients harboring large VADAs and treated with TFDs were prospectively collected and analyzed. RESULTS A total of nine TFDs were successfully implanted in six patients. Angiographic follow-up images were available for all patients at a median of 26.0 (18.5, 37.5) months after treatment. Five of the six VADAs were completely occluded, and the last was improved (near complete occlusion). In-stent stenosis was detected in one case and was handled appropriately by angioplasty and stenting. All covered branches and parent arteries remained patent. There were no complications or new neurological deficits observed in any of the patients. At the latest clinical follow-up (36.5 (26.0, 44.5) months), all patients achieved 0 in the modified Rankin scale score. CONCLUSIONS Our preliminary experience suggests that the Tubridge flow diverter might be an alternative treatment for large and recurrent dissecting aneurysms derived from the vertebral artery.
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