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

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• 作者：Yi-Bin Fang ; Kai-Jun Zhao ; Yi-Na Wu ; Yu Zhou…
• 关键词：Vertebral artery dissecting aneurysm ; Internal trapping ; Stent ; assisted coiling
• 刊名：CardioVascular and Interventional Radiology
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：38
• 期：3
• 页码：592-599
• 全文大小：600 KB
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• 作者单位：Yi-Bin Fang (1)
  Kai-Jun Zhao (1)
  Yi-Na Wu (1)
  Yu Zhou (1)
  Qiang Li (1)
  Peng-Fei Yang (1)
  Qing-Hai Huang (1)
  Wen-Yuan Zhao (1)
  Yi Xu (1)
  Jian-Min Liu (1)
  
  1. Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Nuclear Medicine
  Ultrasound
  Cardiology
  
• 出版者：Springer New York
• ISSN：1432-086X

文摘

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.