Endovascular treatment of vertebral artery dissecting aneurysms : a 20-year institutional experience.
J Neurointerv Surg
; 14(3): 257-261, 2022 Mar.
Article
de En
| MEDLINE
| ID: mdl-33906940
ABSTRACT
BACKGROUND:
The ideal treatment for unruptured vertebral artery dissecting aneurysms (VADAs) and ruptured dominant VADAs remains controversial. We report our experience in the management and endovascular treatment of patients with VADAs.METHODS:
Patients treated endovascularly for intradural VADAs at a single institution from January 1, 1999, to December 31, 2019, were retrospectively reviewed. Primary neurological outcomes were assessed using modified Rankin Scale (mRS) scores, with mRS >2 considered a poor neurological outcome. Additionally, any worsening (increase) in the mRS score from the preoperative neurological examination was considered a poor outcome.RESULTS:
Ninety-one patients of mean (SD) age 53 (11.6) years (48 (53%) men) underwent endovascular treatment for VADAs. Fifty-four patients (59%) presented with ruptured VADAs and 44 VADAs (48%) involved the dominant vertebral artery. Forty-seven patients (51%) were treated with vessel sacrifice of the parent artery, 29 (32%) with flow diversion devices (FDDs), and 15 (17%) with stent-assisted coil embolization (stent/coil). Rates of procedural complications and retreatment were significantly higher with stent/coil treatment (complications 4/15; retreatment 6/15) than with vessel sacrifice (complications 1/47; retreatment 2/47) or FDD (complications 2/29; retreatment 4/29) (p=0.008 and p=0.002, respectively). Of 37 patients with unruptured VADAs treated, only two (5%) had mRS scores >2 on follow-up.CONCLUSION:
Endovascular FDD treatment of VADAs appears to be associated with lower retreatment and complication rates than stenting/coiling, although further study is required for confirmation. Endovascular treatment of unruptured VADAs was safe and was associated with favorable angiographic and neurological outcomes.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Anévrysme intracrânien
/
Rupture d'anévrysme
/
Dissection vertébrale
/
Embolisation thérapeutique
/
Procédures endovasculaires
Type d'étude:
Observational_studies
/
Risk_factors_studies
Limites:
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
J Neurointerv Surg
Année:
2022
Type de document:
Article
Pays d'affiliation:
États-Unis d'Amérique