Details

Autor(en) / Beteiligte

• Catapano, Joshua
• Cadigan, Megan
• Farhadi, Dara
• Nguyen, Candice
• Cole, Tyler S
• Baranoski, Jacob F
• Majmundar, Neil J
• Wilkinson, D. Andrew
• Fredrickson, Vance
• Albuquerque, Felipe
• Ducruet, Andrew F

Titel

Endovascular Treatment of Dissecting Vertebral Artery Aneurysms: A 20-year Institutional Experience

Ist Teil von

• Neurosurgery, 2020-12, Vol.67 (Supplement_1)

Ort / Verlag

Philadelphia: Wolters Kluwer Health, Inc

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION Vertebral artery dissecting aneurysms (VADAs) are a rare, but serious cause of acute subarachnoid hemorrhage (aSAH), associated with high rates of morbidity and mortality. METHODS All patients with a VADA treated endovascularly at a single facility from 1999 to 2019 were retrospectively analyzed. VADAs were categorized as either dominant or non-dominant vertebral artery. Llocation of the VADA was classified as either the 4th section of the vertebral artery (V4 segment, proximal to PICA), incorporating PICA origin, or vertebral basilar (VB, distal to PICA). Primary neurological outcomes were measured via mRS, with a mRS > 2 categorized as a poor neurological outcome. RESULTS 91 patients were found to have an endovascular treatment for a VADA. Coil-occlusion was performed in 47(51%), FDD in 29(32%), and stent/coil in 15(17%) cases. 54 patients(59%) presented with a ruptured VADA (treated via coil-occlusion in 39, FDD in 7, and stent/coil in 8 cases; P < .001) and 44 VADAs(48%) involved a dominant vertebral artery (all dominant vertebral arteries were treated by either a FDD or stent/coil; P < .001). Rates of an endovascular complication and retreatment were both significantly higher in patients treated with stent/coil(complication: N = 4, 27%, retreatment: N = 6, 40%) vs either coil-occlusion(complication: N = 1, 2%, retreatment = 2, 4%) or FDD(complication: N = 2, 7%, retreatment: N = 4, 14%)(P = .008 and P = .002, respectively). Coil-occlusion (22, 46%) was associated with a higher percentage of patients with a mRS > 2 on follow-up than FDD(4, 14%) or stent/coil (3, 20%)(P = .006). For dominant vertebral arteries, stent/coil (6, 40%) was found to have a greater percentage of retreatments than FDD(4, 14%)(P = .049). Of the unruptured VADAs (N = 37), 1 patient had a complication (3%), 4 patients(11%) required retreatment, 2 patients(5%) were found to have mRS > 2, and 8 patients (22%) with a worse mRS on follow-up. CONCLUSION The majority of ruptured VADAs treated endovascularly are via coil-occlusion of non-dominant vertebral arteries. For dominant vertebral arteries, FDD has a lower rate of retreatment than stent/coil, but with similar neurological outcomes. Furthermore, endovascular treatment of unruptured VADAs is safe and associated with relatively favorable angiographic and neurological outcomes especially when considering the poor natural history of these lesions.