Reconstructive Treatment of Ruptured Intracranial Spontaneous Vertebral Artery Dissection Aneurysms: Long-Term Results and Predictors of Unfavorable Outcomes

Abstract

Introduction: Few studies focused on predictors of unfavorable outcomes (modified Rankin Scale, 2-6) after reconstructive treatment of the ruptured intracranial spontaneous vertebral artery dissection aneurysms (ris-VADAs), which was evaluated based on 57 reconstructed lesions in this study.

Methods: Results of 57 consecutive patients (M:F = 29∶28; median age, 48 years; range, 27 to 69 years) harboring 57 ris-VADAs, which were treated with coils combined with single stent(n = 32), double overlapping stents (n = 16), and triple overlapping stents (n = 9) between October 2000 to March 2011, were retrospectively reviewed and analyzed.

Results: The available (n = 54) mean durations of angiographic and clinical follow-ups were 27 months (range, 12 to 78) and 62 months (range, 12 to 132), respectively. The involvement of PICA (p = 0.004), size of lesions (p = 0.000), quantity of stent (p = 0.001), and coil type (p = 0.002) affected the immediate obliteration grade, which was only risk factor for angiographic recurrences (p = 0.031). Although the post-treatment outcomes did not differ between single stent and multiple stents (p = 0.434), 5 angiographic recurrences, 1 rebleeding and 1 suspected rebleeding, all occurred in partial obliteration after single-stent-assisted coiling. Progressive thrombosis and in-stent obliteration were not detected on follow-up angiograms. Older age (odds ratio [OR] = 1.090; 95% confidence interval [CI], 1.004-1.184; p = 0.040) and unfavorable Hunt-Hess scale (OR = 4.289; 95%CI, 1.232-14.933; p = 0.022) were independent predictors of unfavorable outcomes in the reconstructed ris-VADAs.

Conclusions: Immediate obliteration grade was only risk factor for angiographic recurrence after reconstructive treatment. Unfavorable Hunt-Hess grade and older age were independent predictors of unfavorable outcomes in ris-VADAs.

Figure 1. Reconstructive treatment of ris-VADAs.

(A–B) a ris-VADA was treated with single balloon-expandable stent, showing partial obliteration (A), 78 months follow-up imaging (B) confirmed complete obliteration. (C–D) a ris-VADA with partial obliteration (C) recurred (D) 3 months after treatment of single stent. (E–F) a ris-VADAs with partial obliteration was cured 12 months after treatment using 3 Enterprise stents.

Figure 2. Three adverse events.

A ris-VADA (A) was treated by single stent and coiling,(B) but rebleed 48 hours after treatment; A ris-VADA in accompany with focal vasospasm (C) was completely occluded (D) with 3 Enterprises, but the worsening ischemic event resulted in death; A ris-VADA (E) was completely occluded with 3 Enterprises, showing immediate PICA obliteration (F).