Endovascular treatment for ruptured vertebral artery dissecting aneurysms: results from Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2

Neurol Med Chir (Tokyo). 2014;54(2):98-106. doi: 10.2176/nmc.oa.2013-0184. Epub 2013 Dec 27.

Abstract

In treating ruptured vertebral artery dissecting aneurysms (VADAs), neuroendovascular therapy (NET) represented by coil obliteration is considered to be a reliable intervention. However, there has been no multi-center based study in this setting so far. In this article, results of NET for ruptured VADA obtained from Japanese Registry of Neuroendovascular Therapy (JR-NET) 1 and 2 were assessed to elucidate the factors associated with favorable outcome. A total of 213 in JR-NET1 and 381 patients in JR-NET2 with ruptured VADA were included, and they were separately analyzed because several important datasets such as vasospasm and site of dissecting aneurysms in relation to the posterior inferior cerebellar artery (PICA) were collected only in JR-NET1. The ratio of poor World Federation of Neurosurgical Societies (WFNS) grade (4 and 5) was 48.8% and 53.9%, and the ratio of favorable outcome (modified Rankin scale, mRS 0 to 2) at 30 days after onset was 61.1 % and 49.1% in JR-NET1 and 2, respectively. In both studies, poor WFNS grade and procedural complication were independently correlated as negative factors for favorable outcome. In JR-NET1, PICA-involved lesion was also designated as a negative factor while elderly age and absence of postprocedural antithrombotic therapy was detected as other negative factors in JR-NET2. The ratios of favorable outcome in poor grade patients were 25.4% in JR-NET1 and 31.3% in JR-NET2, which seemed compatible with the previous studies. These results may provide a baseline data for the NET in this disease and could be useful for validating the benefits of novel devices.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / complications
  • Aneurysm, Ruptured / therapy*
  • Angioplasty, Balloon / statistics & numerical data*
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use
  • Brain Ischemia / etiology
  • Brain Ischemia / prevention & control
  • Embolization, Therapeutic / instrumentation
  • Embolization, Therapeutic / methods
  • Embolization, Therapeutic / statistics & numerical data*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use
  • Health Care Surveys
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / therapy*
  • Japan
  • Male
  • Middle Aged
  • Recurrence
  • Registries
  • Risk Factors
  • Severity of Illness Index
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / therapy
  • Vertebral Artery Dissection / complications
  • Vertebral Artery Dissection / therapy*

Substances

  • Anticoagulants
  • Fibrinolytic Agents