Comparison of Parent Artery Occlusion and Stent-Assisted Treatments in Ruptured Vertebral Artery Dissecting Aneurysms

Hyeong Jin Lee; Woo Cheul Cho; Jai Ho Choi; Bum-Soo Kim; Yong Sam Shin

doi:10.1016/j.wneu.2022.08.047

Comparison of Parent Artery Occlusion and Stent-Assisted Treatments in Ruptured Vertebral Artery Dissecting Aneurysms

World Neurosurg. 2022 Nov:167:e533-e540. doi: 10.1016/j.wneu.2022.08.047. Epub 2022 Aug 14.

Authors

Hyeong Jin Lee¹, Woo Cheul Cho¹, Jai Ho Choi², Bum-Soo Kim³, Yong Sam Shin¹

Affiliations

¹ Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea.
² Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea. Electronic address: bivalvia@catholic.ac.kr.
³ Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea.

PMID: 35977685
DOI: 10.1016/j.wneu.2022.08.047

Abstract

Objective: To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications.

Methods: This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications.

Results: Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications.

Conclusions: Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.

Keywords: Parent artery occlusion; Posterior inferior cerebellar artery; Risk factor; Ruptured vertebral artery dissecting aneurysm; Stent.

MeSH terms

Aneurysm, Ruptured* / diagnostic imaging
Aneurysm, Ruptured* / surgery
Aortic Dissection*
Craniocerebral Trauma* / therapy
Embolization, Therapeutic* / methods
Endovascular Procedures* / methods
Humans
Infant
Intracranial Aneurysm* / therapy
Retrospective Studies
Stents
Treatment Outcome
Vertebral Artery / diagnostic imaging
Vertebral Artery / surgery
Vertebral Artery Dissection* / diagnostic imaging
Vertebral Artery Dissection* / surgery