Periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms

Jiangli Han; Fei Liu; Jigang Chen; Xin Tong; Mingyang Han; Fei Peng; Hao Niu; Lang Liu; Aihua Liu

doi:10.3171/2022.10.JNS221953

Periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms

J Neurosurg. 2022 Nov 18;138(6):1503-1511. doi: 10.3171/2022.10.JNS221953. Print 2023 Jun 1.

Authors

Jiangli Han¹, Fei Liu^{1

2}, Jigang Chen³, Xin Tong³, Mingyang Han¹, Fei Peng³, Hao Niu³, Lang Liu¹, Aihua Liu^{1

3}

Affiliations

¹ 1Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China.
² 2Department of Neurosurgery, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China; and.
³ 3Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

PMID: 36401540
DOI: 10.3171/2022.10.JNS221953

Abstract

Objective: The authors undertook an evaluation of periprocedural cerebrovascular complications and 30-day outcomes of endovascular treatment for intracranial vertebral artery dissecting aneurysms (IVADAs) and assessed the relevant risk factors.

Methods: The authors included a series of 195 patients who had undergone endovascular treatment for 198 IVADAs. Clinical data, morphological characteristics, treatment details, and periprocedural cerebrovascular complications including intraprocedural rupture, intraprocedural thrombosis, intracranial hemorrhage (ICH), transient ischemic attack (TIA), and ischemic stroke (IS) were recorded. After evaluation of the 30-day modified Rankin Scale (mRS) scores, the authors applied univariate and multivariate logistic regression analyses to identify the risk factors for complications and 30-day unfavorable clinical outcomes.

Results: There were no intraprocedural ruptures, but the authors recorded intraprocedural thrombosis (n = 5), ICH (n = 3), TIA (n = 1), and IS (n = 13), comprising an 11.1% (22/198) complication rate. Multivariate logistic regression analysis indicated that hyperlipidemia (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.20-8.41, p = 0.020), IS history (OR 5.55, 95% CI 1.46-21.01, p = 0.012), and subarachnoid hemorrhage (SAH) (OR 4.48, 95% CI 1.52-13.20, p = 0.007) were risk factors for overall complications, whereas aneurysmal height (OR 0.77, 95% CI 0.61-0.98, p = 0.032) was a protective factor. SAH (OR 6.44, 95% CI 1.54-26.89, p = 0.011) and preprocedural mRS score > 2 (OR 5.07, 95% CI 1.01-25.59, p = 0.049) were independent risk factors for perforator occlusion stroke. Periprocedural cerebrovascular complications (OR 32.09, 95% CI 3.00-343.94, p = 0.004) and preprocedural mRS score > 2 (OR 319.92, 95% CI 30.28-3379.98, p < 0.001) were independent risk factors for 30-day unfavorable clinical outcomes.

Conclusions: Hyperlipidemia, IS history, and SAH were independent predictors for overall periprocedural cerebrovascular complications of endovascular treatment for IVADAs, but aneurysmal height was an independent protective factor. SAH and preprocedural mRS score > 2 were independent risk factors for perforator occlusion stroke. Preprocedural mRS score > 2 and periprocedural complications were independent risk factors for 30-day unfavorable clinical outcomes.

Keywords: complication; dissecting aneurysm; endovascular neurosurgery; endovascular treatment; flow diversion; predictive factor; vascular disorders; vertebral artery.