Limits...
The interaction between stent(s) implantation, PICA involvement, and immediate occlusion degree affect symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment with stent(s)-assisted coiling.

Zhao KJ, Zhao R, Huang QH, Xu Y, Hong B, Fang YB, Li Q, Yang PF, Liu JM, Zhao WY - Eur Radiol (2014)

Bottom Line: Fifty-eight sis-VADAs underwent single-stent treatment, and the remaining 55 sis-VADAs underwent treatment with 2-4 overlapping stents.This single centre cohort study indicated that the interaction effect between stent (s) implantation, PICA involvement, and immediate occlusion degree were closely associated with recurrence after reconstructive treatment of sis-VADA.The interaction between PICA involvement and immediate occlusion degree affect aneurysmal recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China, zkjwcfzwh@163.com.

ABSTRACT

Objectives: We aimed to evaluate risk factors of sis-VADAs recurrence after reconstructive treatment based on 113 reconstructed lesions.

Methods: A total of 111 patients (M:F = 68:43; median age, 47 years) with 113 sis-VADAs underwent reconstruction from October 2000 to March 2011, using stent(s) and coils. Treatments and predictors of recurrence were retrospectively analysed.

Results: Fifty-eight sis-VADAs underwent single-stent treatment, and the remaining 55 sis-VADAs underwent treatment with 2-4 overlapping stents. Follow-up angiography was available for 94 sis-VADAs 12 -78 months, with recurrence in ten patients, including seven angiographic recurrences and three post-treatment haemorrhagic recurrences. A higher rate of post-treatment recurrence was observed in the single stent group than in the multiple stents group (p = 0.010). The interaction between stent (s) implantation and immediate occlusion degree (odds ratio [OR] =3.152; 95% confidence interval [CI], 1.293-7.686; p = 0.012), between stent (s) implantation and the posterior inferior cerebellar artery (PICA) involvement (OR = 4.607; 95% CI, 1.172-18.113; p = 0.029), and between PICA involvement and immediate occlusion degree (OR = 5.018; 95% CI, 1.263-19.933; p = 0.022) affect recurrence in the reconstructed sis-VADAs.

Conclusions: This single centre cohort study indicated that the interaction effect between stent (s) implantation, PICA involvement, and immediate occlusion degree were closely associated with recurrence after reconstructive treatment of sis-VADA.

Key points: The interaction between stent (s) and immediate occlusion degree affect aneurysmal recurrence. The interaction between stent and PICA involvement affect aneurysmal recurrence. The interaction between PICA involvement and immediate occlusion degree affect aneurysmal recurrence.

Show MeSH

Related in: MedlinePlus

sis-VADAs reconstructed with multiple stents and coiling. (A-C) A VADA involving the PICA was reconstructed with three Enterprise stents (A). After 6 months, a recurrence was observed at the origin of the PICA (B) and was effectively retreated with an additional Solitaire AB stent and followed up for 6 months (C). (D-F) A VADA (D) was reconstructed with four overlapping stents, and immediate partial obliteration was achieved (E). An 8-month follow-up angiogram showed normalization (F)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4127004&req=5

Fig2: sis-VADAs reconstructed with multiple stents and coiling. (A-C) A VADA involving the PICA was reconstructed with three Enterprise stents (A). After 6 months, a recurrence was observed at the origin of the PICA (B) and was effectively retreated with an additional Solitaire AB stent and followed up for 6 months (C). (D-F) A VADA (D) was reconstructed with four overlapping stents, and immediate partial obliteration was achieved (E). An 8-month follow-up angiogram showed normalization (F)

Mentions: Generally, the recurrence and rupture of the reconstructed VADAs were a continuous course. Post-treatment recurrence attributed to antegrade (Fig. 1B) or retrograde (Fig. 1D) coil mass compaction, sac growth (Fig. 1F) or a new dissection formation (Fig. 2B), and a high wall shear stresses (WSS) within the recanalization zone may play critical roles in recurrence [16]. Table 3 indicates that lesions involving the PICA, single-stent reconstructions, and partial obliteration were risk factors for post-treatment recurrence by univariate analysis. However, none of these variables was an independent predictor of recurrence by logistic regression analysis. This finding was inconsistent with a previous study in which PICA involvement was the only independent risk factor for recurrence after the endovascular treatment of vertebrobasilar dissecting aneurysms [7]. These differences could be attributed to differences in treatment method.Fig. 1


The interaction between stent(s) implantation, PICA involvement, and immediate occlusion degree affect symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment with stent(s)-assisted coiling.

Zhao KJ, Zhao R, Huang QH, Xu Y, Hong B, Fang YB, Li Q, Yang PF, Liu JM, Zhao WY - Eur Radiol (2014)

sis-VADAs reconstructed with multiple stents and coiling. (A-C) A VADA involving the PICA was reconstructed with three Enterprise stents (A). After 6 months, a recurrence was observed at the origin of the PICA (B) and was effectively retreated with an additional Solitaire AB stent and followed up for 6 months (C). (D-F) A VADA (D) was reconstructed with four overlapping stents, and immediate partial obliteration was achieved (E). An 8-month follow-up angiogram showed normalization (F)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4127004&req=5

Fig2: sis-VADAs reconstructed with multiple stents and coiling. (A-C) A VADA involving the PICA was reconstructed with three Enterprise stents (A). After 6 months, a recurrence was observed at the origin of the PICA (B) and was effectively retreated with an additional Solitaire AB stent and followed up for 6 months (C). (D-F) A VADA (D) was reconstructed with four overlapping stents, and immediate partial obliteration was achieved (E). An 8-month follow-up angiogram showed normalization (F)
Mentions: Generally, the recurrence and rupture of the reconstructed VADAs were a continuous course. Post-treatment recurrence attributed to antegrade (Fig. 1B) or retrograde (Fig. 1D) coil mass compaction, sac growth (Fig. 1F) or a new dissection formation (Fig. 2B), and a high wall shear stresses (WSS) within the recanalization zone may play critical roles in recurrence [16]. Table 3 indicates that lesions involving the PICA, single-stent reconstructions, and partial obliteration were risk factors for post-treatment recurrence by univariate analysis. However, none of these variables was an independent predictor of recurrence by logistic regression analysis. This finding was inconsistent with a previous study in which PICA involvement was the only independent risk factor for recurrence after the endovascular treatment of vertebrobasilar dissecting aneurysms [7]. These differences could be attributed to differences in treatment method.Fig. 1

Bottom Line: Fifty-eight sis-VADAs underwent single-stent treatment, and the remaining 55 sis-VADAs underwent treatment with 2-4 overlapping stents.This single centre cohort study indicated that the interaction effect between stent (s) implantation, PICA involvement, and immediate occlusion degree were closely associated with recurrence after reconstructive treatment of sis-VADA.The interaction between PICA involvement and immediate occlusion degree affect aneurysmal recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China, zkjwcfzwh@163.com.

ABSTRACT

Objectives: We aimed to evaluate risk factors of sis-VADAs recurrence after reconstructive treatment based on 113 reconstructed lesions.

Methods: A total of 111 patients (M:F = 68:43; median age, 47 years) with 113 sis-VADAs underwent reconstruction from October 2000 to March 2011, using stent(s) and coils. Treatments and predictors of recurrence were retrospectively analysed.

Results: Fifty-eight sis-VADAs underwent single-stent treatment, and the remaining 55 sis-VADAs underwent treatment with 2-4 overlapping stents. Follow-up angiography was available for 94 sis-VADAs 12 -78 months, with recurrence in ten patients, including seven angiographic recurrences and three post-treatment haemorrhagic recurrences. A higher rate of post-treatment recurrence was observed in the single stent group than in the multiple stents group (p = 0.010). The interaction between stent (s) implantation and immediate occlusion degree (odds ratio [OR] =3.152; 95% confidence interval [CI], 1.293-7.686; p = 0.012), between stent (s) implantation and the posterior inferior cerebellar artery (PICA) involvement (OR = 4.607; 95% CI, 1.172-18.113; p = 0.029), and between PICA involvement and immediate occlusion degree (OR = 5.018; 95% CI, 1.263-19.933; p = 0.022) affect recurrence in the reconstructed sis-VADAs.

Conclusions: This single centre cohort study indicated that the interaction effect between stent (s) implantation, PICA involvement, and immediate occlusion degree were closely associated with recurrence after reconstructive treatment of sis-VADA.

Key points: The interaction between stent (s) and immediate occlusion degree affect aneurysmal recurrence. The interaction between stent and PICA involvement affect aneurysmal recurrence. The interaction between PICA involvement and immediate occlusion degree affect aneurysmal recurrence.

Show MeSH
Related in: MedlinePlus