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Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience.

Song Y, Wang Y, Li C, Wang Y, Mu S, Yang X - PLoS ONE (2014)

Bottom Line: All cases were technically successful.No complications related to endovascular procedures occurred.The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

ABSTRACT

Background and purpose: The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs) after stent assisted coiling (SAC) has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.

Methods: Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years). The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.

Results: Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months). Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.

Conclusions: Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be enacted according to the characteristics and reasons for the recurrence.

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Related in: MedlinePlus

Retreatment with coil embolization was performed for recurrent intracranial VADA after SAC.A 29-year old male presented with dizziness and hemiplegia. Sagittal view of MR imaging showed intramural hematoma and compression to brain stem (A). Right vertebral angiograms showed a dissecting aneurysm involving PICA (B). SAC (C) were performed with nearly complete occlusion (D). Follow up angiography after three months revealed recanalization of the dissecting aneurysm (black arrow) (E). Retreatment was performed by coil embolization (F, G). Follow up angiography after 7 months of retreatment showed complete occlusion of right vertebral dissecting aneurysm (H).
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pone-0113027-g002: Retreatment with coil embolization was performed for recurrent intracranial VADA after SAC.A 29-year old male presented with dizziness and hemiplegia. Sagittal view of MR imaging showed intramural hematoma and compression to brain stem (A). Right vertebral angiograms showed a dissecting aneurysm involving PICA (B). SAC (C) were performed with nearly complete occlusion (D). Follow up angiography after three months revealed recanalization of the dissecting aneurysm (black arrow) (E). Retreatment was performed by coil embolization (F, G). Follow up angiography after 7 months of retreatment showed complete occlusion of right vertebral dissecting aneurysm (H).

Mentions: In case 3, recurrence was shown as recanalization of previously embolized dissecting aneurysms (Fig. 2 E). The volume of dissecting aneurysm did not enlarged continuously. The reason of recurrence was due to flow disruption and consequent coil compaction, which was similar to recurrence of the sac aneurysm. So, in this case, we performed coil embolization for the recanalization. Complete occlusion was achieved as seen on immediate angiography.


Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience.

Song Y, Wang Y, Li C, Wang Y, Mu S, Yang X - PLoS ONE (2014)

Retreatment with coil embolization was performed for recurrent intracranial VADA after SAC.A 29-year old male presented with dizziness and hemiplegia. Sagittal view of MR imaging showed intramural hematoma and compression to brain stem (A). Right vertebral angiograms showed a dissecting aneurysm involving PICA (B). SAC (C) were performed with nearly complete occlusion (D). Follow up angiography after three months revealed recanalization of the dissecting aneurysm (black arrow) (E). Retreatment was performed by coil embolization (F, G). Follow up angiography after 7 months of retreatment showed complete occlusion of right vertebral dissecting aneurysm (H).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231114&req=5

pone-0113027-g002: Retreatment with coil embolization was performed for recurrent intracranial VADA after SAC.A 29-year old male presented with dizziness and hemiplegia. Sagittal view of MR imaging showed intramural hematoma and compression to brain stem (A). Right vertebral angiograms showed a dissecting aneurysm involving PICA (B). SAC (C) were performed with nearly complete occlusion (D). Follow up angiography after three months revealed recanalization of the dissecting aneurysm (black arrow) (E). Retreatment was performed by coil embolization (F, G). Follow up angiography after 7 months of retreatment showed complete occlusion of right vertebral dissecting aneurysm (H).
Mentions: In case 3, recurrence was shown as recanalization of previously embolized dissecting aneurysms (Fig. 2 E). The volume of dissecting aneurysm did not enlarged continuously. The reason of recurrence was due to flow disruption and consequent coil compaction, which was similar to recurrence of the sac aneurysm. So, in this case, we performed coil embolization for the recanalization. Complete occlusion was achieved as seen on immediate angiography.

Bottom Line: All cases were technically successful.No complications related to endovascular procedures occurred.The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

ABSTRACT

Background and purpose: The retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs) after stent assisted coiling (SAC) has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.

Methods: Between September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years). The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.

Results: Six patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months). Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.

Conclusions: Endovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be enacted according to the characteristics and reasons for the recurrence.

Show MeSH
Related in: MedlinePlus