Limits...
Endovascular Treatment of Intracranial Vertebral Artery Dissecting Aneurysms: Follow up Angiographic and Clinical Results of Endovascular Treatment in Serial Cases.

Shin GW, Jeong HW - Neurointervention (2015)

Bottom Line: Immediate angiographic results revealed complete occlusion in 31 cases and incomplete occlusion in 14 cases.Endovascular treatment of intracranial VADA appears to be safe and effective.Follow-up angiographic study is needed because parent artery recanalization or aneurysmal recurrence can occur.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, Korea.

ABSTRACT

Purpose: To report angiographic and clinical results of endovascular treatment in 45 intracranial vertebral artery dissecting aneurysms (VADAs).

Materials and methods: From July 2002 to September 2013, a total of 42 patients with 45 VADAs received endovascular treatment. Endovascular treatment consisted of internal trapping with detachable coils, stent-assisted coiling, and stenting only. Immediate and follow-up angiographic findings and clinical outcome were retrospectively reviewed.

Results: There were 17 ruptured VADAs and 28 unruptured VADAs. Overall, 26 VADAs were treated with internal trapping, 14 with stent-assisted coil embolization, and 5 with stenting only. Immediate angiographic results revealed complete occlusion in 31 cases and incomplete occlusion in 14 cases. Follow-up imaging studies were available in 31 cases. On follow-up imaging, antegrade recanalization occurred in 2 of 16 cases treated with internal trapping. Aneurysmal recurrence occurred in one case treated with stent-assisted coiling. Procedural complications occurred in 8 patients. In cases of unruptured VADA, favorable outcome (mRS 0 and 1) was achieved in 26 cases and poor outcome (mRS 2-5) in 2 cases. There was no mortality in patients with unruptured VADAs.

Conclusion: Endovascular treatment of intracranial VADA appears to be safe and effective. Follow-up angiographic study is needed because parent artery recanalization or aneurysmal recurrence can occur.

No MeSH data available.


Related in: MedlinePlus

A 41-year-old female with acute SAH. A. Working projection of the left vertebral angiogram shows a dissecting aneurysm arising from the left vertebral artery proximal to origin of PICA. B. The dissecting aneurysm and affected left vertebral artery are completely occluded. C. Follow-up angiogram after 6 months reveals recanalization of the occluded left vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4355641&req=5

Figure 1: A 41-year-old female with acute SAH. A. Working projection of the left vertebral angiogram shows a dissecting aneurysm arising from the left vertebral artery proximal to origin of PICA. B. The dissecting aneurysm and affected left vertebral artery are completely occluded. C. Follow-up angiogram after 6 months reveals recanalization of the occluded left vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery.

Mentions: Of 17 ruptured VADAs, 5 cases initially presented with poor grades (4 or 5), 8 cases with grade 3, 2 cases with grade 2, and 1 patient with grade 1. Results of immediate and follow up imaging studies in ruptured VADAs are presented in the table. In ruptured cases (n=17), endovascular treatment consisted of internal trapping with coil embolization (n=13) and stent-assisted coil embolization using self-expandable stent (n=4). Immediate angiographic results revealed complete occlusion in 14 cases and incomplete occlusion in 3 cases. Eight cases were lost to follow up. Follow up imaging study in 7 cases treated with internal trapping revealed complete occlusion in 6 cases and antegrade recanalization in 1 case (Fig. 1). In 2 cases treated with stent-assisted coil embolization, follow up imaging studies showed no change in 1 case and complete occlusion with vessel remodeling in 1 case (Fig. 2). There were 6 procedure-related complications: lateral medullary infarction (n=2), embolic infarction (n=2), unintended arterial occlusion (n=1), and parent artery dissection (n=1). Follow-up mRS was available in 13 patients. Favorable outcome (mRS 0 and 1) was achieved in 5 patients and poor outcome in 8 patients. Four patients died.


Endovascular Treatment of Intracranial Vertebral Artery Dissecting Aneurysms: Follow up Angiographic and Clinical Results of Endovascular Treatment in Serial Cases.

Shin GW, Jeong HW - Neurointervention (2015)

A 41-year-old female with acute SAH. A. Working projection of the left vertebral angiogram shows a dissecting aneurysm arising from the left vertebral artery proximal to origin of PICA. B. The dissecting aneurysm and affected left vertebral artery are completely occluded. C. Follow-up angiogram after 6 months reveals recanalization of the occluded left vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4355641&req=5

Figure 1: A 41-year-old female with acute SAH. A. Working projection of the left vertebral angiogram shows a dissecting aneurysm arising from the left vertebral artery proximal to origin of PICA. B. The dissecting aneurysm and affected left vertebral artery are completely occluded. C. Follow-up angiogram after 6 months reveals recanalization of the occluded left vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery.
Mentions: Of 17 ruptured VADAs, 5 cases initially presented with poor grades (4 or 5), 8 cases with grade 3, 2 cases with grade 2, and 1 patient with grade 1. Results of immediate and follow up imaging studies in ruptured VADAs are presented in the table. In ruptured cases (n=17), endovascular treatment consisted of internal trapping with coil embolization (n=13) and stent-assisted coil embolization using self-expandable stent (n=4). Immediate angiographic results revealed complete occlusion in 14 cases and incomplete occlusion in 3 cases. Eight cases were lost to follow up. Follow up imaging study in 7 cases treated with internal trapping revealed complete occlusion in 6 cases and antegrade recanalization in 1 case (Fig. 1). In 2 cases treated with stent-assisted coil embolization, follow up imaging studies showed no change in 1 case and complete occlusion with vessel remodeling in 1 case (Fig. 2). There were 6 procedure-related complications: lateral medullary infarction (n=2), embolic infarction (n=2), unintended arterial occlusion (n=1), and parent artery dissection (n=1). Follow-up mRS was available in 13 patients. Favorable outcome (mRS 0 and 1) was achieved in 5 patients and poor outcome in 8 patients. Four patients died.

Bottom Line: Immediate angiographic results revealed complete occlusion in 31 cases and incomplete occlusion in 14 cases.Endovascular treatment of intracranial VADA appears to be safe and effective.Follow-up angiographic study is needed because parent artery recanalization or aneurysmal recurrence can occur.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Busan Paik Hospital, Inje University, Busan, Korea.

ABSTRACT

Purpose: To report angiographic and clinical results of endovascular treatment in 45 intracranial vertebral artery dissecting aneurysms (VADAs).

Materials and methods: From July 2002 to September 2013, a total of 42 patients with 45 VADAs received endovascular treatment. Endovascular treatment consisted of internal trapping with detachable coils, stent-assisted coiling, and stenting only. Immediate and follow-up angiographic findings and clinical outcome were retrospectively reviewed.

Results: There were 17 ruptured VADAs and 28 unruptured VADAs. Overall, 26 VADAs were treated with internal trapping, 14 with stent-assisted coil embolization, and 5 with stenting only. Immediate angiographic results revealed complete occlusion in 31 cases and incomplete occlusion in 14 cases. Follow-up imaging studies were available in 31 cases. On follow-up imaging, antegrade recanalization occurred in 2 of 16 cases treated with internal trapping. Aneurysmal recurrence occurred in one case treated with stent-assisted coiling. Procedural complications occurred in 8 patients. In cases of unruptured VADA, favorable outcome (mRS 0 and 1) was achieved in 26 cases and poor outcome (mRS 2-5) in 2 cases. There was no mortality in patients with unruptured VADAs.

Conclusion: Endovascular treatment of intracranial VADA appears to be safe and effective. Follow-up angiographic study is needed because parent artery recanalization or aneurysmal recurrence can occur.

No MeSH data available.


Related in: MedlinePlus