Deconstructive and Reconstructive Techniques in Treatment of Vertebrobasilar Dissecting Aneurysms: A Systematic Review and Meta-Analysis

Ö Sönmez, W Brinjikji, M H Murad, G Lanzino, Ö Sönmez, W Brinjikji, M H Murad, G Lanzino

Abstract

Background and purpose: Various endovascular techniques have been applied to the treatment of vertebrobasilar dissecting aneurysms, including parent artery preservation with coiling, stent placement or flow diverter placement, and trapping and proximal occlusion. We performed a systematic review and meta-analysis to study clinical and angiographic outcomes of patients undergoing endovascular treatment of vertebrobasilar dissecting aneurysms.

Materials and methods: We performed a comprehensive literature search for studies on the endovascular treatment of vertebrobasilar dissecting aneurysms. From each study we abstracted the following data: immediate occlusion, long-term occlusion, long-term good neurologic outcome, perioperative morbidity, perioperative mortality, rebleed (ruptured only), recurrence, and retreatment. We performed subgroup analyses of patients undergoing deconstructive-versus-reconstructive techniques. Meta-analysis was performed by using a random effects model.

Results: Seventeen studies with 478 patients were included in this analysis. Sixteen studies had at least 6 months of clinical/angiographic follow-up. Endovascular treatment was associated with high rates of long-term occlusion (87.0%; 95% CI, 74.0%-94.0%) and low recurrence (7.0%; 95% CI, 5.0%-10.0%) and retreatment rates (3.0%; 95% CI, 2.0%-6.0%). Long-term good neurologic outcome was 84.0% (95% CI, 65.0%-94.0%). Deconstructive techniques were associated with higher rates of long-term complete occlusion compared with reconstructive techniques (88.0%; 95% CI, 35.0%-99.0% versus 81.0%; 95% CI, 64.0%-91.0%; P < .0001). Deconstructive and reconstructive techniques were both associated with high rates of good neurologic outcome (86.0%; 95% CI, 68.0%-95.0% versus 92.0%; 95% CI, 86.0%-95.0%; P = .10).

Conclusions: Endovascular treatment of vertebrobasilar dissecting aneurysms is associated with high rates of complete occlusion and good long-term neurologic outcomes. Deconstructive techniques are associated with higher occlusion rates. There was no statistical difference in neurologic outcomes between groups, possibly due to low power.

© 2015 by American Journal of Neuroradiology.

References

    1. Mizutani T, Aruga T, Kirino T, et al. . Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 1995;36:905–11; discussion 912–13
    1. Yoshimoto Y, Wakai S. Unruptured intracranial vertebral artery dissection: clinical course and serial radiographic imagings. Stroke 1997;28:370–74
    1. Kobayashi N, Murayama Y, Yuki I, et al. . Natural course of dissecting vertebrobasilar artery aneurysms without stroke. AJNR Am J Neuroradiol 2014;35:1371–75
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–88
    1. Higgins JP, Thompson SG, Deeks JJ, et al. . Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539–58
    1. Kim BM, Shin YS, Kim SH, et al. . Incidence and risk factors of recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms. Stroke 2011;42:2425–30
    1. Wakhloo AK, Mandell J, Gounis MJ, et al. . Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up. Stroke 2008;39:3288–96
    1. Zenteno MA, Murillo-Bonilla LM, Guinto G, et al. . Sole stenting bypass for the treatment of vertebral artery aneurysms: technical case report. Neurosurgery 2005;57(1 suppl):E208; discussion E208
    1. Zhao KJ, Fang YB, Huang QH, et al. . Reconstructive treatment of ruptured intracranial spontaneous vertebral artery dissection aneurysms: long-term results and predictors of unfavorable outcomes. PLoS One 2013;8:e67169.
    1. Yoon WK, Kim YW, Kim SR, et al. . Angiographic and clinical outcomes of stent-alone treatment for spontaneous vertebrobasilar dissecting aneurysm. Acta Neurochir (Wein) 2010;152:1477–86; discussion 1486
    1. Park SI, Kim BM, Kim DI, et al. . Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 2009;30:1351–56
    1. Kashiwazaki D, Ushikoshi S, Asano T, et al. . Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection. Neuroradiology 2013;55:201–06
    1. Brinjikji W, Murad MH, Lanzino G, et al. . Endovascular treatment of intracranial aneurysms with flow diverters: a meta-analysis. Stroke 2013;44:442–47
    1. Jin SC, Kwon DH, Choi CG, et al. . Endovascular strategies for vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 2009;30:1518–23
    1. Rabinov JD, Hellinger FR, Morris PP, et al. . Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 2003;24:1421–28
    1. Yuki I, Murayama Y, Vinuela F. Endovascular management of dissecting vertebrobasilar artery aneurysms in patients presenting with acute subarachnoid hemorrhage. J Neurosurg 2005;103:649–55
    1. Kai Y, Nishi T, Watanabe M, et al. . Strategy for treating unruptured vertebral artery dissecting aneurysms. Neurosurgery 2011;69:1085–91
    1. Park W, Ahn JS, Park JC, et al. . Occipital artery-posterior inferior cerebellar artery bypass for the treatment of aneurysms arising from the vertebral artery and its branches. World Neurosurg 2014;82:714–21
    1. Balshem H, Helfand M, Schunemann HJ, et al. . GRADE guidelines. 3. Rating the quality of evidence. J Clin Epidemiol 2011;64:401–06
    1. Guyatt GH, Oxman AD, Kunz R, et al. . GRADE guidelines. 6. Rating the quality of evidence–imprecision. J Clin Epidemiol 2011;64:1283–93
    1. Luo CB, Chang CY, Teng MM, et al. . Endovascular treatment of ruptured vertebral dissecting aneurysms with electrodetachable coils. J Chin Med Assoc 2005;68:578–84
    1. Purkayastha S, Gupta K, Krishnamoorthy AT, et al. . Endovascular treatment of ruptured posterior circulation dissecting aneurysms. J Neuroradiol 2006;33:329–37
    1. Rho MH, Park HJ, Chung EC, et al. . Various techniques of stent-assisted coil embolization of wide-necked or fusiform atherosclerotic and dissecting unruptured vertebrobasilar artery aneurysms for reducing recanalization: mid-term results. Acta Neurochir (Wein) 2013;155:2009–17
    1. Suh SH, Kim BM, Park SI, et al. . Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery: clinical article. J Neurosurg 2009;111:48–52
    1. Tsuura M, Terada T, Yokote H, et al. . Endovascular treatment for vertebral dissecting aneurysm presenting with subarachnoid hemorrhage. Interv Neuroradiol 1999;5(suppl 1):203–06
    1. Wang J, Sun Z, Bao J, et al. . Endovascular management of vertebrobasilar artery dissecting aneurysms. Turk Neurosurg 2013;23:323–28
    1. Yamaura I, Tani E, Yokota M, et al. . Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 1999;90:853–56

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