Risk Factors of Recurrence after Stent(s)-Assisted Coiling of Intracranial Vertebrobasilar Dissecting Aneurysms: A Multicenter Study

Kun Wang, Zhongbin Tian, Junfan Chen, Jian Liu, Yang Wang, Hongqi Zhang, Jun Wang, Yisen Zhang, Xinjian Yang, Kun Wang, Zhongbin Tian, Junfan Chen, Jian Liu, Yang Wang, Hongqi Zhang, Jun Wang, Yisen Zhang, Xinjian Yang

Abstract

Background: We aimed to evaluate the risk factors of recurrence after stent(s)-assisted coiling (SAC) of intracranial vertebrobasilar dissecting aneurysms (VBDAs) based on 168 consecutive patients.

Methods: Between January 2011 and December 2015, 168 consecutive patients with 170 intracranial VBDAs, which were treated by SAC, were recruited from four high-volume centers. We used multivariate logistic regression to examine factors that affected recurrence of VBDAs.

Results: The mean duration of clinical follow-up of the 168 patients was 7.81 months (range, 3-24 months). Of the 168 patients, 4 (2.38%) suffered from intraoperative complications and 16 (9.52%) had postoperative complications. Two (1.19%) had severe disability. Imaging follow-up was available for 168 patients (170 VBDAs), with a mean duration 7.81 months, and 24 (14.12%) cases of recurrence of aneurysms were noted. Aneurysm size and metal coverage of stent(s) at the neck were independent predictors of recurrence after SAC by logistic regression analysis.

Conclusion: This multicenter cohort study shows that aneurysm size and the metal coverage of stent(s) at aneurysmal neck are independent factors associated with recurrence of VBDAs after SAC.

Keywords: dissection; endovascular treatment; intracranial aneurysms; recurrence; vertebrobasilar artery.

Figures

Figure 1
Figure 1
A 18-year-old male presented with hemiplegia and alalia. (A) Left vertebral angiography in frontal view demonstrates dissection of the basilar artery. (B) The basilar dissecting aneurysm was treated with stent(s)-assisted coiling (SAC) (double Enterprise stents). (C) Frontal view of the left vertebral artery showed complete occlusion after SAC. (D) Follow-up angiography after 3 months showed recanalization of the dissecting aneurysm. (E) Then, the dissecting aneurysm was retreated with SAC (LVIS stent). (F) Frontal view of the right vertebral artery showed complete occlusion after SAC. (G) Follow-up angiography after 6 months showed complete occlusion of the dissecting aneurysm.
Figure 2
Figure 2
A 64-year-old female presented with headache. (A) Right vertebral angiography showed a dissecting aneurysm. (B) Stent(s)-assisted coiling (SAC) (double LVIS stents) were performed. (C) The right vertebral angiography after SAC treatment demonstrated complete occlusion. (D) Follow-up digital subtraction angiography after 6 months showed a complete occlusion of the dissecting aneurysm sac.

References

    1. Debette S, Compter A, Labeyrie MA, Uyttenboogaart M, Metso TM, Majersik JJ, et al. Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol (2015) 14(6):640–54.10.1016/S1474-4422(15)00009-5
    1. Kim BM, Shin YS, Kim SH, Suh SH, Ihn YK, Kim DI, et al. Incidence and risk factors of recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms. Stroke (2011) 42(9):2425–30.10.1161/STROKEAHA.111.617381
    1. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T. Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery (1995) 36(5):905–11; discussion 12–3.10.1097/00006123-199505000-00003
    1. Park KW, Park JS, Hwang SC, Im SB, Shin WH, Kim BT. Vertebral artery dissection: natural history, clinical features and therapeutic considerations. J Korean Neurosurg Soc (2008) 44(3):109–15.10.3340/jkns.2008.44.3.109
    1. Jin SC, Kwon DH, Choi CG, Ahn JS, Kwun BD. Endovascular strategies for vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol (2009) 30(8):1518–23.10.3174/ajnr.A1621
    1. Sikkema T, Uyttenboogaart M, Eshghi O, De Keyser J, Brouns R, van Dijk JM, et al. Intracranial artery dissection. Eur J Neurol (2014) 21(6):820–6.10.1111/ene.12384
    1. Ono H, Nakatomi H, Tsutsumi K, Inoue T, Teraoka A, Yoshimoto Y, et al. Symptomatic recurrence of intracranial arterial dissections: follow-up study of 143 consecutive cases and pathological investigation. Stroke (2013) 44(1):126–31.10.1161/STROKEAHA.112.670745
    1. Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Lee BH, et al. Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol (2006) 27(7):1514–20.
    1. MacKay CI, Han PP, Albuquerque FC, McDougall CG. Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report. Neurosurgery (2003) 53(3):754–9; discussion 60–1.10.1227/01.NEU.0000080065.49651.48
    1. O’Kelly C, Macdonald RL. Coiling and aneurysm rerupture: incomplete treatment is a causal intermediate not a confounder. Stroke (2008) 39(7):e121; author reply e122.10.1161/STROKEAHA.107.519561
    1. Sluzewski M, van Rooij WJ, Rinkel GJ, Wijnalda D. Endovascular treatment of ruptured intracranial aneurysms with detachable coils: long-term clinical and serial angiographic results. Radiology (2003) 227(3):720–4.10.1148/radiol.2273020656
    1. Campi A, Ramzi N, Molyneux AJ, Summers PE, Kerr RS, Sneade M, et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke (2007) 38(5):1538–44.10.1161/STROKEAHA.106.466987
    1. Zhao KJ, Fang YB, Huang QH, Xu Y, Hong B, Li Q, et al. Reconstructive treatment of ruptured intracranial spontaneous vertebral artery dissection aneurysms: long-term results and predictors of unfavorable outcomes. PLoS One (2013) 8(6):e67169.10.1371/journal.pone.0067169
    1. Ferns SP, Sprengers ME, van Rooij WJ, Rinkel GJ, van Rijn JC, Bipat S, et al. Coiling of intracranial aneurysms: a systematic review on initial occlusion and reopening and retreatment rates. Stroke (2009) 40(8):e523–9.10.1161/STROKEAHA.109.553099
    1. Krischek O, Miloslavski E, Fischer S, Shrivastava S, Henkes H. A comparison of functional and physical properties of self-expanding intracranial stents [Neuroform3, Wingspan, Solitaire, Leo+, Enterprise]. Minim Invasive Neurosurg (2011) 54(1):21–8.10.1055/s-0031-1271681
    1. Wang C, Tian Z, Liu J, Jing L, Paliwal N, Wang S, et al. Flow diverter effect of LVIS stent on cerebral aneurysm hemodynamics: a comparison with Enterprise stents and the Pipeline device. J Transl Med (2016) 14(1):199.10.1186/s12967-016-0959-9
    1. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke (2003) 34(6):1398–403.10.1161/01.STR.0000073841.88563.E9
    1. Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ, 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(1):48–52.10.3171/2009.2.JNS081418
    1. Zhao KJ, Zhao R, Huang QH, Xu Y, Hong B, Fang YB, et al. 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. Eur Radiol (2014) 24(9):2088–96.10.1007/s00330-014-3225-7
    1. Gonzalez NR, Duckwiler G, Jahan R, Murayama Y, Vinuela F. Challenges in the endovascular treatment of giant intracranial aneurysms. Neurosurgery (2006) 59(5 Suppl 3):S113–24; discussion S3–13.10.1227/01.NEU.0000237559.93852.F1
    1. Wakhloo AK, Mandell J, Gounis MJ, Brooks C, Linfante I, Winer J, et al. Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up. Stroke (2008) 39(12):3288–96.10.1161/STROKEAHA.107.512996
    1. Huang YC, Chen YF, Wang YH, Tu YK, Jeng JS, Liu HM. Cervicocranial arterial dissection: experience of 73 patients in a single center. Surg Neurol (2009) 72(Suppl 2):S20–7; discussion S7.10.1016/j.surneu.2008.10.002
    1. Flis CM, Jager HR, Sidhu PS. Carotid and vertebral artery dissections: clinical aspects, imaging features and endovascular treatment. Eur Radiol (2007) 17(3):820–34.10.1007/s00330-006-0346-7
    1. Ahn SS, Kim BM, Suh SH, Kim DJ, Kim DI, Shin YS, et al. Spontaneous symptomatic intracranial vertebrobasilar dissection: initial and follow-up imaging findings. Radiology (2012) 264(1):196–202.10.1148/radiol.12112331
    1. Mu S, Li C, Yang X, Wang Y, Li Y, Jiang C, et al. Reconstructive endovascular treatment of spontaneous symptomatic large or giant vertebrobasilar dissecting aneurysms: clinical and angiographic outcomes. Clin Neuroradiol (2016) 26(3):291–300.10.1007/s00062-014-0369-4
    1. Zhang Y, Lv M, Zhao C, Zhang Y, Yang X, Wu Z. Endovascular treatment of ruptured vertebrobasilar dissecting aneurysms: review of 40 consecutive cases. Neurol India (2016) 64(Suppl):S52–61.10.4103/0028-3886.178043
    1. Meng H, Wang Z, Kim M, Ecker RD, Hopkins LN. Saccular aneurysms on straight and curved vessels are subject to different hemodynamics: implications of intravascular stenting. AJNR Am J Neuroradiol (2006) 27(9):1861–5.
    1. Kim M, Levy EI, Meng H, Hopkins LN. Quantification of hemodynamic changes induced by virtual placement of multiple stents across a wide-necked basilar trunk aneurysm. Neurosurgery (2007) 61(6):1305–12; discussion 12–3.10.1227/01.neu.0000306110.55174.30
    1. Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge HS. Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. AJNR Am J Neuroradiol (2012) 33(8):1436–46.10.3174/ajnr.A3246

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