Safety and strategy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm
10.3760/cma.j.cn115354-20240115-00042
- VernacularTitle:血管内介入治疗破裂椎动脉颅内段夹层动脉瘤的安全性及策略分析
- Author:
Hao ZHU
1
;
Yingang WU
;
Hao CUI
;
Jian YU
;
Yu CHEN
;
Daqun GU
;
Yang ZHANG
;
Chaoshi NIU
;
Ge GAO
Author Information
1. 中国科学技术大学附属第一医院（安徽省立医院）神经外科，合肥 230001
- Keywords:
Vertebral artery dissection;
Ruptured aneurysm;
Endovascular treatment;
Safety
- From:
Chinese Journal of Neuromedicine
2024;23(2):164-168
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety and efficacy of intravascular intervention in ruptured intracranial vertebral artery dissecting aneurysm (IVADA).Methods:A retrospective analysis was performed; 25 patients with ruptured IVADA (25 aneurysms) admitted to Department of Neurosurgery, First Affiliated Hospital of University of Science and Technology of China from January 2020 to June 2023, were chosen. Aneurysm and parent artery occlusion or stent-assisted spring coil embolization were performed according to location of the aneurysms, degrees of aneurysm immediate embolization were evaluated by Raymond grading, and perioperative adverse events were recorded. The patients were followed up for 6-48 months, and aneurysm recurrence was determined according to DSA results; prognoses were assessed by modified Rankin Scale (mRS), with scores of 0-2 as good prognosis and scores of 3-6 as poor prognosis.Results:All 25 patients had unilateral ruptured IVADA, 10 (40%) received aneurysm and parent artery occlusion (occlusion of dissection segment) and 15 (60%) received stent-assisted embolization. Immediately after surgery, 19 patients (76%) had grading I embolization, 4 (16%) grading II embolization, and 2 (8%) grading III embolization. No aneurysm rupture or stent related thrombosis was observed during procedure; 3 patients (12%) died after procedure, with postoperative rebleeding in 1, postoperative cerebellar infarction with respiratory failure in 1, and severe pneumonia in 1. In the 22 survivals, 18 had good prognosis and 4 had poor prognosis. In the 5 relapsed patients (all accepted stent-assisted embolization), 4 underwent re-intervention, and one with visualization at aneurysm neck was relatively stable on re-examination and accepted regular follow up.Conclusion:Aneurysm and parent artery occlusion can be used for non-dominant vertebral artery aneurysms not involving posterior inferior cerebellar artery, whose recurrence rate is lower than that of stent-assisted coil embolization.
