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

Sönmez, Osman; Brinjikji, Waleed; Murad, M. Hassan; Lanzino, Giuseppe

doi:10.3174/ajnr.a4360

Cited by 100 publications

(97 citation statements)

References 27 publications

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“…6,13) Kim BM et al 6) showed that in 21 patients, the percentage of patients with a favorable outcome was clearly higher (90.9% vs. 50.0%) by endovascular treatment than by conservative treatment. Similarly, Sönmez Ö et al 13) showed very satisfactory results with a long-term aneurysm occlusion rate of 87% and a long-term favorable outcome rate of 84% by endovascular treatment in a meta-analysis of 478 patients with dissecting AN of the posterior circulation, and endovascular treatment is being established as a surgical treatment for BA dissecting AN.…”

Section: Discussionmentioning

confidence: 99%

“…As for the procedure of endovascular treatment, deconstructive treatment by parent artery occlusion (PAO) of the BA has shown favorable results with a high occlusion rate in patients treated for BA dissecting AN by performing PAO of the VA on the dominant side to induce flow reduction and flow reversal of the BA 5,10) and patients in whom the collateral blood flow is secured, 8,9,13) and the procedure is still employed as an effective treatment in some patients because of the high complete occlusion rate. However, as PAO cannot be performed in many patients with aneurysms of the BA trunk depending on the state of the collateral blood flow, reconstructive treatment is desirable, and reports of stent-assisted coil embolization have increased since the late 1990s.…”

Section: Discussionmentioning

confidence: 99%

“…However, as PAO cannot be performed in many patients with aneurysms of the BA trunk depending on the state of the collateral blood flow, reconstructive treatment is desirable, and reports of stent-assisted coil embolization have increased since the late 1990s. 1,3,6,13,14) Stent-assisted coil embolization has yielded favorable therapeutic results and is considered to be more clinically effective than stent or coil alone. 3,15) Jiang C et al 3) performed endovascular treatment in 29 patients with BA dissecting AN and reported that a favorable outcome with a modified Rankin Scale (mRS) coil embolization or, in the future, a procedure using FD is considered recommendable as the initial treatment.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Case of Repeatedly Recurrent Basilar Trunk Dissecting Aneurysm Successfully Treated by the “Coil Sandwich Technique”

Hayashi

Kawanishi

Shindo

et al. 2016

JNET

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Objective: We report a case of dissecting aneurysm of the basilar artery that showed repeated rupture and regrowth but was successfully occluded by "sandwich" placement of a coil between two stents.Case Presentation: The patient was a 41-year-old man. He had subarachnoid hemorrhage (SAH) due to rupture of dissecting aneurysm of the basilar artery 4.5 years before, and a temporary cure was achieved by stent-assisted coil embolization. However, he had SAH again from de novo dissecting aneurysm of the basilar trunk, and, despite repeated treatment by multiple stent-assisted embolization, the aneurysm was recanalized due to coil compaction, and a fourth treatment became necessary. Since it was difficult to insert a microcatheter by the trans-cell approach through three layers of stents, we placed a coil by sandwiching it between two layers of stents in front of the inflow and achieved complete occlusion of the aneurysm. Conclusion:This "coil sandwich technique" is expected to be useful as an option for the treatment of recurrence after stent-assisted coil embolization.Keywords▶ ruptured dissecting aneurysm of the basilar trunk, subarachnoid hemorrhage, stent-assisted coil embolization, coil sandwich technique

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Case of Repeatedly Recurrent Basilar Trunk Dissecting Aneurysm Successfully Treated by the “Coil Sandwich Technique”

Hayashi

Kawanishi

Shindo

et al. 2016

JNET

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“…In this type of situation, such ''deconstructive techniques'' are an effective alternative to the ''constructive'' techniques preserving the carrier vessel using stents or FDs [31].…”

Section: Techniquesmentioning

confidence: 99%

Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results

Anxionnat¹,

Tonnelet²,

Derelle³

et al. 2015

Diagnostic and Interventional Imaging

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Rupture of an intracranial aneurysm is a diagnostic and therapeutic emergency. Occlusion of the aneurysm with coils is the first line treatment and should be performed promptly to avoid any further rupture, which carries a poor prognosis. Most aneurysms are accessible to this type of treatment. The risks of coiling, which are mostly thromboembolic and less commonly hemorrhagic due to peroperative rupture, are low. The use of stents or a flow diverter requires dual anti-aggregation which increases their risks so that their use are restricted to specific situations such as dissecting aneurysms. Endovascular treatment is effective in the long and short term prevention of recurrent hemorrhage provided that patients are followed up by imaging, which allows possible early recanalization to be detected early and treated if necessary.

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“…Nevertheless, their pathogenesis and management [76] remains unclear and debated, so far. Even though their conservative, endovascular, and surgical treatment have proved successful, with the availability of endovascular procedures, the method has become preferred in treating of IDAs in vertebrobasilar (VB) territory [141]. However, the purely endovascular treatment is unlikely to stop the disease process [156].…”

Section: Introductionmentioning

confidence: 99%

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

Balik

Yamada

Talari³

et al. 2016

Neurosurg Rev

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Vertebrobasilar (VB) intracranial dissecting aneurysms (IDAs) pose difficult therapeutic issues and are especially among the most difficult to manage surgically. There are, however, some cases where selective aneurysm obliteration by endovascular approach is impossible or is associated with an unacceptable risk of morbidity. This is particularly true when the aneurysm is dissecting, giant, or has a large neck. In such cases, surgical treatment may be the only alternative. Optimal management of these lesions is therefore challenging and treatment decisions have to be made on a case-by-case basis. Ideal treatment should be a complete surgical excision of the lesion; however, this procedure might only be possible after distal and proximal vessel wall occlusion which might not be tolerated by the patient depending on the location of the aneurysm. Therefore, formulation of recommendations concerning the surgical strategy remains still difficult due to inconsistency of surgical outcomes. The literature describing surgical strategy of VB IDAs is varying in quality and content, and many studies deal with only a few patients. In the presented review, the authors summarize the current knowledge on the incidence, pathogenesis, clinical presentation, and diagnostic procedures with special emphasis on surgical treatment of IDAs in posterior circulation.

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

Cited by 100 publications

References 27 publications

A Case of Repeatedly Recurrent Basilar Trunk Dissecting Aneurysm Successfully Treated by the “Coil Sandwich Technique”

A Case of Repeatedly Recurrent Basilar Trunk Dissecting Aneurysm Successfully Treated by the “Coil Sandwich Technique”

Endovascular treatment of ruptured intracranial aneurysms: Indications, techniques and results

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

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