Endovascular Treatment of Dissecting Aneurysms of the Posterior Inferior Cerebellar Artery and Predictors of Outcome

Li, Hui; He, Xiaofu; Zhang, Xin; Zhu, Guohui; Fang, Qinrui; Wang, Zequn; Duan, Chuan‐Zhi

doi:10.1016/j.jstrokecerebrovasdis.2015.05.034

Cited by 19 publications

(9 citation statements)

References 21 publications

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“…Or results are almost matching with the published endovascular studies by Jin et al [17], Mohammadian et al [6], Li et al [18] and Debette et al [1]. In contrast to the endovascular outcome; Kitanaka et al reported that the long-term outcome of surgically treated lesions was somehow favorable, but there was a very high rate of postoperative neurological complications, and the major causes of disability were attributable to lower cranial nerve palsy and associated events in half of the patients with poor outcome [19].…”

Section: Discussionsupporting

confidence: 90%

Deconstructive versus reconstructive endovascular approaches for intracranial dissecting aneurysms

Saad

Salamah

Salam

et al. 2021

Egypt J Radiol Nucl Med

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Background The annual incidence of the intracranial dissecting aneurysms is about 1 to 1.5 per 100,000. This is a well-known cause of stroke and subarachnoid hemorrhage in young and middle-aged patients (Santos-Franco et al. in Neurosurg Rev, 2008. https://doi.org/10.1007/s10143-008-0124-x). Various surgical and endovascular treatment methods have been proposed for intracranial dissecting aneurysms. All treatment methods aim to reduce the blood flow in the dissected region. Deconstructive techniques sacrifice the parent artery, whereas reconstructive techniques aim to maintain a parent artery (Stéphanie et al. in Lancet Neurol 14(6):640–654, 2015. https://doi.org/10.1016/S1474-4422(15)00009-5). Due to its dissecting nature, wall friability can make surgical clipping difficult and even risky. On the other hand, recanalization after coiling alone is almost certain. Therefore, deconstructive modalities of treatment like trapping or parent vessel occlusion, performed either surgically or endovascularly, have predominated for managing those lesions, usually with good results. Nevertheless, in absence of efficient collateral pathways, the deconstructive technique carries an ischemic risk. In situations in which parent artery preservation is mandatory, the use of stent-assisted techniques may be the most appropriate choice (de Barros Faria et al. in Am J Neuroradiol 32(11):2192–2195, 2011. https://doi.org/10.3174/ajnr.A2671). However, the usage of stent with recently ruptured aneurysms is always perplexing due to the necessity of dual antiplatelet administration. Hence the management of dissecting aneurysms remain challenging. Results Between January 2017 and July 2019, 19 patients presenting with intracranial dissecting aneurysms were referred to our department for endovascular treatment. Among the nineteen patients, 11 cases were treated by parent artery occlusion representing 57.9% of the cases, and 7 cases (36.8%) were treated by artery preserving technique, and only one case (5.3%) was treated by combination of parent artery occlusion and artery preserving technique. One week after the intervention 26.3% of patients had no disability (mRS = 0), 47.4% had no significant disability (mRS = 1), 15.8% had slight disability (mRS = 2) and 10.5% had moderate to severe disability (mRS = 3–4). After three months we found an overall improvement of the clinical outcome, as 57.9% of patients had no disability (mRS = 0), 26.3% had no significant disability (mRS = 1) and 15.8% had mild disability (mRS = 2). Finally, after six months reassessment with angiography showed that 89.5% of patients had stable aneurysmal occlusion, and 10.5% had recurrence of aneurysm. Conclusions Both endovascular approaches, whether parent artery occlusion or artery preserving technique showed favorable outcome which indicates the safety and efficacy of both approaches if selected properly according to the morphology of the aneurysm.

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Section: Discussionsupporting

confidence: 90%

Deconstructive versus reconstructive endovascular approaches for intracranial dissecting aneurysms

Saad

Salamah

Salam

et al. 2021

Egypt J Radiol Nucl Med

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“…Fujimura et al reported a case of fatal rebleeding after selective embolization of dissecting PICA aneurysms [22] while PAO is reported to have no recurrence or lower rate of recurrence. [14,23,11,21] Those 9 patients in our institution that took repeated DSA examination at 1 year after the operation showed no recurrence. The number of these cases was so limited that the recurrence rate of aneurysms cannot be reflected well.…”

Section: Discussionmentioning

confidence: 97%

“…Li et al reported 4 such cases with good clinical outcome. [14] In this research, we classified the tonsillomedullary segment into distal segment. 4 of 8 patients with aneurysms located in tonsillomedullary segment were managed with PAO.…”

Section: Discussionmentioning

confidence: 99%

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Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms

Chen¹,

Sun²,

Shi³

et al. 2018

Medicine

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Distal posterior inferior cerebellar artery (PICA) aneurysm is a kind of rare intracranial aneurysm with controversial evidence in managements. The main purposes of this research are to study the safety and effectiveness of parent artery occlusion (PAO) compared with selective aneurysm coiling (SAC) as well as figure out factors that affect the outcomes.All characteristics of patients that diagnosed with ruptured distal PICA aneurysm and treated with endovascular management in our hospital from July 2009 to February 2016 were retrospectively collected. Details include complete occlusion rate, procedure-related complications and Modified Rankin Scale (mRS) of 31 months (mean) follow-up.Total 36 patients finally met the criterions and were included in the present study. New imaging infarction was observed in 12 (33.33%) patients. And 10 of them showed no apparent neurological dysfunctions after 34 months (mean) follow-up; 1 remained coma status since the symptom onset; and 1 patient died. 27 (75%) patients got a mRS ≤ 2 at the discharge while 20 (86.96%) patients with 3-year follow-up after the operation. There is no significant difference between patients treated with SAC and PAO in both complications and functional recovery in 3-years follow-up period. Hunt&Hess classification (H&H), age, and hydrocephalus are risk factors for functional recovery at discharge.PAO is safe and efficient in the management of distal PICA aneurysms while complications and outcomes are similar with SAC. H&H, age, and hydrocephalus are predicting factors for the mRS at discharge. Further prospective study is still needed to confirm the results of present study.

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“…Many studies have tried to study the risk factors for recanalization. The aneurysm size, morphologies, treatment strategies, and hemodynamics have been found to be associated recanalization (4)(5)(6)(7)(8)(9). Some studies have tried to develop the models or grading scales to predict treatment outcome (4,(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Automated Machine Learning Model Development for Intracranial Aneurysm Treatment Outcome Prediction: A Feasibility Study

Liu

Qian

et al. 2021

Front. Neurol.

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Background: The prediction of aneurysm treatment outcomes can help to optimize the treatment strategies. Machine learning (ML) has shown positive results in many clinical areas. However, the development of such models requires expertise in ML, which is not an easy task for surgeons.Objectives: The recently emerged automated machine learning (AutoML) has shown promise in making ML more accessible to non-computer experts. We aimed to evaluate the feasibility of applying AutoML to develop the ML models for treatment outcome prediction.Methods: The patients with aneurysms treated by endovascular treatment were prospectively recruited from 2016 to 2020. Treatment was considered successful if angiographic complete occlusion was achieved at follow-up. A statistical prediction model was developed using multivariate logistic regression. In addition, two ML models were developed. One was developed manually and the other was developed by AutoML. Three models were compared based on their area under the precision-recall curve (AUPRC) and area under the receiver operating characteristic curve (AUROC).Results: The aneurysm size, stent-assisted coiling (SAC), and posterior circulation were the three significant and independent variables associated with treatment outcome. The statistical model showed an AUPRC of 0.432 and AUROC of 0.745. The conventional manually trained ML model showed an improved AUPRC of 0.545 and AUROC of 0.781. The AutoML derived ML model showed the best performance with AUPRC of 0.632 and AUROC of 0.832, significantly better than the other two models.Conclusions: This study demonstrated the feasibility of using AutoML to develop a high-quality ML model, which may outperform the statistical model and manually derived ML models. AutoML could be a useful tool that makes ML more accessible to the clinical researchers.

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Endovascular Treatment of Dissecting Aneurysms of the Posterior Inferior Cerebellar Artery and Predictors of Outcome

Cited by 19 publications

References 21 publications

Deconstructive versus reconstructive endovascular approaches for intracranial dissecting aneurysms

Deconstructive versus reconstructive endovascular approaches for intracranial dissecting aneurysms

Endovascular management of ruptured distal posterior inferior cerebellar artery aneurysms

Automated Machine Learning Model Development for Intracranial Aneurysm Treatment Outcome Prediction: A Feasibility Study

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