Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms

Zang, Yizheng; Wang, Chengwei; Zhang, Yuan; Xuan, Dong; Wang, Yihua; Wang, Xiaofei; Wang, Zhigang

doi:10.1016/j.clineuro.2015.07.004

Cited by 11 publications

(9 citation statements)

References 42 publications

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“…67-69, 71-75, 77-79, 81-92 Twenty-six studies reported mortality rates in patients with SAH secondary to IAD. [66][67][68][69][70][71][72][73][74][75][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] One study focused only on patients managed medically, 66 4 studies reported mortality for both patients managed medically or with interventions, [67][68][69][70] while the remaining studies described survival rates only in patients undergoing intervention. The mortality of IAD with SAH, when treated by intervention, was 10% (95%CI, 7%-12%) (Figure 3.10) as compared to 55% (95%CI, 34%-76%) in absence of intervention (Figure 3.5).…”

Section: Additional Informationmentioning

confidence: 99%

ESO guideline for the management of extracranial and intracranial artery dissection

Debette

Mazighi

Bijlenga³

et al. 2021

European Stroke Journal

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The aim of the present European Stroke Organisation guideline is to provide clinically useful evidence-based recommendations on the management of extracranial artery dissection (EAD) and intracranial artery dissection (IAD). EAD and IAD represent leading causes of stroke in the young, but are uncommon in the general population, thus making it challenging to conduct clinical trials and large observational studies. The guidelines were prepared following the Standard Operational Procedure for European Stroke Organisation guidelines and according to GRADE methodology. Our four recommendations result from a thorough analysis of the literature comprising two randomized clinical trials (RCTs) comparing anticoagulants to anti-platelets in the acute phase of ischemic stroke and twenty-six comparative observational studies. In EAD patients with acute ischemic stroke we recommend using intravenous thrombolysis (IVT) with alteplase within 4.5 hours of onset if standard inclusion/exclusion criteria are met, and mechanical thrombectomy in patients with large vessel occlusion of the anterior circulation. We further recommend early endovascular or surgical intervention for IAD patients with subarachnoid hemorrhage (SAH). Based on evidence from two phase 2 RCTs that have shown no difference between the benefits and risks of anticoagulants versus anti-platelets in the acute phase of symptomatic EAD, we strongly recommend that clinicians can prescribe either option. In post-acute EAD patients with residual stenosis or dissecting aneurysms and in symptomatic IAD patients with an intracranial dissecting aneurysm and isolated headache, there is insufficient data to provide a recommendation on the benefits and risks of endovascular/surgical treatment. Finally, nine expert consensus statements, adopted by 8 to 11 of the 11 experts involved, propose guidance for clinicians when the quality of evidence was too low to provide recommendations. Some of these pertain to the management of IAD (use of IVT, endovascular treatment, and antiplatelets versus anticoagulation in IAD with ischemic stroke and use of endovascular or surgical interventions for IAD with headache only). Other expert consensus statements address the use of direct anticoagulants and dual antiplatelet therapy in EAD-related cerebral ischemia, endovascular treatment of the EAD/IAD lesion and multidisciplinary assessment of the best therapeutic approaches in specific situations.

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Section: Additional Informationmentioning

confidence: 99%

ESO guideline for the management of extracranial and intracranial artery dissection

Debette

Mazighi

Bijlenga³

et al. 2021

European Stroke Journal

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“…The degree of intra-aneurysmal flow reduction achieved with conventional stents is usually too low to complete thrombosis for aneurysms after treatment (Wakhloo et al, 2008; Sebastian et al, 2014). Studies indicate that reduced stent porosity promotes favorable flow modification (Zang et al, 2015). In theory, the metal coverage of conventional stents can be increased by the overlapping technique, accomplishing excellent flow diversion in the aneurysmal lumen.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Large or Giant Non-saccular Vertebrobasilar Aneurysms: Pipeline Embolization Devices Versus Conventional Stents

et al. 2019

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BackgroundEndovascular treatment of large or giant non-saccular vertebrobasilar aneurysms (VBAs) by conventional stents is difficult and has unsatisfactory outcomes.ObjectThis study was performed to retrospectively analyze the safety and efficacy of a flow diverter in treating large and giant non-saccular VBAs.MethodsWe identified 78 patients with 83 large or giant non-saccular VBAs who accepted endovascular treatment with a pipeline embolization device (PED) or conventional stent from January 2014 to June 2018. The technical details of the procedure, procedure-associated complications, angiographic outcomes, and clinical outcomes were evaluated.ResultsForty-two patients (53.8%, 42/78) with 44 aneurysms (53.0%, 44/83) underwent endovascular treatment with PEDs. Thirty-six patients (46.2%, 36/78) with 39 aneurysms (47.0%, 39/83) underwent endovascular treatment with conventional stents. The complication rate of PED group and conventional stent group was 7.1% (3/42) and 5.6% (2/36), respectively (odds ratio, 0.765; 95% confidence interval, 0.121–4.851; P = 0.776). During a median follow-up time of 28.8 months, the complete occlusion rate in the PED group and conventional stent group was 90.2% (37/41) and 70.3% (26/37), respectively (odds ratio, 3.913; 95% confidence interval, 1.122–13.652; P = 0.032).ConclusionEndovascular treatment with a PED is a promising and safe modality for large and giant non-saccular VBAs, and the complication rate is acceptable, compared with conventional endovascular treatment.

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“…Infarcts of the vertebrobasilar circulation are responsible for 12-27% of all strokes in hospitalised patients, and 20-25% of these are believed to be due to stenosis of vertebral arteries [15,19]. Despite its apparent aetiological importance, optimal management (endovascular or surgical) of VA stenosis and other vasculopathies remains uncertain [22,28].…”

Section: Hypoplasia Of the Vertebral Arterymentioning

confidence: 99%

Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness

Dzierżanowski

Szarmach²,

Baścik³

et al. 2017

Folia Morphol

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The presented knowledge of anatomical variation and abnormali-ties of vertebral circulation can improve the accuracy and "safety" of the surgical procedures in this region, help to determine the range of surgical approach and avoid associated complications. The radiological examinations using 3D CT, DSA reveal unlimited observation of anatomical structures in contrast to studies based on cadavers, and can complement the morphometry in anatomical preparations.

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Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms

Cited by 11 publications

References 42 publications

ESO guideline for the management of extracranial and intracranial artery dissection

ESO guideline for the management of extracranial and intracranial artery dissection

Endovascular Treatment of Large or Giant Non-saccular Vertebrobasilar Aneurysms: Pipeline Embolization Devices Versus Conventional Stents

Intracranial region of the vertebral artery: morphometric study in the context of clinical usefulness

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