Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China; Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON Canada.
Department of Medical Imaging,St. Michael's Hospital, Toronto, Ontario, Canada.
Eur J Radiol. 2018 Feb;99:68-75. doi: 10.1016/j.ejrad.2017.12.009. Epub 2017 Dec 16.
To compare the safety and efficacy of endovascular parent artery occlusion (PAO) and flow diverter (FD) treatment in treating vertebrobasilar dissecting aneurysms (VBDAs).
A review of a prospective aneurysm database at our institution was performed to identify all consecutive patients with intracranial VBDAs managed with endovascular treatment, which were either PAO or FD. Clinical and imaging findings were compared between the two groups.
A total of 25 consecutive patients with 27 VBDAs were included. Seventeen VBDAs were treated by PAO, and 11 VBDAs were treated with FDs. Immediate total occlusion rate after initial treatment was higher in the PAO group than in the FD group (62.5% v.s. 9.1%, p = .018). Complete occlusion on follow-up at 18 months was more frequently observed in the PAO group (81.8%) compared to the FD group (55.6%), although the difference was not statistically significant (p = .433). Procedure related complication rate and mortality for the whole case series was 28% and 24% respectively, and were comparable in the two groups. Excellent outcome at discharge was achieved in 77.8% and 40% of patients treated with FD and PAO respectively, which was not statistically significant (p = .169). Excellent outcome at followed-up was comparable as well.
PAO and FD treatment are both feasible options for treatment of VBDAs. PAO provide higher immediate complete occlusion rate compared to FD. Despite low initial complete occlusion rates, FD group presented a comparable long-term outcome and similar perioperative events rate compared to the PAO group.
比较血管内母动脉闭塞（PAO）和血流导向装置（FD）治疗椎基底动脉夹层动脉瘤（VBDAs）的安全性和有效性。
对我院前瞻性动脉瘤数据库进行回顾性分析，以确定所有接受血管内治疗的颅内 VBDAs 患者，包括 PAO 或 FD。比较两组患者的临床和影像学发现。
共纳入 25 例 27 个 VBDAs 的连续患者。17 个 VBDAs 采用 PAO 治疗，11 个 VBDAs 采用 FD 治疗。初次治疗后即刻完全闭塞率在 PAO 组高于 FD 组（62.5%比 9.1%，p=0.018）。PAO 组随访 18 个月时完全闭塞率（81.8%）明显高于 FD 组（55.6%），但差异无统计学意义（p=0.433）。整个病例系列的手术相关并发症发生率和死亡率分别为 28%和 24%，两组间无统计学差异。FD 和 PAO 治疗的患者出院时的良好预后率分别为 77.8%和 40%，差异无统计学意义（p=0.169）。随访时的良好预后率也相似。
PAO 和 FD 治疗均是 VBDAs 的可行治疗选择。PAO 与 FD 相比，即刻完全闭塞率更高。尽管初始完全闭塞率较低，但 FD 组与 PAO 组的长期结果和围手术期事件发生率相当。
