Endo Hidenori, Tanoue Shuichi, Hiramatsu Masafumi, Matsumoto Yasushi, Sato Kenichi, Sato Masayuki, Matsumaru Yuji, Tsuruta Wataro, Kiyosue Hiro
Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Department of Radiology, Kurume University School of Medicine, Kurume, Japan.
Neurosurg Rev. 2021 Aug;44(4):2283-2290. doi: 10.1007/s10143-020-01424-x. Epub 2020 Oct 21.
Internal trapping (IT) is a treatment option for intracranial vertebral artery dissecting aneurysms (VADAs). Medullary infarction (MI) is a complication linked to this treatment. This study aims to clarify the outcomes of IT for VADAs and the risk factors for MIs. We retrospectively reviewed the databases from 2010 to 2017 to identify patients with VADAs treated by IT at seven collaborating institutions. Radiological findings, clinical courses, and outcomes were analyzed. Perforating arteries were classified into terminal or longitudinal types using preoperative angiography. IT was completed in 90 patients (74 ruptured and 16 unruptured VADA). Postoperative rebleeding did not occur in any ruptured VADA patients. Postoperative MRI detected MIs in 26 patients (28.9%). The incidence of MIs in the ruptured VADA (32%) was higher compared with that in the unruptured VADA (13%), though it was not significant. In the MI group, the occlusion or blind alley of the terminal-type and longitudinal-type perforator was confirmed in 23 patients (88%) and 11 patients (42%), respectively. The occlusion or blind alley of the terminal-type perforator was an independent risk factor for MIs in the logistic regression analysis (OR 5.81; 95% CI 1.34-25.11; p = 0.018). In ruptured VADA, postoperative MI (OR 12.2; 95% CI 3.19-64.55; p = 0.0001) and high-grade SAH (OR 8.02; 95% CI 2.32-37.70; p = 0.0006) were independent risk factors of an unfavorable clinical outcome. In conclusion, MIs were an independent risk factor for unfavorable outcomes after IT, especially for a ruptured VADA. The occlusion or blind alley of the terminal-type perforator caused by the IT was associated with postoperative MIs.
血管内栓塞术（IT）是治疗颅内椎动脉夹层动脉瘤（VADA）的一种选择。延髓梗死（MI）是该治疗方法的一种并发症。本研究旨在阐明IT治疗VADA的疗效以及MI的危险因素。我们回顾性分析了2010年至2017年期间7家合作机构中接受IT治疗的VADA患者的数据库。分析了影像学检查结果、临床病程及预后情况。术前血管造影将穿支动脉分为终末型或纵行型。90例患者（74例破裂型和16例未破裂型VADA）完成了IT治疗。所有破裂型VADA患者术后均未发生再出血。术后MRI检查发现26例患者（28.9%）发生MI。破裂型VADA患者的MI发生率（32%）高于未破裂型VADA患者（13%），但差异无统计学意义。在MI组中，分别有23例患者（88%）和11例患者（42%）证实终末型和纵行型穿支动脉闭塞或呈盲端。在逻辑回归分析中，终末型穿支动脉闭塞或呈盲端是MI的独立危险因素（比值比5.81；95%可信区间1.34 - 25.11；p = 0.018）。在破裂型VADA中，术后MI（比值比12.2；95%可信区间3.19 - 64.55；p = 0.0001）和高级别蛛网膜下腔出血（SAH）（比值比8.02；95%可信区间2.32 - 37.70；p = 0.0006）是不良临床结局的独立危险因素。总之，MI是IT术后不良结局的独立危险因素，尤其是对于破裂型VADA。IT导致的终末型穿支动脉闭塞或呈盲端与术后MI相关。
