Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea.
Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea.
World Neurosurg. 2022 Nov;167:e533-e540. doi: 10.1016/j.wneu.2022.08.047. Epub 2022 Aug 14.
To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications.
This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications.
Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications.
Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.
评估破裂椎动脉夹层动脉瘤的临床结果，重点比较单纯血管内闭塞（PAO）与支架辅助治疗，并确定不良结局和术后并发症的危险因素。
本回顾性研究纳入 2009 年 2 月至 2020 年 4 月期间治疗的 36 例破裂椎动脉夹层动脉瘤患者。治疗方法包括单纯 PAO 无支架和支架辅助治疗。支架辅助治疗包括后下小脑后动脉（PICA）支架置入和支架辅助弹簧圈栓塞。采用单因素和多因素分析评估不良结局和术后并发症的危险因素。
患者接受单纯 PAO 治疗（24 例，66.7%）、PAO 联合 PICA 支架置入（4 例，11.1%）和 PAO 联合支架辅助弹簧圈栓塞（8 例，22.2%）。仅 PICA 受累的动脉瘤为梭形，支架辅助弹簧圈栓塞组中有 4 个动脉瘤合并 PICA，4 个动脉瘤累及优势椎动脉。老年（比值比 [OR] = 1.25，95%置信区间 [CI] = 1.01-1.56，P = 0.044）和较差的 Hunt-Hess 分级（OR = 537.99，95%CI = 6.73-42994.1，P = 0.005）与平均 37.5 ± 32.8 个月随访后的不良临床结局显著相关。梭形扩张形态（OR = 15.97，95%CI = 1.52-167.38，P = 0.021）和 PICA 受累（OR = 13.71，95%CI = 1.29-145.89，P = 0.030）是缺血性并发症的独立危险因素。
不良临床结局与高龄和较差的 Hunt-Hess 分级显著相关。各组间临床结局或缺血性并发症无显著差异。支架辅助治疗可能是破裂椎动脉夹层动脉瘤的有效且安全的方法。
