Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization

  • Jeon, Jin Pyeong (Department of Neurosurgery, Hallym University College of Medicine) ;
  • Cho, Young Dae (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Rhim, Jong Kook (Department of Neurosurgery, Jeju National University College of Medicine, Jeju National University Hospital) ;
  • Park, Jeong Jin (Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine) ;
  • Cho, Won-Sang (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Kang, Hyun-Seung (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Kim, Jeong Eun (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital) ;
  • Hwang, Gyojun (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Kwon, O-Ki (Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Han, Moon Hee (Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital)
  • Received : 2015.08.13
  • Accepted : 2016.04.24
  • Published : 2016.09.01
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Abstract

Objective: Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs. Materials and Methods: A total of 47 patients (M:F, 30:17; mean age ${\pm}$ SD, $53.7{\pm}12.6$ years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE. Results: Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on post-embolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring. Conclusion: Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.

Keywords

References

  1. Kim BM, Kim SH, Kim DI, Shin YS, Suh SH, Kim DJ, et al. Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 2011;76:1735-1741 https://doi.org/10.1212/WNL.0b013e31821a7d94
  2. Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Lee BH, et al. Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol 2006;27:1514-1520
  3. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C. Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 2001;94:427-432 https://doi.org/10.3171/jns.2001.94.3.0427
  4. Lv X, Jiang C, Li Y, Wu Z. Clinical outcomes of ruptured and unruptured vertebral artery-posterior inferior cerebellar artery complex dissecting aneurysms after endovascular embolization. AJNR Am J Neuroradiol 2010;31:1232-1235 https://doi.org/10.3174/ajnr.A2087
  5. Shin GW, Jeong HW. Endovascular treatment of intracranial vertebral artery dissecting aneurysms: follow up angiographic and clinical results of endovascular treatment in serial cases. Neurointervention 2015;10:14-21 https://doi.org/10.5469/neuroint.2015.10.1.14
  6. Debette S, Grond-Ginsbach C, Bodenant M, Kloss M, Engelter S, Metso T, et al. Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology 2011;77:1174-1181 https://doi.org/10.1212/WNL.0b013e31822f03fc
  7. Kim BM, Shin YS, Kim SH, Suh SH, Ihn YK, Kim DI, et al. Incidence and risk factors of recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms. Stroke 2011;42:2425-2430 https://doi.org/10.1161/STROKEAHA.111.617381
  8. Park SI, Kim BM, Kim DI, Shin YS, Suh SH, Chung EC, et al. Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 2009;30:1351-1356 https://doi.org/10.3174/ajnr.A1561
  9. Kobayashi N, Murayama Y, Yuki I, Ishibashi T, Ebara M, Arakawa H, et al. Natural course of dissecting vertebrobasilar artery aneurysms without stroke. AJNR Am J Neuroradiol 2014;35:1371-1375 https://doi.org/10.3174/ajnr.A3873
  10. Jeon P, Kim BM, Kim DI, Park SI, Kim KH, Kim DJ, et al. Reconstructive endovascular treatment of fusiform or ultrawide-neck circumferential aneurysms with multiple overlapping enterprise stents and coiling. AJNR Am J Neuroradiol 2012;33:965-971 https://doi.org/10.3174/ajnr.A2857
  11. Cho YD, Lee WJ, Kim KM, Kang HS, Kim JE, Han MH. Stentassisted coil embolization of posterior communicating artery aneurysms. AJNR Am J Neuroradiol 2013;34:2171-2176 https://doi.org/10.3174/ajnr.A3541
  12. Kang HS, Han MH, Kwon BJ, Jung C, Kim JE, Kwon OK, et al. Is clopidogrel premedication useful to reduce thromboembolic events during coil embolization for unruptured intracranial aneurysms? Neurosurgery 2010;67:1371-1376; discussion 1376 https://doi.org/10.1227/NEU.0b013e3181efe3ef
  13. Raymond J, Guilbert F, Weill A, Georganos SA, Juravsky L, Lambert A, et al. Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke 2003;34:1398-1403 https://doi.org/10.1161/01.STR.0000073841.88563.E9
  14. Cho YD, Han MH, Ahn JH, Jung SC, Kim CH, Kang HS, et al. Simultaneous endovascular treatment of ruptured cerebral aneurysms and vasospasm. Korean J Radiol 2015;16:180-187 https://doi.org/10.3348/kjr.2015.16.1.180
  15. Cho YD, Rhim JK, Kang HS, Park JJ, Jeon JP, Kim JE, et al. Use of triple microcatheters for endovascular treatment of wide-necked intracranial aneurysms: a single center experience. Korean J Radiol 2015;16:1109-1118 https://doi.org/10.3348/kjr.2015.16.5.1109
  16. Cho YD, Rhim JK, Park JJ, Jeon JS, Yoo RE, Kang HS, et al. Microcatheter looping to facilitate aneurysm selection in coil embolization of paraclinoid aneurysms. Korean J Radiol 2015;16:899-905 https://doi.org/10.3348/kjr.2015.16.4.899
  17. Cho YD, Lee JY, Seo JH, Lee SJ, Kang HS, Kim JE, et al. Does stent implantation improve the result of repeat embolization in recanalized aneurysms? Neurosurgery 2012;71(2 Suppl Operative):ons253-ons259; discussion ons259
  18. Wakhloo AK, Mandell J, Gounis MJ, Brooks C, Linfante I, Winer J, et al. Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up. Stroke 2008;39:3288-3296 https://doi.org/10.1161/STROKEAHA.107.512996
  19. Suh SH, Kim BM, Chung TS, Kim DI, Kim DJ, Hong CK, et al. Reconstructive endovascular treatment of intracranial fusiform aneurysms: a 1-stage procedure with stent and balloon. AJNR Am J Neuroradiol 2010;31:155-160 https://doi.org/10.3174/ajnr.A1784
  20. Dabus G, Lin E, Linfante I. Endovascular treatment of fusiform intracranial vertebral artery aneurysms using reconstructive techniques. J Neurointerv Surg 2014;6:589-594 https://doi.org/10.1136/neurintsurg-2013-010897
  21. Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ, et al. Stent-assisted coil embolization followed by a stent-withina- stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. Clinical article. J Neurosurg 2009;111:48-52 https://doi.org/10.3171/2009.2.JNS081418
  22. Zhao KJ, Zhao R, Huang QH, Xu Y, Hong B, Fang YB, et al. The interaction between stent(s) implantation, PICA involvement, and immediate occlusion degree affect symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment with stent(s)-assisted coiling. Eur Radiol 2014;24:2088-2096 https://doi.org/10.1007/s00330-014-3225-7
  23. Ro A, Kageyama N. Pathomorphometry of ruptured intracranial vertebral arterial dissection: adventitial rupture, dilated lesion, intimal tear, and medial defect. J Neurosurg 2013;119:221-227 https://doi.org/10.3171/2013.2.JNS121586
  24. Fiorella D, Albuquerque FC, Masaryk TJ, Rasmussen PA, McDougall CG. Balloon-in-stent technique for the constructive endovascular treatment of "ultra-wide necked" circumferential aneurysms. Neurosurgery 2005;57:1218-1227; discussion 1218-1227 https://doi.org/10.1227/01.NEU.0000186036.35823.10
  25. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, et al. Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. J Neurosurg 2003;98:959-966 https://doi.org/10.3171/jns.2003.98.5.0959
  26. Mizutani T, Miki Y, Kojima H, Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery 1999;45:253-259; discussion 259-260 https://doi.org/10.1097/00006123-199908000-00010
  27. Mizutani T, Kojima H, Asamoto S, Miki Y. Pathological mechanism and three-dimensional structure of cerebral dissecting aneurysms. J Neurosurg 2001;94:712-717 https://doi.org/10.3171/jns.2001.94.5.0712
  28. Ng P, Khangure MS, Phatouros CC, Bynevelt M, ApSimon H, McAuliffe W. Endovascular treatment of intracranial aneurysms with Guglielmi detachable coils: analysis of midterm angiographic and clinical outcomes. Stroke 2002;33:210-217 https://doi.org/10.1161/hs0102.100486
  29. Mizutani T. Natural course of intracranial arterial dissections. J Neurosurg 2011;114:1037-1044 https://doi.org/10.3171/2010.9.JNS10668
  30. Nakiri GS, Santos AC, Abud TG, Aragon DC, Colli BO, Abud DG. A comparison between magnetic resonance angiography at 3 Teslas (time-of-flight and contrast-enhanced) and flat-panel digital subtraction angiography in the assessment of embolized brain aneurysms. Clinics (Sao Paulo) 2011;66:641-648 https://doi.org/10.1590/S1807-59322011000400020
  31. Ferre JC, Carsin-Nicol B, Morandi X, Carsin M, de Kersaint-Gilly A, Gauvrit JY, et al. Time-of-flight MR angiography at 3T versus digital subtraction angiography in the imaging followup of 51 intracranial aneurysms treated with coils. Eur J Radiol 2009;72:365-369 https://doi.org/10.1016/j.ejrad.2008.08.005
  32. Jeon JP, Cho YD, Rhim JK, Park JJ, Cho WS, Kang HS, et al. Effect of stenting on progressive occlusion of small unruptured saccular intracranial aneurysms with residual sac immediately after coil embolization: a propensity score analysis. J Neurointerv Surg 2015 Oct 27 [Epub]. http://dx.doi.org/10.1136/neurintsurg-2015-011947

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