Dataset Information

Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization.

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 ± SD, 53.7 ± 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 postembolization 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.

SUBMITTER: Jeon JP

PROVIDER: S-EPMC5007409 | biostudies-literature | 2016 Sep-Oct

REPOSITORIES: biostudies-literature

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Publications

Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization.

Jeon Jin Pyeong JP Cho Young Dae YD Rhim Jong Kook JK Park Jeong Jin JJ Cho Won-Sang WS Kang Hyun-Seung HS Kim Jeong Eun JE Hwang Gyojun G Kwon O-Ki OK Han Moon Hee MH

Korean journal of radiology 20160823 5

<h4>Objective</h4>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.<h4>Materials and methods</h4>A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 an ...[more]

PMID: 27587971

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Project description:PurposeHemodynamics play a key role in the management of cerebral aneurysm recanalization after coil embolization; however, the most reliable hemodynamic parameter remains unknown. Previous studies have explored the use of both spatiotemporally averaged and maximal definitions for hemodynamic parameters, based on computational fluid dynamics (CFD) analysis, to build predictive models for aneurysmal recanalization. In this study, we aimed to assess the influence of different spatiotemporal characteristics of hemodynamic parameters on predictive performance.MethodsHemodynamics were simulated using CFD for 66 cerebral aneurysms from 65 patients. We evaluated 14 types of spatiotemporal definitions for two hemodynamic parameters in the pre-coiling model and five in virtual post-coiling model (VM) created by cutting the aneurysm from the pre-coiling model. A total of 91 spatiotemporal hemodynamic features were derived and utilized to develop univariate predictor (UP) and multivariate logistic regression (LR) models. The model's performance was assessed using two metrics: the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC).ResultsDifferent spatiotemporal hemodynamic features exhibited a wide range of AUROC values ranging from 0.224 to 0.747, with 22 feature pairs showing a significant difference in AUROC value (P-value <0.05), despite being derived from the same hemodynamic parameter. PDave,q1 was identified as the strongest UP with AUROC/AUPRC values of 0.747/0.385, yielding sensitivity and specificity value of 0.889 and 0.614 at the optimal cut-off value, respectively. The LR model further improved the prediction performance, having AUROC/AUPRC values of 0.890/0.903. At the optimal cut-off value, the LR model achieved a specificity of 0.877, sensitivity of 0.719, outperforming the UP model.ConclusionOur research indicated that the characteristics of hemodynamic parameters in terms of space and time had a significant impact on the development of predictive model. Our findings suggest that LR model based on spatiotemporal hemodynamic features could be clinically useful in predicting recanalization after coil embolization in patients, without the need for invasive procedures.

Project description:Background and purposeThe retreatment of recurrent intracranial vertebral artery dissecting aneurysms (VADAs) after stent assisted coiling (SAC) has not yet been studied. The purpose of this study was to evaluate the strategies and outcomes for retreatment of recurrent VADAs after SAC.MethodsBetween September 2009 and November 2013, six consecutive patients presenting with recurrent intracranial VADAs after SAC were enrolled in this study. They were all male with age ranging from 29 to 54 years (mean age, 46.2 years). The procedures of treatments and angiographic and clinical follow-up were reviewed retrospectively. Retreatment modalities were selected individually according to the characteristics of recurrence. The outcomes of retreatment were evaluated by angiographic and clinical follow-up.ResultsSix patients with recurrent intracranial VADAs after SAC were retreated, with second SAC in three patients, coil embolization, double overlapping stents placement and endovascular occlusion with aneurysm trapping in one patient, respectively. Immediate angiographic outcomes of retreatment were: complete occlusion in three patients, nearly complete occlusion in two patients, and contrast medium retention in dissecting aneurysm in one patient. All cases were technically successful. No complications related to endovascular procedures occurred. Angiographic follow-up was available in all five patients treated with second SAC or double overlapping stents, which was complete occlusion in four patients, obliteration of parent artery in one patient, showing no recurrence at 4-11 months (mean: 8.6 months). Clinical follow-up was performed in all six patients at 11-51 months after initial endovascular treatment and at 9-43 months after retreatment. The mRS of last clinical follow-up was excellent in five patients and mild disability in only one patient.ConclusionsEndovascular retreatment is feasible and effective for recurrent intracranial VADAs after SAC. Individualized strategies of retreatment should be enacted according to the characteristics and reasons for the recurrence.

Project description:Background It is necessary to explore the safety and efficacy of various endovascular treatment techniques in the treatment of patients with intracranial vertebrobasilar trunk dissecting aneurysms (VBTDAs). This study sought to compare the clinical and angiographic outcomes of patients with intracranial VBTDAs following low-profile visualized intraluminal support (LVIS)-within-Enterprise overlapping-stent technique with those of flow diversion (FD). Methods This was a retrospective, observational, cohort study. Between January 2014 and March 2022, 9,147 patients with intracranial aneurysms were screened, and 91 patients with 95 VBTDAs who underwent LVIS-within-Enterprise overlapping-stent assisted–coiling technique or FD were included in the analysis. The primary outcome was the complete occlusion rate at the last angiographic follow-up. The secondary outcomes included adequate aneurysm occlusion, in-stent stenosis/thrombosis, general neurological complications, neurological complications within 30 days after the procedure, the mortality rate, and unfavorable outcomes. Results Among the 91 included patients, 55 were treated with LVIS-within-Enterprise overlapping-stent technique (the LE group) and 36 were treated with FD (the FD group). The angiography results at the median follow-up time of 8 months showed complete occlusion rates of 90.0% and 60.9% for the LE and FD groups, respectively, with an adjusted odds ratio of 5.79 (95% CI: 1.35–24.85; P=0.01). Adequate aneurysm occlusion (P=0.98), in-stent stenosis/thrombosis (P=0.46), general neurological complications (P=0.22), neurological complications within 30 days after the procedure (P=0.63), mortality rate (P=0.31), and unfavorable outcomes (P=0.07) at the last clinical follow-up did not differ significantly between the 2 groups. Conclusions A significantly higher complete occlusion rate for VBTDAs was found following LVIS-within-Enterprise overlapping-stent technique as compared with FD. The 2 treatment modalities have comparable adequate occlusion rates and safety profiles.

Dataset Information

Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization.

Objective

Materials and methods

Results

Conclusion

Publications

Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization.

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