Clinical Study Of Pipeline Embolization Device In The Treatment Of Vertebral Artery Dissecting Aneurysm

Objective: To evaluate the efficacy and safety of flow diversion device(PED)in the treatment of vertebral artery dissecting aneurysm(VADA),and to analyze the related factors affecting the occurrence of perioperative complications using related statistical methods.Methods: The clinical data of 123 cases of VADA treated with PED in 14 neurosurgical centers from November 2014 to October 2019 were retrospectively analyzed.Clinical prognosis was assessed using the modified Rankin Scale score(mRs),and imaging was assessed using the O ′ Keely-Marotta(OKM)grade and Raymond angiographic scoring criteria.Statistical methods,univariate and multivariate logistic regression were used to analyze the related factors affecting the occurrence of perioperative complications.Results: One hundred and twenty-three patients with 142 vertebral artery dissecting aneurysms were treated with 130 PEDs(117 with 1 PED,5 with 2,and 1with 3),including 98 patients(79.7%)treated with PED alone and 25 patients(20.3%)treated with PED combined with coils.PED alone showed OKMA grade in52 cases,OKMB grade in 40 cases,and OKMC grade in 6 cases;PED combined with coil therapy showed Raymond grade I in 7 cases,grade II in 4 cases,and grade III in 14 cases.Immediate postoperative angiography showed significant contrast agent retention in the aneurysm in 70 cases,moderate retention in 30 cases,and mild retention in 23 cases.There were 2 patients with intraoperative bleeding,2 patients with stent thrombosis and 5 patients with postoperative ischemia.91 patients were followed up for 3-26 months,with an average follow-up time of 8.1 months.The clinical follow-up m Rs0-1 score.The imaging evaluation showed that 76 patients(83.5%)were cured of aneurysm(OKMD grade),10 patients(11.0%)had residual neck(OKMC grade)and 5 patients(5.5%)had partial visualization of aneurysm(OKMB grade).Univariate and multivariate logistic regression analysis showed that the inclusion of related factors p > 0.05,and there was no significant correlation with the occurrence of surgical complications.Conclusion: The application of flow diversion device(PED)in the treatment of vertebral artery dissecting aneurysm(VADA)has a higher occlusion rate,without significant carrier artery stenosis and a lower incidence of permanent neurological impairment;this study will be further followed up and evaluated by the follow-up time.Another univariate and multivariate logistic regression analysis showed that the inclusion of related factors p > 0.05,had no significant correlation with the occurrence of surgical complications,and more possible related factors needed to be included for statistical analysis at a later stage.