| Background:Vertebrobasilar fusiform aneurysm (VBFA) is an important type of complex intracranial aneurysms with low incidence and poor prognosis, presenting great challenges for both surgical and interventional therapies. Nowadays, there is still a lack of safe and effective treatment, and classification of lesion types, choice of treatment strategies, and factors affecting prognosis are still uncertain.Purposes:First, this study aims to explore endovascular treatment modalities and strategies for VBFA, to judge the clinical and imaging follow-up results, and to find out possible factors affecting prognosis. Second, we aim to find out the role of etiology of dissection in VBFA by comparing in two groups of dissecting VBFA and non-dissecting VBFA. Based on the above results, we come up with a new classification of VBFA by integrating clinical manifestation, multi-model imaging and angiography results, thus, different lesion features, treatment modalities and prognostic results are compared among different lesion types. Last, directing at the valuable technique of multiple overlapping stenting techniques in VBFA, safety and efficacy are to be further developed.Methods:Patients of VBFA treated by endovascular approaches between September 2007 and March 2016 were included and retrospectively studied. ? Patient information, VBFA features, imaging sources, treatment and follow-up data were collected. Factors influencing treatment modalities and strategies were analyzed, clinical and imaging follow-up results were explored, and univariate analysis and multifactor logistic regression were performed to explore influencing factors for prognosis. ?Lesions were divided into two groups of dissecting VBFA and non-dissecting VBFA to comparing lesion features, endovascular therapies and prognosis. With the newly proposed classification scheme, lesion features, therapies and prognosis would be compared among different types, either. ?Safety and efficacy data were explored for the multiple overlapping stenting technique, also, the results would be compared with single stenting technique during the same period.Results:Influencing factors for VBFA treatment strategies including:VBFA locating at perforating and distal arteries are to be treated by parent artery occlusion, while, reconstructive treatment are suitable for vertebrobasilar trunks, patients with SAH and aneurysms with higher width/length ratio are to be treated by stent-assisted coiling, and aneurysms with higher length diameter and lower width/length ratio are to be treated by multiple overlapping stenting technique. During a mean clinical follow-up time of 42.7 ±29.6 months,92.2% of patients received good prognosis of mRS 0-2, and for a mean time of 15.3+14.9 months of imaging follow-up, complete healing of aneurysms were achieved in 42.5%, stable or further thrombosis in 35.0%, and recurrence was found in 22.5%. Multifactor logistic regression analysis found that good clinical prognosis were in negative correlation with VBFA width diameter, imaging findings of complete aneurysm occlusion were in relation with VBFA locations, in which intracranial vertebral artery were in positive correlation and basilar artery in negative correlation.By comparing dissecting and non-dissecting VBFA, mean age, SAH ratio, favorite locations, VBFA width diameter and clinical prognosis were found to be significantly different in two groups. The newly developed classification divided VBFA into Type I of dissecting type, including Type I a of acute dissecting phase and type I b of reparative phase), Type? of chronic progressing type, Type ? of segmental ectasia, and Type ? of saccular aneurysm with fusiform morphology. There are distinct features of different types, also, Type ?a, I b and ? are found with nice clinical and imaging results, Type ? and IV with poor prognosis, and the recurrence rate of 66.7% was extremely among different typesMultiple overlapping stenting techniques was relatively safe and effective, with good clinical prognosis of 93.8%, imaging results of complete occlusion of 60%, and the recurrence rate was 20%.Conclusions: ? Aneurysm locations, width/length ratio and rupture status are found to be related with treatment strategies for VBFA, excellent clinical and imaging results may be achieved by current endovascular treatment, also, aneurysm width diameter and locations are possible factors affecting prognosis. ?Dissecting origin is an important factors in judging lesion types and prognosis. Moreover, the new classifications are developed to differentiating different lesions further, which may manifesting with nice recognition of different types, guiding clinical treatment and judging prognosis. ?Multiple overlapping stenting techniques are relatively safe and effective, with satisfactory short-term clinical and imaging results. |
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