Endovascular Treatment Of Intracranial Dissecting Aneurysms And Follow-up Study

Objectives To evaluate the safety and efficacy of endovascular intervention in the treatment of intracranial dissecting aneurysms(IDAs),to propose a modified classification of intracranial dissecting aneurysms and to guide the treatment for IDAs.Methods This study was divided into two parts.In the first part,the results of 40 consecutive patients with ruptured vertebrobasilar dissecting aneurysms in our department,who were treated with internal trapping(n = 7),stent(s)-assisted coiling(n = 26),and solely stenting(n = 7)from January 2010 to June 2014,were retrospectively.In the second part,309 patients harboring 323 IDAs were identified from the data base of our department between January 2010 and December 2015.Based on a modified imaging classification,IDAs were classified into four subtypes: classic dissecting aneurysm,segmental ectasia,dolichoectatic dissecting aneurysm,and large mural bleeding ectasia.The logistic regression analysis was performed to find predictors of clinical outcome of patients.SPSS 22.0 was used for statistical analyses.Results In the first part,all 7 patients treated with internal trapping had satisfactory outcomes;none had treatment?related complications,rebleeding,or recanalization after treatment.Of the 26 patients treated with stent?assisted coiling,one patient suffered from an acute in?stent thrombosis during the operation,one had a small cerebral cortical infarction,one had rebleeding,and one had recanalization of his obliterated aneurysm after surgery.Of the seven patients treated solely with stenting,one patient had recanalization and two patients suffered rebleeding,of whom one patient died.In the second part,of the 323 IDAs,216(66.87%)were treated with stent-assisted coiling,47(14.55%)with internal trapping,and 60(18.58%)with sole stenting.Of the 309 patients,8(2.59%)suffered intraoperative complications and 40(12.94%)had postoperative complications;9 patients(2.79%)died and 1(0.32%)had severe disability.The mean duration of clinical follow-up of the 309 patients was 10.40 months(range,3–72 months).Imaging follow-up was available for 262 patients(274 IDAs)with a mean duration 7.10 months(range,3–60 months),and 24(9.16%)aneurysm recurrences was noted.Aneurysm type was the only independent predictor of different outcome by logistic regression analysis(P=0.004).Compared with type I,type III had a significantly unfavorable outcome(P=0.013)with an odds ratio(OR)of 7.091 and 95% confidence interval(CI)of 1.520–3.076;Type IV had a significantly unfavorable outcome(OR 6.798,95% CI 2.200–21.008;P=0.001),but type II showed no significant difference(P=0.941).Conclusions If a proper endovascular strategy is in place,an effective treatment outcome for ruptured vertebrobasilar dissecting aneurysms can be obtained.There was a strong relationship between the subtypes of the IDAs and their clinical course.This modified classification was confirmed as helpful in assessing the prognosis of patients and guiding their treatment.