Related Factors For Endovascular Treatment Strategies And Complications Of Intracranial Vertebral Artery Dissecting Aneurysms

Objectives To investigate the related factors for endovascular treatment strategies on deciding deconstructive or reconstructive techniques and for peri-operational complications of intracranial vertebral artery dissecting aneurysms(VADAs),in order to make optimal individualized and standardized protocols to manage this lesion with favorite clinical outcomes.Methods From February 2009 to December 2016,125 Patients with 133 VADAs in our neurosurgical interventional department and cooperated hospitals were enrolled consecutively after patient selection process.We collected the size of dissecting aneurysms,the size of mass,the rate of stenosis,the clinical presentation,PICA involvement,the collateral supply.The factors for treatment strategies and perioperational complications were retrospectively evaluated by univariate analysis and the logistic regression analysis.Results Parent artery occlusion were conducted in 13(9.77%)VADAs,reconstructive techniques in 120(90.23%)which include stent-assisted coiling in 93(69.92%),sole stents in 11(8.27%),pipeline embolization device in 16(12%).Intra-procedure and post-operation aneurysm rupture were observed in 6(4.8%),antiplatelet drug relatedhemorrhage in 4(3.2%)and ischemic complications in 10(8%).Follow-up was available in 102 patients(82%)at 2.03±1.63 years and angiography was available in 74 patients(59%)at 0.95±0.87 years after treatment.The rate of favorite outcome(m RS<2)was 85% and there was a 9% recurrence after endovascular treatment.Severe stenosis and PICA involvement was highly related to choosing deconstructive technique.For ischemic complications,the significant factors were PICA involvement and parent artery occlusion.For hemorrhagic complications,the stenosis rate and uncomplete occlusion was of significance.Conclusions For VADAs,deconstructive techniques and reconstructive techniques after individualized evaluation were safe and efficient.For VADAs with stenosis and without PICA origin,deconstructive technique may be a proper treatment but increasing ischemic complications.And for VADAs,severe stenosis and uncomplete occlusion may increase the risk of hemorrhagic complications.