Endovascular Treatment For Intracranial Vertebral Artery Dissecting Aneurysms:A Clinical Study

Objective: To evaluate the safety and efficacy of endovascular treatment for intracranial vertebral artery dissecting aneurysms(IVADA),and invastigate the risk factors of adverse prognosis,as well as,incomplete embolization,then estimate the effect of stent remodeling on pathological vertebral artery.Methods: The clinical and imaging data of 73 IVADA patients admitted to the Department of Neurosurgery of the First Affiliated Hospital of Wannan Medical College from December 2012 to November 2019 were analyzed retrospectively,collecting the basic data of the patients,clinical symptoms,severity of the disease,characteristics of the dissections,treatment methods,perioperative complications,diameter of the diseased vertebral arteries.The modified Rankin scale(mRS)was used to evaluate the clinical prognosis,and the embolization degree was determined by extent of contrast agent filling in aneurysmal body.Then comparing the diameter changes of the injured vertebral arteries after interventional operations to explore the remodeling effect of stent on the vessels.Results: 25 males and 48 females,with mean age of(55.0±10.7)years,ranged from 28 to 78 years.?At hospital discharge,patients with favorable outcome in ruptured group was 20/25(80.0%),19/24(79.2%),21/34(61.8%)when GCS? 9,Hunt-Hess:I~III,modified Fisher:0~II;but it was only 3/20(15.0%),4/21(19.0%),2/11(18.2%)when GCS?8,H-H:IV~V,modified Fisher:III~IV,respectively,these differences were stastically significant(P<.05).Patients with aneurysms involving posterior inferior cerebellar artery(PICA)acquired favorable outcome in 5/12(41.7%),and without PICA involvement in 18/33(54.5%).There were 13/29(44.8%)patients with good prognosis in male,10/16(62.5%)in female,and 5/15(33.3%)aged ?60 years,18/30(60.0%)aged < 60 years.56 patients had mid-long term clinical follow-up for(31.0±21.6)months.At final follow-up,patients had good prognosis in 25/26(96.2%)in unruptured group and 29/42(69.0%)in ruptured group.? After initial operation,there were immediate complete embolization in 17/30(44.7%)in SACE,zero(.0%)in MS,21/21(100%)in PAO,1/2(50%)in coiling alone.50 IVADA had angiographic follow-up for(15.4±14.9)months,complete occlusion were achieved in 18/30(60.0%),5/8(62.5%),11/12(91.7%)and recurrence occured in 7/30(23.3%),1/8(12.5%),1/12(8.3%)in SACE,MS,PAO respectively.At Follow-up,aneurysmal body stablized and shrank or dilation of pathological vessel improved in 30/38(78.9%)in PAR.After initial treatment,aneurysms involving the PICA achieved complete occlusion in 4/22(18.2%)and 13/25(52.0%)when PICA was not involved.At follow-up,aneurysms with PICA involvement achieved complete embolization in 4/15(26.7%)and reoccured in 6/15(40.0%),and without PICA involvement,these were 19/ 23(82.6%)and 2/23(8.7%)respectively,these differences had statistical significance(P<.05).Dissection with complete embolization after first procedure kept angiographic cure in 10/11(90.9%)and reoccured in 1/11(9.1%),and those with incomplete embolization had turnd to complete in 8/19(42.1%)and reoccured in 6/19(31.6%)at follow-up,the former difference was statistically significant(P<.05).?There were 38 aneurysms with angiographic follow-up in PAR,preoperative mean diameter of dilation was(5.3±1.0)mm and stenosis was(1.7±0.6)mm,but the former shrank to(4.1±1.0)mm and the later expanded to(2.6±0.7)mm at follow-up,this difference had statistical significance(P<.05).? Intraoperative in-stent thrombosis occurred in 3/47(6.4%),postoperative symptomatic cerebral ischemia occurred in 1/47(2.1%),cerebral stem or cerebellar infarction occurred in 2/21(9.5%),and spontaneous bleeding in front of the brain stem occurred in 1/67(1.5%),which had adverse effects on prognosis.Conclusion: ? Endovascular treatment for IVADA is safe and effective,clinical prognosis depends on severity of the illness on onset and age ?60 years,male,PICA involvement and perioperative complications have adverse influences on clinical outcome.?At follow-up,complete occlusion rate of aneurysms with PICA involvement or incomplete embolization after initial treatment was lower and recurrence rate was higher.?Intracranial self-expanding stent can improve the stenosis and dilation of the diseased vertebral artery effectively,with excellent remodeling effect on local lesion.