Jian Guan1, Guilin Li2, Xiangyi Kong1, Chuan He2, Jianwu Long3, Hao Qin4, Hongqi Zhang2, Renzhi Wang1. 1. Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China. 2. Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China. 3. Department of Neurosurgery, The 3rd Hospital of Xiamen, Fujian, P. R. China. 4. Department of Neurosurgery, Zaozhuang Municipal Hospital of Shandong Province, Shandong, P. R. China.
Abstract
BACKGROUND: Different endovascular modalities have been applied to the treatment of vertebral artery dissecting aneurysms, the most commonly used being internal trapping and stent-assisted coiling, although the ideal treatment remains controversial. OBJECTIVE: To perform a meta-analysis to study clinical outcomes of patients with vertebral artery dissecting aneurysms who were treated with internal trapping or stent-assisted coiling. MATERIALS AND METHODS: We conducted a meta-analysis of eight retrospective studies that compared internal trapping with stent-assisted coiling for the treatment of vertebral artery dissecting aneurysms. The primary outcomes of this study were immediate occlusion, long-term occlusion, good outcome ratio, perioperative mortality, and angiographic recurrence. Subgroup analyses were conducted of patients with ruptured versus unruptured vertebral artery dissecting aneurysms. RESULTS: Eight studies comprising a total of 188 patients were included in the analysis. For ruptured cases, in comparison with stent-assisted coiling groups, the patients treated with trapping techniques had a higher rate of immediate postoperative occlusion (OR=0.165; 95% CI 0.067 to 0.405; p<0.01), although there was no significant difference in long-term occlusion (OR=1.059; 95% CI 0.033 to 34.121; p=0.974), good clinical outcome rates, recurrence rates, and perioperative mortality. For unruptured cases, patients in the trapping groups also had higher immediate occlusion rates than those who underwent stent-assisted coiling (OR=0.175; 95% CI 0.043 to 0.709; p=0.015), while rates of both recurrence and good clinical outcome were similar between the two groups. CONCLUSIONS: Both internal trapping and stent-assisted coiling are technically feasible for ruptured vertebral artery dissecting aneurysms, with high rates of good long-term neurologic outcomes and low recurrence and mortality rates. For unruptured aneurysms, conservative treatment is recommended. When a posterior inferior cerebellar artery (PICA) origin is involved, bypass surgery or vertebral artery-to-PICA stent placement plus coil embolization should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
BACKGROUND: Different endovascular modalities have been applied to the treatment of vertebral artery dissecting aneurysms, the most commonly used being internal trapping and stent-assisted coiling, although the ideal treatment remains controversial. OBJECTIVE: To perform a meta-analysis to study clinical outcomes of patients with vertebral artery dissecting aneurysms who were treated with internal trapping or stent-assisted coiling. MATERIALS AND METHODS: We conducted a meta-analysis of eight retrospective studies that compared internal trapping with stent-assisted coiling for the treatment of vertebral artery dissecting aneurysms. The primary outcomes of this study were immediate occlusion, long-term occlusion, good outcome ratio, perioperative mortality, and angiographic recurrence. Subgroup analyses were conducted of patients with ruptured versus unruptured vertebral artery dissecting aneurysms. RESULTS: Eight studies comprising a total of 188 patients were included in the analysis. For ruptured cases, in comparison with stent-assisted coiling groups, the patients treated with trapping techniques had a higher rate of immediate postoperative occlusion (OR=0.165; 95% CI 0.067 to 0.405; p<0.01), although there was no significant difference in long-term occlusion (OR=1.059; 95% CI 0.033 to 34.121; p=0.974), good clinical outcome rates, recurrence rates, and perioperative mortality. For unruptured cases, patients in the trapping groups also had higher immediate occlusion rates than those who underwent stent-assisted coiling (OR=0.175; 95% CI 0.043 to 0.709; p=0.015), while rates of both recurrence and good clinical outcome were similar between the two groups. CONCLUSIONS: Both internal trapping and stent-assisted coiling are technically feasible for ruptured vertebral artery dissecting aneurysms, with high rates of good long-term neurologic outcomes and low recurrence and mortality rates. For unruptured aneurysms, conservative treatment is recommended. When a posterior inferior cerebellar artery (PICA) origin is involved, bypass surgery or vertebral artery-to-PICA stent placement plus coil embolization should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: A Alwakeal; N A Shlobin; P Golnari; W Metcalf-Doetsch; P Nazari; S A Ansari; M C Hurley; D R Cantrell; A Shaibani; B S Jahromi; M B Potts Journal: AJNR Am J Neuroradiol Date: 2021-08-12 Impact factor: 4.966