Clinical characteristics, endovascular choices, and surgical outcomes of intracranial vertebral artery dissecting aneurysms: a consecutive series of 196 patients

Peixi LiuDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Zongze LiDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Liuxun HuDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Yingjun LiuDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Peiliang LiDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Wei ZhuDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Yanlong TianDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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Ying MaoDepartment of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai;
National Center for Neurological Disorders, Shanghai;
Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Shanghai;
Neurosurgical Institute of Fudan University, Shanghai; and
Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China

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OBJECTIVE

The authors aimed to evaluate the clinical features, endovascular strategy selection, and outcomes of vertebral artery (VA) dissecting aneurysms (VADAs) near the origin of the posterior inferior cerebellar artery (PICA).

METHODS

Clinical data were obtained from 196 patients with 202 VADAs who had been surgically treated at the authors’ hospital between 2005 and 2021. The patients’ medical records, imaging data, and follow-up outcomes were retrospectively analyzed.

RESULTS

All 196 patients (148 male, 48 female; mean age 53 years) underwent endovascular therapy for VADA. The most common chief complaints were headache (56.6%), dizziness (40.8%), and other occasional symptoms (18.4%). Twenty-six patients experienced posterior circulation ischemia, and 25 patients experienced subarachnoid hemorrhage (SAH). On DSA images, 37 aneurysms were found in the dominant VA, and 165 aneurysms were found on the nondominant side. Eighty-eight VADAs had stenosis. Regarding the VADA location, there were 59 distal, 51 proximal, 23 ventral, 64 PICA, and 5 obliteration types. Single-stent implantation (10.9%), overlapping stent implantation (23.8%), flow diverter (FD) implantation (11.9%), single stent-assisted coil (SAC) embolization (31.7%), overlapping SAC embolization (12.9%), parent artery occlusion (PAO) (8.4%), and FD-assisted coil embolization (0.5%) were chosen. The follow-up rate was 82.7%. The modified Rankin Scale (mRS) score was 0.5 ± 1.1. Ninety-six patients underwent DSA. The complete occlusion rates were 100%, 81.4%, 56.7%, and 76.5% in the PAO group, SAC reconstruction group, stent implantation group, and FD implantation group, respectively.

CONCLUSIONS

Young patients showed a higher probability of SAH, and elderly patients showed a higher probability of posterior circulation infarction. The surgical plan selection should be based on the SAH history, VA dominant side, and PICA origin location.

ABBREVIATIONS

FD = flow diverter; mRS = modified Rankin Scale; PAO = parent artery occlusion; PICA = posterior inferior cerebellar artery; SAC = stent-assisted coil; SAH = subarachnoid hemorrhage; VA = vertebral artery; VADA = VA dissecting aneurysm.

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Figure from Ramos et al. (pp 95–103).

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