Comparison of Parent Artery Occlusion and Stent-Assisted Treatments in Ruptured Vertebral Artery Dissecting Aneurysms.

Abstract

To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications. Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR]= 1.25, 95% confidence interval [CI]= 1.01-1.56, P= 0.044) and poor Hunt-Hess grade (OR= 537.99, 95% CI= 6.73-42994.1, P= 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR= 15.97, 95% CI= 1.52-167.38, P= 0.021) and PICA involvement (OR= 13.71, 95% CI= 1.29-145.89, P= 0.030) were independent risk factors for ischemic complications. Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.