Endovascular treatment of ruptured intracranial vertebral artery dissecting aneurysm: correlation between location and outcome

Abstract

Objective To investigate the correlation between the location of ruptured intracranial vertebral artery dissecting aneurysm (VADA) and the outcome after endovascular treatment. Methods Thirty-six patients with ruptured intracranial VADA undergoing endovascular treatment were enrolled retrospectively. According to the relationship between VADA and the location of the opening of posterior inferior cerebellar artery (PICA), they were divided into 3 groups: proximal to PICA group (n=13), distal to PICA group (n=13), and PICA involvement group (n=10). The demographic data, vascular risk factors, clinical features, imaging features, endovascular treatment mode, postoperative complications, and differece of the good outcome rate (defined as the modified Rankin scale 0-2) after 6 months of treatment were compared. Results Seven patients in the proximal to PICA group received reconstructive endovascular treatment (RET), and 6 received endovascular internal trapping (EIT); the good outcome rate was 100%(13/13). Seven patients in the distal to PICA group received RET, 6 were treated with EIT; the good outcome rate was 84.6%(11/13). Four patients in the PICA involvement group received RET, and 6 received EIT, and 2 of them received contralateral vertebral artery retrograde PICA stenting combined with VADA segment and proximal vertebral artery coil embolization; the good outcome rate was 60.0%(6/10). There were significant differences in the overall outcome good rate among the 3 groups (P<0.05). The good outcome rate in the PICA involvement group was significant lower than that in the proximal to PICA group, and significantly lower than that in the proximal to PICA combined with distal to PICA group (P<0.05). Multivariate logistic regression analysis showed that only Fisher grade 3-4 was the independent risk factor for poor outcome (odds ratio 28.0, 95% confidence interval 1.71-458.82; P=0.020). Conclusions The surgical options of endovascular treatment for ruptured intracranial VADA needs to evaluate the relationship between the location of dissecting aneurysms and the PICA origin. The risk of endovascular treatment in patients with intracranial VADA involving the origin of PICA is higher and it may affect the outcome. Key words: Intracranial Aneurysm; Aneurysm, Dissecting; Vertebral Artery Dissection; Subarachnoid Hemorrhage; Endovascular Procedures; Embolization, Therapeutic; Stents; Treatment Outcome