Prognosis and its predictors after treatment of unruptured intracranial spontaneous vertebral artery dissecting aneurysms with stent-related reconstructive techniques

Abstract

Objective To evaluate the prognosis and its predictors after treatment of the unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) with stent-related reconstructive techniques. Methods Clinical data of 182 consecutive patients harboring 182 uis-VADAs, which were treated with the stent-related reconstructive techniques at Department of Neurosurgery, Changhai Hospital, Naval Military Medical University(92 cases) and Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University(90 cases) from January 2009 to December 2015, were retrospectively reviewed and analyzed. The prognosis [favorable prognosis, modified Rankin Scale (mRS): 0-2; unfavorable prognosis, mRS: 3-6] and its predictors were evaluated and analyzed. Results The postoperative control angiography confirmed complete obliteration or near-complete obliteration in 135 (74.2%) cases and partial obliteration in 47 (25.8%) cases. Four (2.2%) patients suffered from periprocedural complications, which included stent thrombosis in 2 cases and occlusion of the distal posterior inferior cerebellar artery in 1 case with favorable prognosis, and the cerebellar hemisphere and brainstem multiple infarctions in 1 with unfavorable prognosis. Of 182 patients with uis-VADAs, 12 (6.6%) had unfavorable prognosis and included 4 (2.2%) deaths. In contrast, of 178 survivals with the median follow-up of 45 months (range: 12-72 months), 170(93.4%) patients had favorable prognosis. Follow-up angiography was available for 131 (73.6%) cases and reported recurrence in 23(17.6%). The multivariate logistic regression analysis indicated that preoperative cerebral infarction(OR=9.212, 95% CI: 2.154-39.395, P=0.003) and the largest diameter of VADAs (OR=1.112, 95%CI: 1.036-1.194, P=0.003) were predictors of unfavorable prognosis in the reconstructed uis-VADAs. Conclusions Patients with stent-related reconstructive treatment for uis-VADAs seem to have favorable prognosis with a low complication rate. The largest diameter of VADAs and preoperative cerebral infarction may be 2 independent predictors of unfavorable prognosis in the reconstructed uis-VADAs. Key words: Aneurysm, dissecting; Vertebral artery; Stents; Cerebral revascularization; Prognosis