Endovascular treatment for ruptured and unruptured vertebral artery dissecting aneurysms: a meta-analysis. (24th May 2016)

• Record Type: Journal Article
• Authors: Guan, Jian; Li, Guilin; Kong, Xiangyi; He, Chuan; Long, Jianwu; Qin, Hao; Zhang, Hongqi; Wang, Renzhi
• Is Part Of: Journal of neurointerventional surgery. Volume 9:Number 6(2017)
• Page Start: 558
• Page End: 563
• Publication Date: 2016-05-24
• Subjects: Aneurysm -- Coil -- Stent -- Intervention; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2016-012309
• Languages: English
• ISSNs: 1759-8478

Abstract

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.