Risk factors for medullary infarction after endovascular trapping of vertebral artery dissecting aneurysms
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ORIGINAL ARTICLE
Risk factors for medullary infarction after endovascular trapping of vertebral artery dissecting aneurysms Hidenori Endo 1 & Shuichi Tanoue 2 & Masafumi Hiramatsu 3 & Yasushi Matsumoto 4 & Kenichi Sato 4 & Masayuki Sato 5 & Yuji Matsumaru 5 & Wataro Tsuruta 6 & Hiro Kiyosue 7 & on behalf of the JSNET VADA study group Received: 2 July 2020 / Revised: 22 August 2020 / Accepted: 15 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Internal trapping (IT) is a treatment option for intracranial vertebral artery dissecting aneurysms (VADAs). Medullary infarction (MI) is a complication linked to this treatment. This study aims to clarify the outcomes of IT for VADAs and the risk factors for MIs. We retrospectively reviewed the databases from 2010 to 2017 to identify patients with VADAs treated by IT at seven collaborating institutions. Radiological findings, clinical courses, and outcomes were analyzed. Perforating arteries were classified into terminal or longitudinal types using preoperative angiography. IT was completed in 90 patients (74 ruptured and 16 unruptured VADA). Postoperative rebleeding did not occur in any ruptured VADA patients. Postoperative MRI detected MIs in 26 patients (28.9%). The incidence of MIs in the ruptured VADA (32%) was higher compared with that in the unruptured VADA (13%), though it was not significant. In the MI group, the occlusion or blind alley of the terminal-type and longitudinal-type perforator was confirmed in 23 patients (88%) and 11 patients (42%), respectively. The occlusion or blind alley of the terminaltype perforator was an independent risk factor for MIs in the logistic regression analysis (OR 5.81; 95% CI 1.34–25.11; p = 0.018). In ruptured VADA, postoperative MI (OR 12.2; 95% CI 3.19–64.55; p = 0.0001) and high-grade SAH (OR 8.02; 95% CI 2.32–37.70; p = 0.0006) were independent risk factors of an unfavorable clinical outcome. In conclusion, MIs were an independent risk factor for unfavorable outcomes after IT, especially for a ruptured VADA. The occlusion or blind alley of the terminaltype perforator caused by the IT was associated with postoperative MIs. Keywords Vertebral artery . Dissecting aneurysm . Endobascular therapy . Internal trapping . Medullary infarction
Introduction * Hidenori Endo [email protected] 1
Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8574, Japan
2
Department of Radiology, Kurume University School of Medicine, Kurume, Japan
3
Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
4
Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Japan
5
Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
6
Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan
7
Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
An intracranial vertebral artery dissectin
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