![]() ![]() fusiform-shaped, et al) on both sides of the target vessel. Stent placement was defined as a successful implantation if the deployed single stent or overlapped multiple stents in a telescopic fashion extended at least 5 mm over the aneurysm neck (lateral protrusion-shaped dissection aneurysms) or the border of other dissection lesions (i.e. Later, self-expanding neurovascular stent(s) (Neuroform, Leo, Enterprise ) was/were preferred for reconstruction of the entire dissected segment based on the operator’s experience, anatomic characteristics of the affected and contralateral segments, and hemodynamic modification status after deployment of the first stent. ![]() In the early period, the balloon-expandable stent was employed. All patients received systemic intravenous heparin at the beginning of the procedure with activated clotting time between 250 to 300 seconds during procedure. Regardless of acute phase (≤72 hours) or non-acute phase (>72 hours), the patients with ris-VADAs who underwent a reconstructive treatment were all preloaded rectally 2 hours just before procedure with antiplatelet medication (300 mg aspirin and 300 mg clopidogrel). In this study, we aimed to evaluate the results of endovascular treatment by using1 to 3 stent(s) with coils based on 57 ris-VADAs with long-term follow-ups.Īlthough all patients were treated immediately after admission for the concern of rebleeding, the mean interval time of between SAH to treatment was 4 days (range, 1–20 days ) because 28 patients were from other hospitals. However, little has been known about long-term results and predictors of unfavorable outcomes of reconstructive treatment for ris-VADAs. Theoretically, stent(s)-assisted coiling can maintain the patency of parent artery and occlude ruptured sites as much as possible. Although sole stent therapy was a promising option for unruptured vertebrobasilar dissection, it may not completely prevent rebleeding of lesions. With the continued advances in stent characteristics, stent-supported reconstructive techniques for acute symptomatic dissection aneurysms were increasingly emerging as the promising alternative to deconstructive techniques –. Moreover, once the artery stenosis forms in future, a compensatory artery path will lack for the obliteration of vertebral artery. Additionally, the deconstructive treatment might result in the occurrence or rupture of contralateral VADA(s) and anterior circulation-related aneurysm(s). Besides, the deconstructive treatment was also not suitable for some ris-VADAs, such as hypoplastic or occlusive contralateral vertebral artery and some PICA-involving lesions. Although the majority of ris-VADAs may be treated by either internal coil trapping – or proximal occlusion – of the parent artery, ischemic events or rebleeding still happened in some cases. In the acute stage, surgery has high risks of treatment-related morbidity and mortality, thus deconstructive endovascular treatments, which sacrifice parent artery to obliterate aneurysm, were employed for treatment of these ris-VADAs –. When vertebral artery trunk occurs aneurysmal dilatation, the dissection aneurysm forms, increasing fatal bleeding risk in future. Intracranial spontaneous vertebral artery dissections (VADs) are increasingly diagnosed as the cause of subarachnoid hemorrhage (SAH) or posterior circulation stroke, particularly in young to middle-aged adults –. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: This work was supported by National Natural Science Foundation of China (grant No. Received: MaAccepted: Published: June 26, 2013Ĭopyright: © 2013 Zhao et al. PLoS ONE 8(6):Įditor: Stefan Kiechl, Innsbruck Medical University, Austria (2013) Reconstructive Treatment of Ruptured Intracranial Spontaneous Vertebral Artery Dissection Aneurysms: Long-Term Results and Predictors of Unfavorable Outcomes. Citation: Zhao K-J, Fang Y-B, Huang Q-H, Xu Y, Hong B, Li Q, et al. ![]()
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