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Review
. 2023 Jul 1;93(1):120-127.
doi: 10.1227/neu.0000000000002384. Epub 2023 Feb 9.

Stent-Assisted Coil Embolization Versus Flow-Diverting Stent in Unruptured Vertebral Artery Dissecting Aneurysms: Efficacy and Safety Comparison

Han San Oh  1 , Jin Woo Bae  2 , Chang-Eui Hong  3 , Kang Min Kim  1 , Dong Hyun Yoo  4 , Hyun-Seung Kang  1 , Young Dae Cho  4
Affiliations
Review

Stent-Assisted Coil Embolization Versus Flow-Diverting Stent in Unruptured Vertebral Artery Dissecting Aneurysms: Efficacy and Safety Comparison

Han San Oh et al. Neurosurgery. .

Abstract

Background: Reconstructive strategies for unruptured vertebral artery dissecting aneurysms (VADAs) have increasingly relied on newly developed endovascular devices. However, their clinical performance metrics are seldom reported.

Objective: To compare stent-assisted coil embolization (SACE) and flow-diverting stent (FDS) deployment as treatments for unruptured VADAs, focusing on efficacy and safety.

Methods: A total of 72 VADAs were submitted to SACE (n = 48) or FDS (n = 24) between April 2009 and September 2021. We reviewed medical records and radiological data to assess efficacy and safety outcomes by method, building an inverse probability of treatment-weighted (IPTW) logistic regression model and conducting survival analyses.

Results: Ultimately, 24 aneurysms (33.3%) showed signs of recanalization (major, 14; minor, 10) at 6-month follow-up. Initially determined 6-month rates of overall (SACE, 31.2%; FDS, 41.7%) and major (SACE, 20.8%; FDS, 16.7%) recanalization did not differ significantly by modality; but in the IPTW logistic regression model, adjusted for aneurysm morphology, major recanalization at 6 months was lower for the FDS (vs SACE) subset (odds ratio = 0.196; P = .027). Likewise, the cumulative rate of major recanalization was more favorable for the FDS (vs SACE) subset (hazard ratio = 0.291; P = .048) in IPTW Cox proportional hazards model adjusted for aneurysm morphology. Modality-based assessments of procedural and delayed complications were similar.

Conclusion: Both reconstructive VADA interventions are safe and effective by adjusting treatment modality depending on the angioanatomic configuration. However, follow-up data after treatment proved more favorable for FDS deployment than for SACE in limiting major recanalization. Case-controlled studies of more sizeable cohorts are needed for corroboration.

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References

    1. Santos-Franco JA, Zenteno M, Lee A. Dissecting aneurysms of the vertebrobasilar system. A comprehensive review on natural history and treatment options. Neurosurg Rev. 2008;31(2):131-140.
    1. Schievink WI. Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med. 2001;344(12):898-906.
    1. Cho DY, Choi JH, Kim BS, Shin YS. Comparison of clinical and radiologic outcomes of diverse endovascular treatments in vertebral artery dissecting aneurysm involving the origin of PICA. World Neurosurg. 2019;121:E22-E31.
    1. Jeon JP, Cho YD, Rhim JK, et al. Stent-assisted coil embolization of vertebrobasilar dissecting aneurysms: procedural outcomes and factors for recanalization. Korean J Radiol. 2016;17(5):801-810.
    1. Higashida RT, Smith W, Gress D, et al. Intravascular stent and endovascular coil placement for a ruptured fusiform aneurysm of the basilar artery. Case report and review of the literature. J Neurosurg. 1997;87(6):944-949.