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Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization
Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic resu...
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Published in: | Korean journal of radiology 2016, 17(5), , pp.801-810 |
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description | Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs.
A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.
Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.
Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization. |
doi_str_mv | 10.3348/kjr.2016.17.5.801 |
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A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.
Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.
Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.</description><identifier>ISSN: 1229-6929</identifier><identifier>EISSN: 2005-8330</identifier><identifier>DOI: 10.3348/kjr.2016.17.5.801</identifier><identifier>PMID: 27587971</identifier><language>eng</language><publisher>Korea (South): The Korean Society of Radiology</publisher><subject>Adult ; Aged ; Aneurysm, Dissecting - therapy ; Aneurysms ; Asymptomatic ; Brain Infarction - etiology ; Cardiovascular disease ; Catheters ; Dissection ; Embolization ; Embolization, Therapeutic - adverse effects ; Embolization, Therapeutic - methods ; Female ; Follow-Up Studies ; General anesthesia ; Hemorrhage ; Humans ; Intracranial Aneurysm - therapy ; Ischemia ; Male ; Medical imaging ; Middle Aged ; Neck pain ; Neurointervention ; Patients ; Recurrence ; Retreatment - methods ; Retrospective Studies ; Risk Factors ; Statistical significance ; Stents ; Treatment Outcome ; Vertebral Artery ; 방사선과학</subject><ispartof>Korean Journal of Radiology, 2016, 17(5), , pp.801-810</ispartof><rights>2016. This work is published under http://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2016 The Korean Society of Radiology 2016</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c460t-df4873f34048e392574aaac7b20e0d27c8e54bd6b8b0b5fe13e302627d060aff3</citedby><cites>FETCH-LOGICAL-c460t-df4873f34048e392574aaac7b20e0d27c8e54bd6b8b0b5fe13e302627d060aff3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2728250230/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2728250230?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27587971$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002152690$$DAccess content in National Research Foundation of Korea (NRF)$$Hfree_for_read</backlink></links><search><creatorcontrib>Jeon, Jin Pyeong</creatorcontrib><creatorcontrib>Cho, Young Dae</creatorcontrib><creatorcontrib>Rhim, Jong Kook</creatorcontrib><creatorcontrib>Park, Jeong Jin</creatorcontrib><creatorcontrib>Cho, Won-Sang</creatorcontrib><creatorcontrib>Kang, Hyun-Seung</creatorcontrib><creatorcontrib>Kim, Jeong Eun</creatorcontrib><creatorcontrib>Hwang, Gyojun</creatorcontrib><creatorcontrib>Kwon, O-Ki</creatorcontrib><creatorcontrib>Han, Moon Hee</creatorcontrib><title>Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization</title><title>Korean journal of radiology</title><addtitle>Korean J Radiol</addtitle><description>Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs.
A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.
Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.
Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.</description><subject>Adult</subject><subject>Aged</subject><subject>Aneurysm, Dissecting - therapy</subject><subject>Aneurysms</subject><subject>Asymptomatic</subject><subject>Brain Infarction - etiology</subject><subject>Cardiovascular disease</subject><subject>Catheters</subject><subject>Dissection</subject><subject>Embolization</subject><subject>Embolization, Therapeutic - adverse effects</subject><subject>Embolization, Therapeutic - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>General anesthesia</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>Intracranial Aneurysm - therapy</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Neck pain</subject><subject>Neurointervention</subject><subject>Patients</subject><subject>Recurrence</subject><subject>Retreatment - methods</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Statistical significance</subject><subject>Stents</subject><subject>Treatment Outcome</subject><subject>Vertebral Artery</subject><subject>방사선과학</subject><issn>1229-6929</issn><issn>2005-8330</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdkktv1DAUhS0EotPCD2CDLLFhk-Hajh9hgTQaWqhUqagUtpbjOMUzSTzYDlIrfjxuh5bH6i78nXMfPgi9ILBkrFZvtpu4pEDEksglXyogj9CCAvBKMQaP0YJQ2lSioc0BOkxpA0AbUPVTdEAlV7KRZIF-fs5uytUqJZ-y6_A6-AEfj20Y_I3JPkw49Piri9m1MbQm-cFE_N6n5Gz20xVeTW6O12lMb_GnGKzr5mgGfD5nG0aXsJk6fGJsDjHhPkR84ayZzL33M_SkN0Nyz3_XI_Tl5Phy_bE6O_9wul6dVbYWkKuur5VkPauhVo41lMvaGGNlS8FBR6VVjtdtJ1rVQst7R5hjQAWVHQgwfc-O0Ou97xR7vbVeB-Pv6lXQ26hXF5enWhIuJC3ouz26m9vRdbYcpyykd9GPJl7fCf99mfy3YvNDcwBZQ_On1y6G77NLWY8-WTcMZnJhTpooIgRTUomCvvoP3YQ5lvMkTSVVlANlUCiyp2wMKUXXPwxDQN_GQJcY6NsYaCI11yUGRfPy7y0eFPf_zn4B6RKxJg</recordid><startdate>20160901</startdate><enddate>20160901</enddate><creator>Jeon, Jin Pyeong</creator><creator>Cho, Young Dae</creator><creator>Rhim, Jong Kook</creator><creator>Park, Jeong Jin</creator><creator>Cho, Won-Sang</creator><creator>Kang, Hyun-Seung</creator><creator>Kim, Jeong Eun</creator><creator>Hwang, Gyojun</creator><creator>Kwon, O-Ki</creator><creator>Han, Moon Hee</creator><general>The Korean Society of Radiology</general><general>대한영상의학회</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>ACYCR</scope></search><sort><creationdate>20160901</creationdate><title>Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization</title><author>Jeon, Jin Pyeong ; Cho, Young Dae ; Rhim, Jong Kook ; Park, Jeong Jin ; Cho, Won-Sang ; Kang, Hyun-Seung ; Kim, Jeong Eun ; Hwang, Gyojun ; Kwon, O-Ki ; Han, Moon Hee</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c460t-df4873f34048e392574aaac7b20e0d27c8e54bd6b8b0b5fe13e302627d060aff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aneurysm, Dissecting - therapy</topic><topic>Aneurysms</topic><topic>Asymptomatic</topic><topic>Brain Infarction - etiology</topic><topic>Cardiovascular disease</topic><topic>Catheters</topic><topic>Dissection</topic><topic>Embolization</topic><topic>Embolization, Therapeutic - adverse effects</topic><topic>Embolization, Therapeutic - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>General anesthesia</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>Intracranial Aneurysm - therapy</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Middle Aged</topic><topic>Neck pain</topic><topic>Neurointervention</topic><topic>Patients</topic><topic>Recurrence</topic><topic>Retreatment - methods</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Statistical significance</topic><topic>Stents</topic><topic>Treatment Outcome</topic><topic>Vertebral Artery</topic><topic>방사선과학</topic><toplevel>online_resources</toplevel><creatorcontrib>Jeon, Jin Pyeong</creatorcontrib><creatorcontrib>Cho, Young Dae</creatorcontrib><creatorcontrib>Rhim, Jong Kook</creatorcontrib><creatorcontrib>Park, Jeong Jin</creatorcontrib><creatorcontrib>Cho, Won-Sang</creatorcontrib><creatorcontrib>Kang, Hyun-Seung</creatorcontrib><creatorcontrib>Kim, Jeong Eun</creatorcontrib><creatorcontrib>Hwang, Gyojun</creatorcontrib><creatorcontrib>Kwon, O-Ki</creatorcontrib><creatorcontrib>Han, Moon Hee</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ProQuest - Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Korean Citation Index (Open Access)</collection><jtitle>Korean journal of radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jeon, Jin Pyeong</au><au>Cho, Young Dae</au><au>Rhim, Jong Kook</au><au>Park, Jeong Jin</au><au>Cho, Won-Sang</au><au>Kang, Hyun-Seung</au><au>Kim, Jeong Eun</au><au>Hwang, Gyojun</au><au>Kwon, O-Ki</au><au>Han, Moon Hee</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization</atitle><jtitle>Korean journal of radiology</jtitle><addtitle>Korean J Radiol</addtitle><date>2016-09-01</date><risdate>2016</risdate><volume>17</volume><issue>5</issue><spage>801</spage><epage>810</epage><pages>801-810</pages><issn>1229-6929</issn><eissn>2005-8330</eissn><abstract>Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs.
A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.
Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.
Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.</abstract><cop>Korea (South)</cop><pub>The Korean Society of Radiology</pub><pmid>27587971</pmid><doi>10.3348/kjr.2016.17.5.801</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Aneurysm, Dissecting - therapy Aneurysms Asymptomatic Brain Infarction - etiology Cardiovascular disease Catheters Dissection Embolization Embolization, Therapeutic - adverse effects Embolization, Therapeutic - methods Female Follow-Up Studies General anesthesia Hemorrhage Humans Intracranial Aneurysm - therapy Ischemia Male Medical imaging Middle Aged Neck pain Neurointervention Patients Recurrence Retreatment - methods Retrospective Studies Risk Factors Statistical significance Stents Treatment Outcome Vertebral Artery 방사선과학 |
title | Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization |
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