Article Text

Download PDFPDF
Original research
Predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs): results from a multicenter study
  1. Kaijun Zhao1,2,
  2. Rui Zhao1,
  3. Xinjian Yang3,4,
  4. Sheng Guan5,
  5. Guobiao Liang6,
  6. Hong-Lei Wang7,
  7. Donghai Wang8,
  8. Wenfeng Feng9,
  9. Zhenbao Li10,
  10. Weiwei Wang11,
  11. Ya Peng12,12,
  12. Jing Xu13,
  13. Lei Wang14,
  14. Ming Zhong15,
  15. Guohua Mao16,
  16. Tianxiao Li17,
  17. Yang Zhang18,
  18. Dong Chen19,
  19. Chuwei Cai20,
  20. Xiaochuan Sun21,
  21. Huaizhang Shi22,
  22. Jianjun Yu23,
  23. Yang Wang24,
  24. Zhen Gu25,
  25. Gang Zhu26,
  26. Qing Zhu27,
  27. Jieqing Wan28,
  28. Qiuping Li29,
  29. Hua Yang30,
  30. Gang Li31,
  31. Erqing Chai32,
  32. Qiang Li1,
  33. Pengfei Yang1,
  34. Yibin Fang1,
  35. Dongwei Dai1,
  36. Bo Hong1,
  37. Qinghai Huang1,
  38. Yi Xu1,
  39. Jianmin Liu1,
  40. Jinyu Xu33
  1. 1Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
  2. 2Department of Neurosurgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
  3. 3Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing, China
  4. 4Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
  5. 5Department of Interventional Neuroradiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
  6. 6Department of Neurosurgery, General Hospital of Shenyang Military Command, Shenyang, Liaoning, China
  7. 7Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
  8. 8Department of Neurosurgery, Shandong University Qilu Hospital, Jinan, Shandong, China
  9. 9Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
  10. 10Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
  11. 11Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
  12. 12Cerebral Vascular Disease Center, Changzhou First People's Hospital, Changzhou, Jiangsu, China
  13. 13Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
  14. 14Department of Neurosurgery, Yichang Central People's Hospital, Yichang, Hubei, China
  15. 15Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
  16. 16Department of Neurosurgery, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
  17. 17Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
  18. 18Department of Neurosurgery, Anhui Provincial Hospital, Hefei, Anhui, China
  19. 19Department of Neurosurgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China
  20. 20Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
  21. 21Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
  22. 22Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
  23. 23Department of Cerebrovascular Disease, Linyi People's Hospital, Linyi, Shandong, China
  24. 24Department of Interventional Neuroradiology, Beijing Chaoyang Hospital, Beijing, China
  25. 25Department of Neurosurgery, Kunming Medical College Fourth Affiliated Hospital, Kunming, Yunnan, China
  26. 26Department of Neurosurgery, Third Military Medical University Southwest Hospital, Chongqing, China
  27. 27Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
  28. 28Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Shanghai, China
  29. 29Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
  30. 30Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
  31. 31Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
  32. 32Department of Neurosurgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
  33. 33Department of Neurosurgery, Changhai Hospital,Naval Medical University, Shanghai, China
  1. Correspondence to Professor Jianmin Liu, Neurovascular Centre, Changhai Hospital, Shanghai, China; chstroke{at}163.com; Dr Xinjian Yang; yangxinjian{at}voiceoftiantan.org

Abstract

Objective To evaluate predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) based on 608 reconstructed lesions in 30 medical centres.

Methods A total of 608 patients (male:female=479:129; mean age, 53.26±10.26 years) with 608 symptomatic uis-VADAs underwent reconstructive treatments using stent(s) with coils between January 2009 and December 2015. Treatments and predictors of unfavorable outcomes were retrospectively analyzed.

Results Mainly, three methods were used to treat patients with uis-VADAs, including routine single-stent in 208 patients (such as Enterprise and others), new low-profile LVIS single stent in 107 patients, and multiple stents in 293 patients. During the median 66 months of clinical follow-up, 14 patients died, and 16 of the remaining 594 survivors had unfavorable outcomes (modified Rankin Scale score 3–5). The overall mortality rate was 2.3% (14/608), and the unfavorable outcome (mRS score 3–6) rate was 4.9% (30/608). Multivariate logistic regression analysis indicated that preprocedural ischemic infarctions (OR=3.78; 95% CI 1.52 to 9.40; p<0.01), diabetes mellitus (OR=3.74; 95% CI 1.31 to 10.68; p=0.01), and procedural complications (OR=14.18; 95% CI 5.47 to 36.80; p<0.01) were predictors of unfavorable outcome in the reconstructed VADAs.

Conclusions This multicenter study indicated that preprocedural ischemic infarctions, diabetes mellitus, and procedural complications were related to unfavorable clinical outcomes in the reconstructed uis-VADAs.

  • stent
  • aneurysm
  • stroke

Data availability statement

Data are available upon reasonable request.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request.

View Full Text

Footnotes

  • Twitter @z_ray1979

  • KZ and RZ contributed equally.

  • Contributors All authors participated in collection of data, KZ and RZ drafted and revised the article, XY and JL revised the article, and KZ performed the statistic analysis. Correspondence to JL and XY.

  • Funding This study was funded by Discipline Climbing Scheme (2019YXK023, 2019YXK030) and National Research and Development Project of Key Chronic Diseases (2016YFC1300700), the Outstanding Leaders Training Program and the Key Discipline Construction Project of Pudong Health Bureau of Shanghai (PWR12018-07, PWZxk2017-23).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.