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Original research
Comparing the safety and effectiveness of overlapping stents with flow diverters for unruptured vertebral artery dissecting aneurysms
  1. Hyung Jun Kim1,
  2. Na Rae Yang2,
  3. Tae Keun Jee3,
  4. Je-Young Yeon3,
  5. Keon-Ha Kim4,
  6. Jong-Soo Kim3,
  7. Woo-Keun Seo1,
  8. Pyoung Jeon4
    1. 1Department of Neurology, Samsung Medical Center, Gangnam-gu, Seoul, Korea
    2. 2Department of Neurosurgery, Ewha Womens University Mokdong Hospital, Seoul, Korea
    3. 3Department of Neurosurgery, Samsung Medical Center, Gangnam-gu, Seoul, Korea
    4. 4Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul, Korea
    1. Correspondence to Dr Pyoung Jeon, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul 06351, Korea; drpjeon{at}gmail.com

    Abstract

    Background Endovascular treatment for vertebral artery dissecting aneurysms (VADAs) includes overlapping stents and flow diverters. This study compared the safety and effectiveness of overlapping stents and flow diverters for unruptured VADAs.

    Methods We retrospectively enrolled patients with unruptured VADAs who underwent overlapping stents or flow diverters at two tertiary hospitals in South Korea. The primary clinical outcome was the occurrence of stroke. The primary angiographic outcomes (>12 months) were categorized as regression, no decrease in size, recanalization, or stent occlusion, of which only regression was defined as a favorable angiographic outcomes.

    Results Of the 146 patients with VADAs, 25 (17.1%) had flow diverters and 121 (82.9%) had overlapping stents. For the primary angiographic outcomes over 12 months, the rate of favorable angiographic outcomes for flow diverters was 81.8% and for overlapping stents (triple stents) was 98.8% (P=0.006). In the multivariale analysis, after adjusting for partially thrombosed aneurysms, aneurysm shape, non-dominant vessel, posterior inferior cerebellar artery involvement, and procedure type, overlapping stents (triple stents) was not associated with favorable angiographic outcomes compared with flow diverters (OR 7.040, 95% CI 0.549 to 90.294; P=0.134), but partially thrombosed aneurysms was inversely associated with favorable angiographic outcomes (OR 0.056, 95% CI 0.005 to 0.589; P=0.016). The primary clinical outcome followed up to the last angiography did not occur in all patients.

    Conclusion There was no difference in safety and effectiveness between overlapping stents and flow diverters in unruptured VADAs. Further endovascular treatment studies are needed regarding the association of partially thrombosed aneurysms with unfavorable angiographic outcomes.

    • Aneurysm
    • Dissection
    • Flow Diverter
    • Stent

    Data availability statement

    Data are available upon reasonable request.

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • HJK and NRY contributed equally.

    • Contributors HJK and NRY conceived the study and study design, analyzed and interpreted the data, cleaned and analyzed the data, and drafted and revised the paper. TKJ, J-YY, K-HK, J-SK, and W-KS collected the data and monitored the data collection. PJ conceived the study and study design, collected the data, monitored the data collection, interpreted the data and is the overall guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • 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.