title: Treatment of ruptured vertebral artery dissecting aneurysms distal to the posterior inferior cerebellar artery: stenting or trapping?
abstract: OBJECTIVE
  The treatment of ruptured vertebral artery dissecting aneurysms (VADAs) continues to be controversial. Our goal was to evaluate the safety, efficacy, and long-term outcomes of internal trapping and stent-assisted coiling (SAC) for ruptured VADAs distal to the posterior inferior cerebellar artery (supra-PICA VADAs), which is the most common subset.
  
  
  METHODS
  A retrospective review was conducted of 39 consecutive ruptured supra-PICA VADAs treated with internal trapping (n = 20) or with SAC (n = 19) at our institution. The clinical and angiographic data were retrospectively compared.
  
  
  RESULTS
  The immediate total occlusion rate of the VADAs was 80 % in the trapping group, which improved to 88.9 % at the follow-ups (45 months on average). Unwanted occlusions of the posterior inferior cerebellar artery (PICA) were detected in three trapped cases. Incomplete obliteration of the VADA or unwanted occlusions of the PICA were detected primarily in the VADAs closest to the PICA. In the stenting group, the immediate total occlusion rate was 47.4 %, which improved to 100 % at the follow-ups (39 months on average). The immediate total occlusion rate of the VADAs was higher in the trapping group (p < 0.05), but the later total occlusion was slightly higher in the stenting group (p > 0.05).
  
  
  CONCLUSIONS
  Our preliminary results showed that internal trapping and stent-assisted coiling are both technically feasible for treating ruptured supra-PICA VADAs. Although not statistically significant, procedural related complications occurred more frequently in the trapping group. When the VADAs are close to the PICA, we suggest that the lesions should be treated using SAC.
authors.affiliation: Department of Neurosurgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China, fangyibin@163.com.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Fang
authors.forename: Kai-Jun
authors.initials: KJ
authors.lastname: Zhao
authors.forename: Yi-Na
authors.initials: YN
authors.lastname: Wu
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhou
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Peng-Fei
authors.initials: PF
authors.lastname: Yang
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Huang
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Zhao
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000328:Adult; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D015607:Stents; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000628:therapy*