title: Treatment of unruptured vertebral dissecting aneurysms: internal trapping or stent-assisted coiling.
abstract: OBJECTIVE
  Endovascular treatment is an attractive approach for the treatment of unruptured vertebral dissecting aneurysms, and includes internal trapping and stent-assisted coil embolization. However, the optimal therapy remains debatable. We reviewed our experience with both endovascular treatment modalities and compared the safety, efficacy, and short-term outcomes for each approach.
  
  
  METHODS
  We retrospectively reviewed 65 consecutive patients with unruptured vertebral dissecting aneurysms who underwent endovascular treatment between January 2003 and January 2014. 24 patients underwent endovascular internal trapping (group A) while 41 patients underwent stent-assisted coiling (group B). Thirteen patients underwent single stent with coiling while 28 patients underwent double or three stent-assisted coiling. Short-term outcomes were evaluated using the modified Rankin Scale.
  
  
  RESULTS
  A favorable clinical outcome was achieved in 58 of 65 patients. Procedure-related complications included ischemic symptoms (n = 6) and recurrence (n = 4). There was no statistical difference in modified Rankin Scale scoring between groups. Group A patients had more ischemia symptoms compared with group B patients (p = 0.043), Group B patients had higher recurrence rates compared with group A patients, but the difference had no statistical significance (p = 1.00). However, recurrence only occurred in patients who underwent stent-assisted coiling alone (p = 0.046).
  
  
  CONCLUSIONS
  Stent-assisted coiling for unruptured vertebral dissecting aneurysms may maintain artery patency. Multilayer disposition of stents with coils may decrease complications and facilitate aneurysm occlusion. Larger, prospective studies are necessary to determine the long-term outcomes of reconstructive therapy.
authors.affiliation: a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China.
authors.forename: Xi-Feng
authors.initials: XF
authors.lastname: Li
authors.affiliation: a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.affiliation: a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China.
authors.forename: Xu-Ying
authors.initials: XY
authors.lastname: He
authors.affiliation: a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China.
authors.forename: Chuan-Zhi
authors.initials: CZ
authors.lastname: Duan
authors.affiliation: a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China.
authors.forename: Yan-Chao
authors.initials: YC
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000601:surgery*; D020217:Vertebral Artery Dissection / Q000628:therapy*
keywords: endovascular treatment; internal trapping; outcomes; stent-assisted coiling