title: Endovascular treatment for ruptured and unruptured vertebral artery dissecting aneurysms: a meta-analysis.
abstract: BACKGROUND
  Different endovascular modalities have been applied to the treatment of vertebral artery dissecting aneurysms, the most commonly used being internal trapping and stent-assisted coiling, although the ideal treatment remains controversial.
  
  
  OBJECTIVE
  To perform a meta-analysis to study clinical outcomes of patients with vertebral artery dissecting aneurysms who were treated with internal trapping or stent-assisted coiling.
  
  
  METHODS
  We conducted a meta-analysis of eight retrospective studies that compared internal trapping with stent-assisted coiling for the treatment of vertebral artery dissecting aneurysms. The primary outcomes of this study were immediate occlusion, long-term occlusion, good outcome ratio, perioperative mortality, and angiographic recurrence. Subgroup analyses were conducted of patients with ruptured versus unruptured vertebral artery dissecting aneurysms.
  
  
  RESULTS
  Eight studies comprising a total of 188 patients were included in the analysis. For ruptured cases, in comparison with stent-assisted coiling groups, the patients treated with trapping techniques had a higher rate of immediate postoperative occlusion (OR=0.165; 95% CI 0.067 to 0.405; p<0.01), although there was no significant difference in long-term occlusion (OR=1.059; 95% CI 0.033 to 34.121; p=0.974), good clinical outcome rates, recurrence rates, and perioperative mortality. For unruptured cases, patients in the trapping groups also had higher immediate occlusion rates than those who underwent stent-assisted coiling (OR=0.175; 95% CI 0.043 to 0.709; p=0.015), while rates of both recurrence and good clinical outcome were similar between the two groups.
  
  
  CONCLUSIONS
  Both internal trapping and stent-assisted coiling are technically feasible for ruptured vertebral artery dissecting aneurysms, with high rates of good long-term neurologic outcomes and low recurrence and mortality rates. For unruptured aneurysms, conservative treatment is recommended. When a posterior inferior cerebellar artery (PICA) origin is involved, bypass surgery or vertebral artery-to-PICA stent placement plus coil embolization should be considered.
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China.
authors.forename: Jian
authors.initials: J
authors.lastname: Guan
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China.
authors.forename: Guilin
authors.initials: G
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China.
authors.forename: Xiangyi
authors.initials: X
authors.lastname: Kong
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China.
authors.forename: Chuan
authors.initials: C
authors.lastname: He
authors.affiliation: Department of Neurosurgery, The 3rd Hospital of Xiamen, Fujian, P. R. China.
authors.forename: Jianwu
authors.initials: J
authors.lastname: Long
authors.affiliation: Department of Neurosurgery, Zaozhuang Municipal Hospital of Shandong Province, Shandong, P. R. China.
authors.forename: Hao
authors.initials: H
authors.lastname: Qin
authors.affiliation: Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China.
authors.forename: Hongqi
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China.
authors.forename: Renzhi
authors.initials: R
authors.lastname: Wang
mesh_terms: D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D000072700:Conservative Treatment; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000601:surgery; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000601:surgery*
keywords: Aneurysm; Coil; Intervention; Stent