title: Stent-Assisted Coil Embolization of Vertebrobasilar Dissecting Aneurysms: Procedural Outcomes and Factors for Recanalization.
abstract: Outcomes of stent-assisted coil embolization (SACE) have not been well established in the setting of vertebrobasilar dissecting aneurysms (VBDAs) due to the low percentage of cases that need treatment and the array of available therapeutic options. Herein, we presented clinical and radiographic results of SACE in patients with VBDAs.
  
  
  
  A total of 47 patients (M:F, 30:17; mean age ± SD, 53.7 ± 12.6 years), with a VBDA who underwent SACE between 2008 and 2014 at two institutions were evaluated retrospectively. Medical records and radiologic data were analyzed to assess the outcome of SACE procedures. Cox proportional hazards regression analysis was conducted to determine the factors that were associated with aneurysmal recanalization after SACE.
  
  
  
  Stent-assisted coil embolization technically succeeded in all patients. Three cerebellar infarctions occurred on postembolization day 1, week 2, and month 2, but no other procedure-related complications developed. Immediately following SACE, 25 aneurysms (53.2%) showed no contrast filling into the aneurysmal sac. During a mean follow-up of 20.2 months, 37 lesions (78.7%) appeared completely occluded, whereas 10 lesions showed recanalization, 5 of which required additional embolization. Overall recanalization rate was 12.64% per lesion-year, and mean postoperative time to recanalization was 18 months (range, 3-36 months). In multivariable analysis, major branch involvement (hazard ratio [HR]: 7.28; p = 0.013) and the presence of residual sac filling (HR: 8.49, p = 0.044) were identified as statistically significant independent predictors of recanalization. No bleeding was encountered in follow-up monitoring.
  
  
  
  Stent-assisted coil embolization appears feasible and safe for treatment of VBDAs. Long-term results were acceptable in a majority of patients studied, despite a relatively high rate of incomplete occlusion immediately after SACE. Major branch involvement and coiled aneurysms with residual sac filling may predispose to recanalization.
authors: Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea.
authors: Jin Pyeong
authors: JP
authors: Jeon
authors: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors: Young Dae
authors: YD
authors: Cho
authors: Department of Neurosurgery, Jeju National University College of Medicine, Jeju National University Hospital, Jeju 63241, Korea.
authors: Jong Kook
authors: JK
authors: Rhim
authors: Department of Neurology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 05030, Korea.
authors: Jeong Jin
authors: JJ
authors: Park
authors: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors: Won-Sang
authors: WS
authors: Cho
authors: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors: Hyun-Seung
authors: HS
authors: Kang
authors: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors: Jeong Eun
authors: JE
authors: Kim
authors: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
authors: Gyojun
authors: G
authors: Hwang
authors: Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
authors: O-Ki
authors: OK
authors: Kwon
authors: Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.; Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea.
authors: Moon Hee
authors: MH
authors: Han
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000628:therapy*; D020520:Brain Infarction / Q000209:etiology; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014711:Vertebral Artery
keywords: Aneurysm; Dissecting aneurysm; Posterior circulation; Stents