title: Successful Retreatment of Recurrent Intracranial Vertebral Artery Dissecting Aneurysms After Stent-Assisted Coil Embolization: A Self-Controlled Hemodynamic Analysis.
abstract: BACKGROUND
  Intracranial vertebral artery dissecting aneurysms (VADAs) tend to recur despite successful stent-assisted coil embolization (SACE). Hemodynamics is useful in evaluating aneurysmal formation, growth, and rupture. Our aim was to evaluate the hemodynamic patterns of the recurrence of VADA.
  
  
  METHODS
  Between September 2009 and November 2013, all consecutive patients with recurrent VADAs after SACE in our institutions were enrolled. Recurrence was defined as recanalization and/or regrowth. We assessed the hemodynamic alterations in wall shear stress (WSS) and velocity after the initial SACE and subsequently after retreatment of the aneurysms that recurred.
  
  
  RESULTS
  Five patients were included. After the initial treatment, 3 patients showed recanalization and 2 showed regrowth. In the 2 patients with regrowth, the 2 original aneurysms maintained complete occlusion; however, de novo aneurysm regrowth was confirmed near the previous site. Compared with 3 recanalized aneurysms, the completely occluded aneurysms showed high mean reductions in velocity and WSS after initial treatment (velocity, 77.6% vs. 57.7%; WSS, 74.2% vs. 52.4%); however, WSS remained high at the region near the previous lesion where the new aneurysm originated. After the second retreatment, there was no recurrence in any patient. Compared with the 3 aneurysms that recanalized, the 4 aneurysms that maintained complete occlusion showed higher reductions in velocity (62.9%) and WSS (71.1%).
  
  
  CONCLUSIONS
  Our series indicated that hemodynamics might have an important role in recurrence of VADAs. After endovascular treatment, sufficient hemodynamic reduction in aneurysm dome, orifice, and parent vessel may be one of the key factors for preventing recurrence in VADAs.
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China.
authors.forename: Linkai
authors.initials: L
authors.lastname: Jing
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
authors.forename: Shiqing
authors.initials: S
authors.lastname: Mu
authors.affiliation: Toshiba Stroke and Vascular Research Center, and Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Paliwal
authors.affiliation: Toshiba Stroke and Vascular Research Center, and Department of Mechanical and Aerospace Engineering, University at Buffalo, The State University of New York, Buffalo, New York, USA.
authors.forename: Hui
authors.initials: H
authors.lastname: Meng
authors.affiliation: Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Baptist Hospital, Miami, Florida, USA. Electronic address: italol@baptisthealth.net.
authors.forename: Italo
authors.initials: I
authors.lastname: Linfante
authors.affiliation: Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. Electronic address: yang-xj@163.net.
authors.forename: Xinjian
authors.initials: X
authors.lastname: Yang
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D003198:Computer Simulation; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*
keywords: Hemodynamics; Recurrence; Stent; Vertebral dissecting aneurysms