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    Endovascular reconstruction of unruptured intradural vertebral artery dissecting aneurysms with the Pipeline embolization device

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    Authors
    Kuhn, Anna L.
    Kan, Peter
    Massi, Francesca
    Lozano, Juan Diego
    Hou, Samuel Y.
    Howk, Mary
    Gounis, Matthew J.
    Wakhloo, Ajay K.
    Puri, Ajit S.
    UMass Chan Affiliations
    Department of Biochemistry and Molecular Pharmacology
    New England Center for Stroke Research
    Department of Radiology
    Document Type
    Journal Article
    Publication Date
    2016-10-01
    Keywords
    Aneurysm
    Dissection
    Flow Diverter
    Intervention
    Cardiovascular Diseases
    Nervous System Diseases
    Neurology
    Radiology
    Surgery
    
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    Link to Full Text
    https://doi.org/10.1136/neurintsurg-2015-012028
    Abstract
    BACKGROUND: Dissecting aneurysms of the vertebral artery (VA) are difficult to treat using current surgical and endovascular techniques. OBJECTIVE: To analyze retrospectively the efficacy and safety of flow diverters in the treatment of dissecting aneurysms of the vertebral artery. METHODS: We identified six patients with six unruptured VA dissecting aneurysms either arising from the V4 or V3-V4 junction that were treated with the Pipeline embolization device (PED) at our institution between July 2012 and February 2015. Among other parameters, technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. RESULTS: PED placement was achieved in all cases and immediate angiography follow-up demonstrated intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of dysarthria was noted in one patient. Major procedure-related complications were not observed. The 6-month follow-up (n=6) demonstrated complete/near-complete aneurysm obliteration in five patients and partial obliteration in one. At the 1-year follow-up (n=5) stable complete aneurysm occlusion was seen in two patients. Two cases showed progression from near complete occlusion and partial occlusion at 6 months to complete occlusion and near complete occlusion. One cases showed unchanged near complete occlusion. No aneurysmal bleeding, in-stent stenosis or thromboembolic complication was seen. National Institutes of Health Stroke Scale and modified Rankin scale scores remained unchanged from admission to discharge. CONCLUSIONS: Our preliminary experience with the use of PED for the treatment of intradural VA dissecting aneurysms shows promising short-term results, making this technique a feasible and safe treatment option in patients suitable for this approach. However, long-term and larger cohort studies are needed to validate these results.
    Source
    J Neurointerv Surg. 2016 Oct;8(10):1048-51. Epub 2015 Nov 6. Link to article on publisher's site
    DOI
    10.1136/neurintsurg-2015-012028
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/48115
    PubMed ID
    26546600
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1136/neurintsurg-2015-012028
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