Appropriate Flow Reduction for Unilateral Ruptured Vertebral Artery Dissection by Proximal Clipping to Prevent Rebleeding and Medullary Infarction.
Medullary infarction
Perforating artery
Proximal clipping
Ruptured vertebral artery dissection
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
21
05
2019
revised:
21
06
2019
accepted:
22
06
2019
pubmed:
3
7
2019
medline:
21
1
2020
entrez:
3
7
2019
Statut:
ppublish
Résumé
Medullary infarction (MI) occasionally occurs after treatment of ruptured vertebral artery dissection (VAD). The aim of this study was to validate whether flow reduction for ruptured unilateral VAD by proximal clipping prevents rebleeding and MI in comparison with trapping. Thirty-one patients who underwent direct surgery or endovascular procedures for unilateral ruptured VAD and postoperative magnetic resonance imaging (MRI), including 9 patients treated with trapping and 22 patients treated with proximal clipping, were enrolled. For posterior inferior cerebellar artery (PICA)-involved type VAD, occipital artery to PICA anastomosis was added as needed to isolate the rupture point. The rate of rebleeding and the occurrence of MI on MRI were compared between the 2 groups. There was no rebleeding after treatment in all 31 patients. However, 5 patients had MI on postoperative MRI (16.1%, κ = 0.903). In 5 of the 9 patients treated with trapping, MI was seen on MRI after treatment (55.6%). On the other hand, 0 of the 22 patients treated with proximal clipping developed MI (P < 0.01). Appropriate flow reduction for ruptured unilateral VAD by proximal clipping is thought to be effective for preventing rebleeding and avoiding MI.
Sections du résumé
BACKGROUND
BACKGROUND
Medullary infarction (MI) occasionally occurs after treatment of ruptured vertebral artery dissection (VAD). The aim of this study was to validate whether flow reduction for ruptured unilateral VAD by proximal clipping prevents rebleeding and MI in comparison with trapping.
METHODS
METHODS
Thirty-one patients who underwent direct surgery or endovascular procedures for unilateral ruptured VAD and postoperative magnetic resonance imaging (MRI), including 9 patients treated with trapping and 22 patients treated with proximal clipping, were enrolled. For posterior inferior cerebellar artery (PICA)-involved type VAD, occipital artery to PICA anastomosis was added as needed to isolate the rupture point. The rate of rebleeding and the occurrence of MI on MRI were compared between the 2 groups.
RESULTS
RESULTS
There was no rebleeding after treatment in all 31 patients. However, 5 patients had MI on postoperative MRI (16.1%, κ = 0.903). In 5 of the 9 patients treated with trapping, MI was seen on MRI after treatment (55.6%). On the other hand, 0 of the 22 patients treated with proximal clipping developed MI (P < 0.01).
CONCLUSIONS
CONCLUSIONS
Appropriate flow reduction for ruptured unilateral VAD by proximal clipping is thought to be effective for preventing rebleeding and avoiding MI.
Identifiants
pubmed: 31265925
pii: S1878-8750(19)31831-5
doi: 10.1016/j.wneu.2019.06.174
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e627-e633Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.