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Vertebral artery aneurysms and the risk of cord infarction following spinal artery coverage during flow diversion.

Abstract：

OBJECTIVE:Coverage of the anterior spinal artery (ASA) ostia is a source of considerable consternation regarding flow diversion (FD) in vertebral artery (VA) aneurysms due to cord supply. The authors sought to assess the association between coverage of the ASA, posterior spinal artery (PSA), or lateral spinal artery (LSA) ostia when placing flow diverters in distal VAs and clinical outcomes, with emphasis on cord infarction. METHODS:A multicenter retrospective study of 7 institutions in which VA aneurysms were treated with FD between 2011 and 2019 was performed. The authors evaluated the risk of ASA and PSA/LSA occlusion, associated thromboembolic complication, complications overall, aneurysm occlusion status, and functional outcome. RESULTS:Sixty patients with 63 VA and posterior inferior cerebellar artery aneurysms treated with FD were identified. The median aneurysm diameter was 7 mm and fusiform type was the commonest morphology (42.9%). During a procedure, 1 (61.7%) or 2 (33.3%) flow diverters were placed. Complete occlusion was achieved in 71.9%. Symptomatic thromboembolic complications occurred in 7.4% of cases and intracranial hemorrhage in 10.0% of cases. The ASA and PSA/LSA were identified in 51 (80.9%) and 35 (55.6%) complications and covered by the flow diverter in 29 (56.9%) and 13 (37.1%) of the procedures, respectively. Patency after flow diverter coverage on last follow-up was 89.2% for ASA and 100% for PSA/LSA, not significantly different between covered and noncovered groups (p = 0.5 and p > 0.99, respectively). No complications arose from coverage. CONCLUSIONS:FD aneurysm treatment in the posterior circulation with coverage of ASA or PSA/LSA was not associated with higher rates of occlusion of these branches or any instances of cord infarction.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Dmytriw AA,Kapadia A,Enriquez-Marulanda A,Parra-Fariñas C,Kühn AL,Nicholson PJ,Waqas M,Renieri L,Michelozzi C,Foreman PM,Phan K,Yang IH,Tutino VM,Ogilvy CS,Radovanovic I,Harrigan MR,Siddiqui AH,Levy EI,Limbucci N,Co

doi

10.3171/2020.1.JNS193293

subject

Has Abstract

pub_date

2020-03-27 00:00:00

pages

1-10

eissn

0022-3085

issn

1933-0693

pii

2020.1.JNS193293

pub_type

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Vertebral artery aneurysms and the risk of cord infarction following spinal artery coverage during flow diversion.