PMID- 27742509 OWN - NLM STAT- MEDLINE DCOM- 20170911 LR - 20181113 IS - 1878-8769 (Electronic) IS - 1878-8750 (Print) IS - 1878-8750 (Linking) VI - 97 DP - 2017 Jan TI - Successful Retreatment of Recurrent Intracranial Vertebral Artery Dissecting Aneurysms After Stent-Assisted Coil Embolization: A Self-Controlled Hemodynamic Analysis. PG - 344-350 LID - S1878-8750(16)30989-5 [pii] LID - 10.1016/j.wneu.2016.10.003 [doi] AB - 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. CI - Copyright (c) 2016 Elsevier Inc. All rights reserved. FAU - Liu, Jian AU - Liu J AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Jing, Linkai AU - Jing L AD - Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing, China. FAU - Zhang, Ying AU - Zhang Y AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Song, Ying AU - Song Y AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Wang, Yang AU - Wang Y AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Li, Chuanhui AU - Li C AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Wang, Yanmin AU - Wang Y AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Mu, Shiqing AU - Mu S AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. FAU - Paliwal, Nikhil AU - Paliwal N AD - 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. FAU - Meng, Hui AU - Meng H AD - 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. FAU - Linfante, Italo AU - Linfante I AD - Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Baptist Hospital, Miami, Florida, USA. Electronic address: italol@baptisthealth.net. FAU - Yang, Xinjian AU - Yang X AD - Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China. Electronic address: yang-xj@163.net. LA - eng GR - R01 NS091075/NS/NINDS NIH HHS/United States GR - UL1 TR001412/TR/NCATS NIH HHS/United States PT - Case Reports PT - Journal Article DEP - 20161011 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 SB - IM MH - Adult MH - Blood Flow Velocity MH - Cerebrovascular Circulation MH - Computer Simulation MH - Embolization, Therapeutic/*instrumentation/methods MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Models, Cardiovascular MH - Recurrence MH - Reoperation/*methods MH - *Stents MH - Treatment Outcome MH - Vertebral Artery Dissection/diagnosis/*physiopathology/*surgery PMC - PMC5416824 MID - NIHMS822417 OTO - NOTNLM OT - Hemodynamics OT - Recurrence OT - Stent OT - Vertebral dissecting aneurysms EDAT- 2016/10/16 06:00 MHDA- 2017/09/12 06:00 PMCR- 2018/01/01 CRDT- 2016/10/16 06:00 PHST- 2016/07/03 00:00 [received] PHST- 2016/09/29 00:00 [revised] PHST- 2016/10/01 00:00 [accepted] PHST- 2016/10/16 06:00 [pubmed] PHST- 2017/09/12 06:00 [medline] PHST- 2016/10/16 06:00 [entrez] PHST- 2018/01/01 00:00 [pmc-release] AID - S1878-8750(16)30989-5 [pii] AID - 10.1016/j.wneu.2016.10.003 [doi] PST - ppublish SO - World Neurosurg. 2017 Jan;97:344-350. doi: 10.1016/j.wneu.2016.10.003. Epub 2016 Oct 11.