PMID- 36757195 OWN - NLM STAT- MEDLINE DCOM- 20230619 LR - 20231124 IS - 1524-4040 (Electronic) IS - 0148-396X (Linking) VI - 93 IP - 1 DP - 2023 Jul 1 TI - Stent-Assisted Coil Embolization Versus Flow-Diverting Stent in Unruptured Vertebral Artery Dissecting Aneurysms: Efficacy and Safety Comparison. PG - 120-127 LID - 10.1227/neu.0000000000002384 [doi] AB - BACKGROUND: Reconstructive strategies for unruptured vertebral artery dissecting aneurysms (VADAs) have increasingly relied on newly developed endovascular devices. However, their clinical performance metrics are seldom reported. OBJECTIVE: To compare stent-assisted coil embolization (SACE) and flow-diverting stent (FDS) deployment as treatments for unruptured VADAs, focusing on efficacy and safety. METHODS: A total of 72 VADAs were submitted to SACE (n = 48) or FDS (n = 24) between April 2009 and September 2021. We reviewed medical records and radiological data to assess efficacy and safety outcomes by method, building an inverse probability of treatment-weighted (IPTW) logistic regression model and conducting survival analyses. RESULTS: Ultimately, 24 aneurysms (33.3%) showed signs of recanalization (major, 14; minor, 10) at 6-month follow-up. Initially determined 6-month rates of overall (SACE, 31.2%; FDS, 41.7%) and major (SACE, 20.8%; FDS, 16.7%) recanalization did not differ significantly by modality; but in the IPTW logistic regression model, adjusted for aneurysm morphology, major recanalization at 6 months was lower for the FDS (vs SACE) subset (odds ratio = 0.196; P = .027). Likewise, the cumulative rate of major recanalization was more favorable for the FDS (vs SACE) subset (hazard ratio = 0.291; P = .048) in IPTW Cox proportional hazards model adjusted for aneurysm morphology. Modality-based assessments of procedural and delayed complications were similar. CONCLUSION: Both reconstructive VADA interventions are safe and effective by adjusting treatment modality depending on the angioanatomic configuration. However, follow-up data after treatment proved more favorable for FDS deployment than for SACE in limiting major recanalization. Case-controlled studies of more sizeable cohorts are needed for corroboration. CI - Copyright (c) Congress of Neurological Surgeons 2023. All rights reserved. FAU - Oh, Han San AU - Oh HS AD - Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. FAU - Bae, Jin Woo AU - Bae JW AD - Department of Neurosurgery, Inha University Hospital, Incheon, Korea. FAU - Hong, Chang-Eui AU - Hong CE AD - Department of Neurosurgery, Veterans Health Service Medical Center, Seoul, Korea. FAU - Kim, Kang Min AU - Kim KM AD - Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. FAU - Yoo, Dong Hyun AU - Yoo DH AD - Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. FAU - Kang, Hyun-Seung AU - Kang HS AD - Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. FAU - Cho, Young Dae AU - Cho YD AD - Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. LA - eng PT - Journal Article PT - Review DEP - 20230209 PL - United States TA - Neurosurgery JT - Neurosurgery JID - 7802914 SB - IM MH - Humans MH - *Intracranial Aneurysm/diagnostic imaging/surgery MH - Vertebral Artery/diagnostic imaging/surgery MH - Treatment Outcome MH - *Embolization, Therapeutic/methods MH - Stents MH - Retrospective Studies MH - *Endovascular Procedures/methods MH - *Aortic Dissection EDAT- 2023/02/10 06:00 MHDA- 2023/06/19 13:08 CRDT- 2023/02/09 09:03 PHST- 2022/08/01 00:00 [received] PHST- 2022/12/04 00:00 [accepted] PHST- 2023/06/19 13:08 [medline] PHST- 2023/02/10 06:00 [pubmed] PHST- 2023/02/09 09:03 [entrez] AID - 00006123-202307000-00014 [pii] AID - 10.1227/neu.0000000000002384 [doi] PST - ppublish SO - Neurosurgery. 2023 Jul 1;93(1):120-127. doi: 10.1227/neu.0000000000002384. Epub 2023 Feb 9.