Mobile endovascular therapy for acute treatment of ruptured vertebral artery dissecting aneurysm in multiple hospitals
| Autor: | Hiroyuki Nakashima, Masafumi Hiramatsu, Tomohito Hishikawa, Koji Tokunaga, Hirokazu Kambara, Kenji Sugiu, Naoya Kidani, Kazuki Kobayashi, Kaoru Terasaka, Isao Date |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Subarachnoid hemorrhage Aneurysm Ruptured 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm Modified Rankin Scale Medicine Humans Vertebral Artery Neuroradiology Aged Retrospective Studies Vertebral Artery Dissection medicine.diagnostic_test business.industry Mortality rate Endovascular Procedures Interventional radiology Intracranial Aneurysm Subarachnoid Hemorrhage medicine.disease Embolization Therapeutic Hospitals Surgery Dissection Treatment Outcome Neurology (clinical) Neurosurgery business 030217 neurology & neurosurgery |
| Zdroj: | Acta neurochirurgica. 164(2) |
| ISSN: | 0942-0940 |
| Popis: | Background The patients with ruptured vertebral artery dissecting aneurysm (rVADA) should be treated as early as possible because VADA carries extremely high risk of rebleeding in the acute phase. We have established a mobile endovascular strategy for the patients with rVADA between our flagship center and its affiliated local hospitals. We introduced and reviewed our mobile endovascular therapy in this study. Methods We retrospectively evaluated 98 consecutive patients who underwent endovascular surgery for rVADA from 2000 to 2018 at our institution or five affiliated hospitals. When each patient was initially transported to the local affiliated hospitals, neuroendovascular surgeons traveled directly to the affiliated hospital from the flagship center in order to treat the patient there. Clinical outcomes using modified Rankin Scale at 6 months after treatment, radiological results, and procedure-related complications were reviewed to justify our mobile endovascular strategy. Results All aneurysms were cured successfully by internal trapping. Favorable outcome was achieved in 61 patients (62.2%) even though 53 patients (54.1%) had presented with severe subarachnoid hemorrhage. Overall mortality rate, treatment-related mortality rate, and treatment related complication rate were 18.4% (18/98), 0%, and 16% (16/98), respectively. There were no differences in clinical and radiological outcomes between the patients treated in the flagship center and those who treated in the affiliated hospitals. Treatment in the affiliated hospital was not a predictive factor of unfavorable outcome in our multivariate analysis, and elderly age (>= 60) was negatively associated with favorable outcome. Conclusions Our results prove the efficacy and safety of mobile endovascular therapy for the treatment of rVADA in the ultra-acute stage. Mobile endovascular therapy may work well in the acute treatment of rVADAs in the certain circumstance. |
| Databáze: | OpenAIRE |
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