TY - JOUR
T1 - Endovascular therapy for ruptured vertebral artery dissecting aneurysms
T2 - Results from nationwide, retrospective, multi-center registries in Japan (JR-NET3)
AU - JR-NET3 study group
AU - Nakamura, Hajime
AU - Fujinaka, Toshiyuki
AU - Nishida, Takeo
AU - Kishima, Haruhiko
AU - Sakai, Nobuyuki
AU - Iihara, Koji
AU - Satow, Tetsu
AU - Ezura, Masayuki
AU - Hyodo, Akio
AU - Miyachi, Shigeru
AU - Miyamoto, Susumu
AU - Nagai, Yoji
AU - Nishimura, Kunihiro
AU - Toyoda, Kazunori
AU - Higashi, Toshio
AU - Hirohata, Masaru
AU - Ishii, Akira
AU - Imamura, Hirotoshi
AU - Ito, Yasushi
AU - Kuwayama, Naoya
AU - Oishi, Hidenori
AU - Matsumaru, Yuji
AU - Matsumoto, Yasushi
AU - Nakahara, Ichiro
AU - Sakai, Chiaki
AU - Sugiu, Kenji
AU - Terada, Tomoaki
AU - Yoshimura, Shinichi
N1 - Funding Information:
This study was supported in part by a Grant-in-Aid (Junkanki-Kaihatsu H24-4-3) from the National Cerebral and Cardiovascular Center, Japan and by Hatazaki Foundation, Kobe, Japan. The authors express heartfelt thanks to the doctors who devoted their time to this investigation, including: the JR-NET3 Study Group: Co-Principal investigator Nobuyuki Sakai, Kobe City Medical Center General Hospital, Kobe, Japan; Koji Iihara, Kyushu University, Fukuoka, Japan; Tetsu Satow, National Cerebral and Cardiovascular Center, Suita, Japan; Investigators: Masayuki Ezura, Sendai Medical Center, Sendai, Japan; Akio Hyodo, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan; Shigeru Miyachi, Aichi Medical University, Aichi, Japan; Susumu Miyamoto, Kyoto University, Kyoto, Japan; Yoji Nagai, Kobe University, Kobe, Japan; Kunihiro Nishimura, National Cerebral and Cardiovascular Center, Suita, Japan; Kazunori Toyoda, National Cerebral and Cardiovascular Center, Suita, Japan; Co-investigators: Toshiyuki Fujinaka, Osaka Medical Center, Osaka, Japan; Toshio Higashi, Fukuoka University, Fukuoka, Japan; Masaru Hirohata, Kurume University, Kurume, Japan; Akira Ishii, Kyoto University, Kyoto, Japan; Hirotoshi Imamura, Kobe City Medical Center General Hospital, Kobe, Japan; Yasushi Ito, Shinrakuen Hospital, Niigata, Japan; Naoya Kuwayama, Toyama University, Toyama, Japan; Hidenori Oishi, Juntendo University, Tokyo, Japan; Yuji Matsumaru, Tsukuba University, Tsukuba, Japan; Yasushi Matsumoto, Konan Hospital, Sendai, Japan; Ichiro Nakahara, Fujita Medical University, Aichi, Japan; Chiaki Sakai, Hyogo College of Medicine, Nishinomiya, Japan; Kenji Sugiu, Okayama University, Okayama, Japan; Tomoaki Terada, Showa University Fujigaoka Hospital, Kanagawa, Japan; Shinichi Yoshimura, Hyogo College of Medicine, Nishinomiya, Japan; Certified Specialist of Japanese Society of Neuroendovascular Therapy.
Publisher Copyright:
© 2019 by The Japan Neurosurgical Society.
PY - 2019
Y1 - 2019
N2 - Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93.8%) and favorable outcome was obtained in 303 cases (59.1%). Older age (≥60 years), male sex, use of general anesthesia, non-specialist as the responsible doctor, and time delay from onset to treatment (≥24 h) were negative factors for favorable outcome in multivariate analysis, although these factors were not associated with procedure-related complications. Compared with previous studies (JR-NET1 and 2), the number of endovascular treatments for patients with VADA and severe SAH increased in this decade; however, the percentage of patients with favorable outcome did not decrease. This might be due to not only the improvement of endovascular treatment itself, but also increased access to endovascular specialists or standardization of management.
AB - Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93.8%) and favorable outcome was obtained in 303 cases (59.1%). Older age (≥60 years), male sex, use of general anesthesia, non-specialist as the responsible doctor, and time delay from onset to treatment (≥24 h) were negative factors for favorable outcome in multivariate analysis, although these factors were not associated with procedure-related complications. Compared with previous studies (JR-NET1 and 2), the number of endovascular treatments for patients with VADA and severe SAH increased in this decade; however, the percentage of patients with favorable outcome did not decrease. This might be due to not only the improvement of endovascular treatment itself, but also increased access to endovascular specialists or standardization of management.
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U2 - 10.2176/nmc.st.2018-0191
DO - 10.2176/nmc.st.2018-0191
M3 - Article
C2 - 30531151
AN - SCOPUS:85060004086
VL - 59
SP - 10
EP - 18
JO - Neurologia Medico-Chirurgica
JF - Neurologia Medico-Chirurgica
SN - 0387-2572
IS - 1
ER -