Endovascular therapy for ruptured vertebral artery dissecting aneurysms: Results from nationwide, retrospective, multi-center registries in Japan (JR-NET3)

JR-NET3 study group

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)10-18
Number of pages9
JournalNeurologia medico-chirurgica
Volume59
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

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Vertebral Artery Dissection
Registries
Japan
Endovascular Procedures
Subarachnoid Hemorrhage
Arteries
Therapeutics
General Anesthesia
Multivariate Analysis

Keywords

  • Dissecting aneurysm
  • Endovascular therapy
  • Vertebral artery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{e571d279de6b4a8aad441968ab4a6ad3,
title = "Endovascular therapy for ruptured vertebral artery dissecting aneurysms: Results from nationwide, retrospective, multi-center registries in Japan (JR-NET3)",
abstract = "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.",
keywords = "Dissecting aneurysm, Endovascular therapy, Vertebral artery",
author = "{JR-NET3 study group} and Hajime Nakamura and Toshiyuki Fujinaka and Takeo Nishida and Haruhiko Kishima and Nobuyuki Sakai and Koji Iihara and Tetsu Satow and Masayuki Ezura and Akio Hyodo and Shigeru Miyachi and Susumu Miyamoto and Yoji Nagai and Kunihiro Nishimura and Kazunori Toyoda and Toshio Higashi and Masaru Hirohata and Akira Ishii and Hirotoshi Imamura and Yasushi Ito and Naoya Kuwayama and Hidenori Oishi and Yuji Matsumaru and Yasushi Matsumoto and Ichiro Nakahara and Chiaki Sakai and Kenji Sugiu and Tomoaki Terada and Shinichi Yoshimura",
year = "2019",
month = "1",
day = "1",
doi = "10.2176/nmc.st.2018-0191",
language = "English",
volume = "59",
pages = "10--18",
journal = "Neurologia Medico-Chirurgica",
issn = "0470-8105",
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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

PY - 2019/1/1

Y1 - 2019/1/1

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.

KW - Dissecting aneurysm

KW - Endovascular therapy

KW - Vertebral artery

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U2 - 10.2176/nmc.st.2018-0191

DO - 10.2176/nmc.st.2018-0191

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SP - 10

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JO - Neurologia Medico-Chirurgica

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SN - 0470-8105

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