Dynamic contrast-enhanced MRI analysis for prognosis of intracranial dissecting aneurysm with intramural haematoma after endovascular treatment: an observational registry study

Background and purposeIntracranial dissecting aneurysm (IDA) with intramural haematoma (IMH) is an intractable cerebrovascular disease. The outcome of IDA with IMH after endovascular treatment varies across different individuals: some IMHs stop growing after endovascular treatment, while others continue to grow, even after embolisation of the parent artery. Currently, the mechanism for the continuous growth of IMH after endovascular treatment is still unclear. Continuous haemorrhage of the vasa vasorum in the IMH is considered to be associated with continuous enlargement of the IMH; however, this theory has not been proved by in vivo imaging.Methods and analysisThis study will establish a prospective cohort of 80 patients who had an IDA with IMH and received endovascular treatment. Demographic characteristics, IDA morphological characteristics and treatment characteristics will be collected prospectively. All patients will undergo dynamic contrast-enhanced MRI (DCE-MRI) before and 6 months after the endovascular treatment. According to the follow-up results of the MRI, the IDAs will be divided into two groups: a haematoma stabilisation group and a haematoma enlargement group. Then, quantitative analysis of the vasa vasorum in the IMH will be performed, and differences between the two groups will be compared with determine the association between DCE-MRI related parameters and the outcomes of IMH changes.Ethics and disseminationThe research was approved by the ethics committee of Beijing Tian Tan Hospital (KY 2019-024-03) and written informed consents would be obtained from all patients included in this study. The results of this study will be disseminated in professional printed media.Trial registration numberNCT03940859. Registered: 7 May, 2019. https://clinicaltrials.gov/ct2/show/NCT03940859.

Flow-Diverting Stent for Ruptured Intracranial Dissecting Aneurysm of Vertebral Artery

BACKGROUND: The treatment of ruptured dissecting aneurysms of the intracranial vertebral artery (VA) with parent vessel preservation is a challenge for neurosurgeons and interventional neuroradiologists. OBJECTIVE: To propose an indication for flow-diverting treatment for reconstruction of a dissecting VA with acute subarachnoid hemorrhage. METHODS: Two male patients transferred after acute subarachnoid hemorrhage and dissecting aneurysm on the V4 segment of the dominant VA. An occlusion test was not performed because of their poor clinical state. A flow-diverting stent represented by the Pipeline embolization device was suggested to both patients. RESULTS: Three Pipeline embolization devices were deployed in each VA. One dissecting aneurysm was excluded immediately after 3 stents, and 1 patient had complete exclusion demonstrated at the 48-hour control. No morbidity directly related to the procedure was observed. No recanalization and no rebleeding occurred during the 3 months of follow-up. CONCLUSION: A flow-diverting stent may be considered an option to treat ruptured dissecting aneurysms of the VA, providing remodeling of the parent vessel and complete exclusion of the aneurysm.