Endovascular treatment of vertebral artery dissecting aneurysms : a 20-year institutional experience

Abstract

BackgroundThe ideal treatment for unruptured vertebral artery dissecting aneurysms (VADAs) and ruptured dominant VADAs remains controversial. We report our experience in the management and endovascular treatment of patients with VADAs.MethodsPatients treated endovascularly for intradural VADAs at a single institution from January 1, 1999, to December 31, 2019, were retrospectively reviewed. Primary neurological outcomes were assessed using modified Rankin Scale (mRS) scores, with mRS >2 considered a poor neurological outcome. Additionally, any worsening (increase) in the mRS score from the preoperative neurological examination was considered a poor outcome.ResultsNinety-one patients of mean (SD) age 53 (11.6) years (48 (53%) men) underwent endovascular treatment for VADAs. Fifty-four patients (59%) presented with ruptured VADAs and 44 VADAs (48%) involved the dominant vertebral artery. Forty-seven patients (51%) were treated with vessel sacrifice of the parent artery, 29 (32%) with flow diversion devices (FDDs), and 15 (17%) with stent-assisted coil embolization (stent/coil). Rates of procedural complications and retreatment were significantly higher with stent/coil treatment (complications 4/15; retreatment 6/15) than with vessel sacrifice (complications 1/47; retreatment 2/47) or FDD (complications 2/29; retreatment 4/29) (p=0.008 and p=0.002, respectively). Of 37 patients with unruptured VADAs treated, only two (5%) had mRS scores >2 on follow-up.ConclusionEndovascular FDD treatment of VADAs appears to be associated with lower retreatment and complication rates than stenting/coiling, although further study is required for confirmation. Endovascular treatment of unruptured VADAs was safe and was associated with favorable angiographic and neurological outcomes.

Stent-alone treatment of unruptured vertebral artery fusiform aneurysms: A comparison of flow diverter and conventional stents

“…In a study of multiple stent therapy in patients with VAFAs, Chung et al ( 17 ) reported a 100% success rate without treatment-related complications; in their literature review, they found a 3.6% complication rate in patients treated using multiple stents. Catapano et al ( 24 ) also reported success and no complications with the use of flow diverter stents in patients with vertebral artery dissecting aneurysms. In contrast, Kallmes et al ( 25 ) reported a 7.3% incidence of ischemic stroke in patients with posterior circulation aneurysms who underwent placement of a flow diverter stent (Pipeline embolization device).…”

Far-lateral approach without C1 laminectomy for microsurgical treatment of vertebral artery and proximal posterior inferior cerebellar artery aneurysms: Experience from 48 patients

“…The rates of procedural complications (8%) and retreatment (13%) were significantly higher with stent/coil treatment than with vessel sacrifice or flow diversion devices. 2 …”

“…Owing to the evolution of endovascular techniques and devices and the higher rates of microsurgical complications, vertebral artery (VA) and posterior inferior cerebellar artery (PICA) aneurysms are predominantly treated with endovascular procedures. 1 , 2 , 3 , 4 , 5 , 6 , 7 …”

Effect and safety of Tubridge flow diverter in the treatment of unruptured intracranial aneurysms

“…With the development of treatment concept, flow diverting devices represented by the pipeline embolization device (PED, Medtronic, Irvine, California) have become an important alternative to conventional coil embolization in the treatment of unruptured intracranial aneurysms. [1][2][3][4][5][6][7][8][9] For large and giant aneurysms, the 5-year cure rate is more than 95% with the flow diverting device. [10] Recently, different flow diverting devices have been developed including the PED, the Surpass stent (Stryker Neurovascular, Kalamazoo, MI), the Flow-Redirection Endoluminal Device (MicorVention, Tustin, CA), and the Silk flow diverter (Balt Extrusion, Montmorency, France), which have been increasingly applied in over 50 countries.…”