Flow Diverter Devices for the Treatment of Unruptured Vertebral Artery Dissecting Aneurysm

Abstract

Objective : Vertebral artery dissecting aneurysm (VADA) is a very rare subtype of intracranial aneurysms; when ruptured, it is associated with significantly high rates of morbidity and mortality. Despite several discussions and debates, the optimal treatment for VADA has not yet been established. In the last 10 years, flow diverter devices (FDD) have emerged as a challenging and new treatment method, and various clinical and radiological results have been reported about their safety and effectiveness. The aim of our study was to evaluate the clinical and radiological results with the use of FDD in the treatment of unruptured VADA. Methods : We retrospectively evaluated the data of all patients with unruptured VADA treated with FDD between January 2018 and February 2021 at our hybrid operating room. Nine patients with unruptured VADA, deemed hemodynamically unstable, were treated with FDD. Among other parameters, the technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcomes were evaluated. Results : Successful FDD deployment was achieved in all cases, and the immediate follow-up angiography showed intraaneurysmal contrast stasis with parent artery preservation. A temporary episode of facial numbness and palsy was noted in one patient; however, the symptoms had completely disappeared when followed up at the outpatient clinic 2 weeks after the procedure. The 3-6 months follow-up angiography (n=9) demonstrated complete/near-complete obliteration of the aneurysm in seven patients, and partial obliteration and segmental occlusion in one patient each. In the patient who achieved only partial obliteration, there was a sac 13 mm in size, and there was no change in the 1-year follow-up angiography. In the patient with segmental occlusion, the cause could not be determined. The clinical outcome was modified Rankin Scale 0 in all patients. Conclusion : Our preliminary study using FDD to treat hemodynamically unstable unruptured VADA showed that FDD is safe and effective. Our study has limitations in that the number of cases is small, and it is not a prospective study. However, we believe that the study contributes to evidence regarding the safety and effectiveness of FDD in the treatment of unruptured VADA.

Overlapping Stents-Assisted Coiling for Vertebral Artery Dissecting Aneurysm : LVIS Stent within Neuroform EZ Stent

“…A multicenter study of 131 posterior circulation aneurysms showed that a pipeline embolization device (PED) was effective with an 89.7% complete or near complete occlusion rate for dissecting aneurysms [ 8 ]. In most recent, Kim et al [ 12 ] demonstrated a satisfied angiographic result within 3–6 months follow-up, which showed with 77.8% (7/9) complete or near complete VADA obliteration using FDS. Although one patient showed with segmental occlusion, the clinical outcome was mRS 0 in all patients.…”

Stent implantation in a patient with non-hemorrhagic vertebral artery dissection associated with severe, continuously progressive stenosis in the posterior inferior cerebellar artery bifurcation region: A case report

“…There have recently been reports on the use of flow diverters in non-hemorrhagic vertebral artery dissections [ 14 , 15 ]. However, there have also been reports of stent occlusion and transient cranial nerve palsy when flow diverters were used [14] .…”

“…There have recently been reports on the use of flow diverters in non-hemorrhagic vertebral artery dissections [ 14 , 15 ]. However, there have also been reports of stent occlusion and transient cranial nerve palsy when flow diverters were used [14] . Flow-diverters are a relatively new therapeutic technology, and the number of reports of their use for treating non-hemorrhagic vertebral artery dissection is not great.…”

Endovascular treatment of intracranial vertebral artery unruptured dissecting aneurysms: Comparison of flow diversion and stent-assisted coiling or stenting alone

“…Currently, there are no established treatment approaches for unruptured dissecting aneurysms of the vertebral artery. Even if unruptured intracranial dissecting aneurysms of the vertebral artery have been thought to have a benign clinical course ( 2 , 5 – 10 ), the natural course of these dissections are still unknown and treatment guidelines remain controversial and debatable ( 5 , 11 , 12 ). Moreover, some researchers believed that the risk of bleeding from unruptured dissecting aneurysms of the vertebral artery was higher than previous reports ( 6 , 12 ).…”