The safety and efficacy of using large woven stents to treat vertebrobasilar dolichoectasia

Abstract

ObjectivesTo characterize the safety and efficacy of large woven stents in the treatment of vertebrobasilar dolichoectasia (VBD).MethodsWe retrospectively reviewed 19 consecutive patients with VBD treated with large woven intracranial stent (Leo stents) between January 2016 and December 2018. The clinical symptoms and angiograms of all the patients were recorded.ResultsThe patients were treated with 1–3 large Leo stents (5.5 mm x 75 mm, 5.5 mm x 50 mm, or 4.5 mm x 40 mm), with or without coiling. They had follow-up angiography and MRI between 3 months and 1 year. Digital subtraction angiography showed 16 patients with complete reconstruction of the target vessels, one patient with almost complete reconstruction, and two patients with partial reconstruction. All patients had symptomatic improvement shortly after treatment, but two patients developed recurrent dysphagia at 8 and 18 months, respectively.ConclusionsDeployment of woven stents with or without supportive coiling may offer symptom relief and reconstruction in patients with VBD.

Isolated clival subdural haemorrhage from a dolicoectactic vertebrobasilar aneurysm: Case report and overview of endovascular treatment strategies

“…Large woven stents with or without supportive coiling have been successfully used for reconstruction of symptomatic VB dolicoectasia [ 7 ]. Due to their pore sizes ranging between laser-cut and FD stents, a degree of flow diversion can be achieved when the stent is compacted or placed in an overlapping fashion.…”

“…This highlights the potential benefit of staged treatment in ruptured NSVB aneurysms, which has been advocated to balance the risk of re-bleed and treatment related perforator infarcts. He et al reported no brainstem infarcts in their recent series of 19 patients treated with either stenting alone or with adjunct loose coiling [ 7 ]. The authors postulated that this method likely allowed for remodelling of dolichoectasia whilst allowing filling of important perforators.…”

“…4) Large woven stents with or without supportive coiling have been successfully used for reconstruction of symptomatic VB dolicoectasia. 7) Due to their pore sizes ranging between laser-cut and FD stents, a degree of flow diversion can be achieved when the stent is compacted or placed in an overlapping fashion. In cases of superimposed fusiform dilatation, the risk of growth and perforator infarction remain the main concern as the vessel lumen outside the unopposed stent can continue to fill or thrombose overtime.…”

“…He et al reported no brainstem infarcts in their recent series of 19 patients treated with either stenting alone or with adjunct loose coiling. 7) The authors postulated that this method likely allowed for remodelling of dolichoectasia whilst allowing filling of important perforators.…”

Vestibulocochlear Symptoms Caused by Vertebrobasilar Dolichoectasia

“…Clinical manifestation of VBD, often asymptomatic, may vary widely from exertional headache to fatal consequences such as ischemic stroke or hemorrhage. It is considered a potentially severe condition which may cause dysphagia, choking, quadriplegia or hemiparesis due to posterior fossa compression [5,17]. Compression of the lower brain- stem can trigger vestibulocochlear symptoms such as hearing loss, tinnitus, and vertigo.…”