Neurointervention.  2015 Feb;10(1):14-21. 10.5469/neuroint.2015.10.1.14.

Endovascular Treatment of Intracranial Vertebral Artery Dissecting Aneurysms: Follow up Angiographic and Clinical Results of Endovascular Treatment in Serial Cases

• Shin GW
• Jeong HW

• KMID: 1910755
• DOI: http://doi.org/10.5469/neuroint.2015.10.1.14

Abstract

PURPOSE
To report angiographic and clinical results of endovascular treatment in 45 intracranial vertebral artery dissecting aneurysms (VADAs).
MATERIALS AND METHODS
From July 2002 to September 2013, a total of 42 patients with 45 VADAs received endovascular treatment. Endovascular treatment consisted of internal trapping with detachable coils, stent-assisted coiling, and stenting only. Immediate and follow-up angiographic findings and clinical outcome were retrospectively reviewed.
RESULTS
There were 17 ruptured VADAs and 28 unruptured VADAs. Overall, 26 VADAs were treated with internal trapping, 14 with stent-assisted coil embolization, and 5 with stenting only. Immediate angiographic results revealed complete occlusion in 31 cases and incomplete occlusion in 14 cases. Follow-up imaging studies were available in 31 cases. On follow-up imaging, antegrade recanalization occurred in 2 of 16 cases treated with internal trapping. Aneurysmal recurrence occurred in one case treated with stent-assisted coiling. Procedural complications occurred in 8 patients. In cases of unruptured VADA, favorable outcome (mRS 0 and 1) was achieved in 26 cases and poor outcome (mRS 2-5) in 2 cases. There was no mortality in patients with unruptured VADAs.
CONCLUSION
Endovascular treatment of intracranial VADA appears to be safe and effective. Follow-up angiographic study is needed because parent artery recanalization or aneurysmal recurrence can occur.

Keyword

Vertebral artery; Dissecting aneurysm; Endovascular treatment; Coil embolization

MeSH Terms

Aneurysm
Aneurysm, Dissecting*
Arteries
Embolization, Therapeutic
Follow-Up Studies*
Humans
Mortality
Parents
Recurrence
Retrospective Studies
Stents
Vertebral Artery*

Figure

• 

  Fig. 1 A 41-year-old female with acute SAH. A. Working projection of the left vertebral angiogram shows a dissecting aneurysm arising from the left vertebral artery proximal to origin of PICA. B. The dissecting aneurysm and affected left vertebral artery are completely occluded. C. Follow-up angiogram after 6 months reveals recanalization of the occluded left vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery.

• 

  Fig. 2 A 46-year-old female with SAH. A. Working projection of the left vertebral angiogram shows a dissecting aneurysm in the dominant left vertebral artery. B.The left vertebral dissecting aneurysm is embolized using stent-assisted coiling. C. Follow-up angiogram after 13 months reveals remodeling of the affected left vertebral artery.

• 

  Fig. 3 A 54-year-old female with headache. A, B. Initial anteroposterior angiogram and 3-dimensional reconstruction image of the left vertebral artery show a dissecting aneurysm arising from the left vertebral artery involving origin of PICA. C.The left vertebral dissecting aneurysm is partially embolized using coil and stent. D. Follow-up angiogram obtained after 1 year reveals recanalization of the left vertebral artery dissecting aneurysm. E. The dissecting aneurysm and affected left vertebral artery are occluded by internal trapping with preservation of the left PICA.

• 

  Fig. 4 A 41-year-old male with headache. A, B. Initial right vertebral angiogram and 3-dimensional reconstruction image of the right VA shows a dissecting aneurysm arising from the right VA. C. The double stent insertion without coil embolization in the affected right vertebral artery was done. D. Follow-up CT angiogram obtained after 11 months shows patent and improved blood flow with normalized vessel remodeling in stent inserted parent artery and its distal portion.

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