J Cerebrovasc Endovasc Neurosurg.  2024 Sep;26(3):284-292. 10.7461/jcen.2024.E2024.02.006.

Multiple telescopic stenting versus single flow diverter for the treatment of vertebral artery dissecting aneurysm

• Woo MS
• Son W
• Kang DH
• Park J
• Kim M

• KMID: 2559438
• DOI: http://doi.org/10.7461/jcen.2024.E2024.02.006

Abstract

Objective
Reconstruction methods, including stent-assisted coiling, multiple telescopic stents, and flow diverters, are preferred modalities for the treatment of unruptured vertebral artery dissecting aneurysms (VADAs). We aimed to compare the clinical outcomes between two reconstructive flow diversion techniques: single flow diverter (FD) device and multiple telescopic stenting (TS).
Methods
We retrospectively reviewed the clinical data of 39 patients with unruptured VADAs. Of these, 17 patients were treated with multiple TS and 22 with a single FD device. Aneurysm characteristics and clinical outcomes were compared between the two groups.
Results
All aneurysms included in this study successfully achieved flow diversion, regardless of the treatment modality and duration. However, the mean procedure duration to complete the diversion was shorter in the FD group. Subgroup analysis in TS group showed that there were no significant clinical differences between the low-profile visualized intraluminal support and Enterprise stents, except for the mean procedure duration.
Conclusions
Both the single FD and multiple TS methods showed excellent angiographic and clinical outcomes in the treatment of unruptured VADAs. However, single FD required a shorter procedure duration and was associated with faster achievement of complete flow diversion.

Keyword

Endovascular aneurysm repair; Intracranial aneurysm; Stents; Vertebral artery dissection

Figure

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  Fig. 1. (A) Vertebral artery dissecting aneurysm (VADA) at the right V4 segment. (B) Proximal and distal stent markers (white arrow) showed the complete deployment of the triple telescopic stenting with Enterprise stents. (C)1-year follow-up computed tomography (CT) angiography demonstrate the disappearance and complete diversion of the aneurysm.

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  Fig. 2. (A) Vertebral artery dissecting aneurysm (VADA) at the right V4 segment. (B) Double telescopic stenting with LVIS stent was successfully performed and stent markers showed that stents completely covered the entire aneurysm. (white arrow). (C) 1-year follow-up computed tomography (CT) angiography demonstrates the disappearance and complete diversion of the aneurysm.

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  Fig. 3. (A) Vertebral artery dissecting aneurysm (VADA) with proximal severe stenosis at the right V4 segment. (B) A single flow diverter (Pipeline) was deployed. The aneurysm was successfully covered by the diverter and improvement of the proximal stenosis was observed. (C) 1-year follow-up computed tomography (CT) angiography demonstrates the disappearance and complete diversion of the aneurysm.

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