Sole stenting bypass for the treatment of vertebral artery aneurysms: technical case report

Abstract

Objective and importance: Vertebrobasilar aneurysms have a risk of rupture ranging from 2.5 to 50% (especially those larger than 7 mm) and a repeat bleeding rate of between 30 and 70%. For this reason, patients with aneurysms larger than 7 mm should be treated. Considering the high complexity of surgical approaches in this area, an increasing number of reported cases are being treated with endovascular therapy. The purpose of this article is to determine the effectiveness and safety of sole stenting bypass in the treatment of three consecutive patients with vertebrobasilar aneurysms.

Clinical presentation: Three patients (one woman and two men) with vertebrobasilar junction aneurysms were included in this study. Two of the patients presented with subarachnoid hemorrhage.

Intervention: An endovascular procedure was performed under general (two patients) or local (one patient) anesthesia and via a right femoral approach. By use of road map guidance, sole Express (one patient) or Express 2 (two patients) coronary stents (Boston Scientific/Scimed, Maple Grove, MN) were deployed on the diseased vessel. When the stent was in place, an immediate partial thrombosis of the aneurysm was observed, related primarily to an intra-aneurysmal flow pattern modification, possibly facilitated by modification of the angle of the parent vessel. Follow-up angiograms showed complete exclusion of the aneurysms within the circulation. Only one patient presented visual deficit as a thrombotic complication, but it disappeared completely 6 months after treatment.

Conclusion: The sole stenting bypass technique seems to be a good alternative for the treatment of complex vertebral aneurysms by inducing thrombosis of the aneurysm with preservation of the parent vessel lumen.