Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms

Abstract

Background and purpose: Little has been known about the clinical and angiographic follow-up results of stent-only therapy for intracranial vertebrobasilar dissecting aneurysms (VBDA). The purpose of this study was to evaluate the feasibility, safety, clinical, and angiographic follow-up of stent-only therapy for VBDA.

Materials and methods: Twenty-seven patients with 29 VBDAs (11 ruptured, 18 unruptured), not suitable for deconstructive treatment, underwent stent-only therapy. Feasibility, safety, clinical, and angiographic follow-up were retrospectively evaluated. Angiographic outcomes were compared between single-stent and multiple-stent groups.

Results: All attempted stent placements were successfully accomplished without any treatment-related complication. Of the 11 ruptured VBDAs, 4 were treated by single stents, 6 by double overlapping stents, and 1 by triple overlapping stents. Of the 18 unruptured VBDAs, 6 were treated by stents, and 12 by double overlapping stents. One patient with a ruptured VBDA, treated by single stent, had rebleeding and died. None of the remaining patients had posttreatment bleeding during follow-up (mean, 28 months; range, 7-50 months). Eight patients with ruptured VBDA and all patients with unruptured VBDA had excellent outcomes (modified Rankin Scale, 0-1). The remaining 2 patients with ruptured VBDA were moderately disabled because of the initial damage. Angiographic follow-up was available in 27 VBDAs, 4 to 42 months (mean, 12 months) after treatment. Follow-up angiograms revealed complete obliteration of the dissecting aneurysm in 12, partial obliteration in 12, stable in 1, enlargement in 1, and in-stent occlusion in 1. Angiographic improvement (complete or partial obliteration) was more frequent in the multiple-stent group (17/17) than in the single-stent group (7/9; P < .05).

Conclusions: In this small series, stent-only therapy was safe and effective in the treatment of VBDAs that were not deemed suitable for treatment with parent-artery occlusion.

Fig 1.

Images in a 42-year-old man presenting with an acute SAH. A, Left vertebral artery angiogram reveals a dissecting aneurysm with an asymmetrically fusiform appearance at the segment-bearing left posterior inferior cerebellar artery. At 42 months after treatment with double overlapping stents, a left vertebral angiogram (B) and 3D reconstruction images (C) show complete obliteration of the dissecting aneurysm sac with preservation of the left PICA.

Fig 2.

Images in a 49-year-old man presenting with an acute SAH. A, Right vertebral angiogram reveals irregular dilation of the right intracranial vertebral artery with a pearl-and-string appearance, involving the origin of the right PICA. B, Right vertebral angiography 4 days after double-overlapping stent insertion shows partial resolution of the pearl-and-string appearance but reveals enlarged fusiform dilation of the dissected segment. C, Six-month follow-up angiogram after third overlapping stent reveals complete obliteration of the fusiform dilation with a preserved PICA and smooth reconstruction of the dissected segment.

Fig 3.

Images in a 24-year-old woman presenting with SAH. A, Left vertebral angiogram reveals an asymmetrical fusiform dilation with a bleb (white arrow) of the basilar artery. B, Left vertebral angiogram immediately after a balloon-expandable coronary stent insertion reveals near-complete obliteration of the dissecting aneurysm sac. C, Left vertebral angiogram performed because of rebleeding 3 days after the single-stent placement shows an irregular-shaped and enlarged pseudoaneurysm (black arrow) of the basilar artery.