Treatment of vertebro-basilar dissecting aneurysms using intravascular stents

Abstract

Endovascular surgery is an established primary therapeutic modality for dissecting aneurysms at vertebro-basilar arteries. Intravascular stents can be used to treat the dissecting aneurysms for which simple obliteration procedures cannot be used. In such cases, stent implantation alone or a combination of stents and coils need to be selected properly by taking into consideration the site and shape of dissections. In this report, three patterns of stent application are described and their method of selection is discussed.

Figure 1

Case 1: Left VAG before treatment (A,B), after the second stent placement (C,D), and 3.5 months after the initial treatment (E,F). The dissecting aneurysm involved branching of the left PICA. Stagnation of the blood flow is shown soon after the second stent implantation (D). Complete obliteration of the aneurysm while preserving the left VA and PICA was obtained 2.5 months after placement of the second stent.

Figure 2

Case 2: Left VAG before treatment (A,B), after stent implantation (C), and four weeks after stent implantation (D) and a plain roentgen graph after addition of coils (E). The aneurysm was obliterated six months after the initial treatment (F).

Figure 3

Case 3: A large dissecting aneurysm at the left VA was treated with a stent and coils (A,B). A small remnant neck was shown after coil embolizaion (C), and persisted for more than six months. Follow-up examination at 12 months showed complete obliteration (D).

Figure 4

Case 4: Right (A,B) and left (C) VAG before treatment. Right VAG (D,E) immediately after the implantation of a stent from the BA to right VA and coil embolization of the aneurysm and left VA (F).

Figure 5

Three patterns of stent implantation used in this report: A) single stent or double stent implantation, B,C) combinations of a stent and coils. Broken lines show occlusive portions and gray zones show area that should be thrombosed.