Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms

Abstract

Objective: Vertebrobasilar dissecting aneurysm (VBDA) management is challenging despite the availability of multiple treatment strategies. We reviewed our experiences using endovascular treatment for VBDA patients to assess the efficacy and safety of several VBDA treatment strategies.

Methods: Assisted by intra-arterial digital subtraction angiography, 35 patients in our hospital were treated using various VBDA treatment strategies, including stent-assisted coil embolization (20 patients), placement of single or multiple overlapping stents (5 patients) or coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+PT; 10 patients). We retrospectively reviewed the perioperative records of all 35 patients and the post-procedure angiographic and clinical outcomes of 31 available patients.

Results: Of the 25 cases with ruptured VBDAs, 14 underwent stent-assisted coil embolization, 2 underwent multiple overlapping stent placement and 9 underwent CE+PT. Perioperative complications occurred in four cases (16.0%), including one aneurysm rupture and one parent artery thrombosis during the procedure and two incidences of brainstem ischemia after the procedure. Clinical outcome evaluations were performed using the Modified Rankin Scale and resulted in the following scores: 0-2 for 22 patients (22/25, 88.0%), 5 for one patient (1/25, 4.0%) and 6 for two patients (2/25, 8.0%). No cerebral bleeding events or deaths occurred during the follow-up period. Of the 10 cases with unruptured VBDAs, six underwent stent-assisted coil embolization, three underwent single or multiple overlapping stent placement and one patient underwent CE+PT. All 10 of the patients with unruptured VBDAs had favorable clinical and radiologic outcomes without procedure-related complications.

Conclusions: For patients with ruptured VBDAs, the complication rate associated with endovascular treatment is acceptable. CE+PT is better than stent coiling in preventing aneurysmal rerupture, but is associated with a high incidence of ischemic stroke. For unruptured VBDAs, endovascular treatment is associated with good clinical outcome without perioperative complications, including rerupture and ischemic stroke. However, the high postoperative recurrent aneurysm risk suggests the necessity of long-term angiographic follow-up monitoring of VBDA patients who undergo endovascular treatments.

Keywords: Digital subtraction angiography; Endovascular treatment; Long-term follow-up; Vertebrobasilar dissecting aneurysms.