Comparison of Clinical and Radiologic Outcomes of Diverse Endovascular Treatments in Vertebral Artery Dissecting Aneurysm Involving the Origin of PICA

Abstract

Objective: To determine clinical and radiologic outcomes of vertebral artery dissecting aneurysms involving posterior inferior cerebellar artery according to different types of endovascular treatment.

Methods: This study included 18 vertebral artery dissecting aneurysms (6 ruptured and 12 unruptured) involving posterior inferior cerebellar artery treated from January 2009 to December 2016. Treatments were multiple stenting, stent-assisted coil embolization, vertebral artery trapping with vertebral artery-posterior inferior cerebellar artery stenting, and Pipeline embolization. Clinical and radiologic information were obtained from retrospective chart review and radiologic review.

Results: Subarachnoid hemorrhage was diagnosed initially in 6 of 18 patients, and infarction was diagnosed initially in 2 patients. Multiple stenting was performed in 4 patients, including 1 (25%) who had cerebellar infarction and 1 (25%) who had recurrence. Stent-assisted coil embolization was performed in 8 patients, including 1 (12.5%) who had postoperative cerebellar infarction and 2 (25%) who had recurrence. Vertebral artery trapping with vertebral artery-posterior inferior cerebellar artery stenting was performed in 4 patients, including 1 (25%) who had postoperative cerebellar infarction. There was no recurrence (0%). Pipeline embolization was performed in 2 patients, including 1 (50%) who had recurrence. There was no postoperative infarction (0%). No subarachnoid hemorrhage occurred during follow-up. Deterioration in modified Rankin Scale score was found only in the stent-assisted coil embolization group (1/8; 12.5%).

Conclusions: Vertebral artery trapping with vertebral artery-posterior inferior cerebellar artery stenting showed the lowest rate of aneurysm recurrence with high rate of minor infarction and favorable neurologic outcome. Stent-assisted coil embolization showed high recurrence rates with possible fatal disabling infarction.

Keywords: Endovascular procedure; PICA; Vertebral artery dissection.