Treatment Outcomes of Stent-Assisted Coil Embolization for Ruptured Vertebral Artery Dissecting Aneurysms: The Preservation of Branches May Improve the Prognosis

Stenting of vertebral artery dissecting aneurysms (VADAs) may promote mural apposition of intimal flaps, preserving the patency of injured vessels. Moreover, stent deployment may serve to alter intra-aneurysm flow, inducing saccular thrombus formation, neointimal development, and remodeling of injured vessels. Although an overlapping multistent strategy with coiling has proven successful in this setting, yielding good anatomic and clinical outcomes, coiling may be technically infeasible in some VADAs with unfavorably configured circumferential elevations. Herein, we describe three patients with VADAs for whom coiling was deemed technically problematic. Each underwent double stenting (LVIS within Enterprise), without coil insertion, using local anesthesia. Conventional angiographic follow-up regularly disclosed excellent saccular occlusion and subsequent remodeling of stented arteries. LVIS-within-Enterprise double stenting may be of particular benefit in patients with VADAs, the Enterprise providing outer support to minimize stent bulging (as a fusiform aneurysm) as the inner LVIS reinforces flow diversion.

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Staged, Combined Management of Ruptured Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery: Report of 4 Cases and Review of the Literature

World Neurosurgery ◽

10.1016/j.wneu.2019.05.146 ◽

2019 ◽

Vol 128 ◽

pp. 444-447

Author(s):

You-Sub Kim ◽

Tae-Sun Kim ◽

In-Chul Yang ◽

Sung-Pil Joo

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Review Of The Literature ◽

Cerebellar Artery ◽

Dissecting Aneurysms

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Treatment of Dissecting Distal Vertebral Artery (V4) Aneurysms With Flow Diverters

Operative Neurosurgery ◽

10.1093/ons/opx180 ◽

2017 ◽

Vol 15 (1) ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Jacquelyn A Corley ◽

Ali Zomorodi ◽

L Fernando Gonzalez

Keyword(s):

Vertebral Artery ◽

Neurological Deficits ◽

Medication Regimen ◽

Antiplatelet Medication ◽

Average Improvement ◽

Multiple Challenges ◽

Partial Thrombosis ◽

Flow Diverters ◽

Dissecting Aneurysms

Abstract BACKGROUND Dissecting aneurysms of the intracranial vertebral arteries are rare; however, treatment of these presents multiple challenges, including high risk of rebleeding, development of thromboembolic strokes, and progressive partial thrombosis. Flow diverters, such as Pipeline Endovascular Devices (PEDs; Covidien, Medtronic Inc, Dublin, Ireland), have emerged as a potential treatment option. OBJECTIVE To present our experience with patients treated at our institution with PEDs for dissecting distal vertebral artery (V4 segment) aneurysms. METHODS A retrospective search of our prospectively maintained database was performed between January 2014 and December 2016. We queried our database for all patients treated with PED for dissecting aneurysms of the V4 segment. Information was gathered including demographics, the location and morphology of the aneurysm, the clinical presentation, specific form of treatment, complications, antiplatelet medication regimen, and follow-up time. RESULTS There were a total of 9 patients with dissecting V4 aneurysms treated with PED during the study period. All were treated initially with an average of 1.2 PEDs. All patients were followed with at least one repeat diagnostic angiogram and there was no residual aneurysm seen in 8 of 9 cases. In those that presented with neurological deficits, there was an average improvement in modified Rankin Scale of 2.85 points. CONCLUSION PED is a safe and effective tool that can be used to treat ruptured dissecting aneurysms of this specific segment of the posterior circulation, but it does require close management of antiplatelet therapy in the setting of subarachnoid hemorrhage and close angiographic follow-up.

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