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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1514-1520, August 2006
© 2006 American Society of Neuroradiology

INTERVENTIONAL

Endovascular Treatment of Intracranial Vertebral Artery Dissections with Stent Placement or Stent-assisted Coiling

J.Y. Ahn^a, I.B. Han^c, T.G. Kim^c, P.H. Yoon^d, Y.J. Lee^d, B.-H. Lee^e, S.H. Seo^b, D.I. Kim^b, C.K. Hong^a and J.Y. Joo^a

^a Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
^b Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, South Korea
^c Department of Neurosurgery, Pochon CHA University, Sungnam, South Korea
^d Department of Diagnostic Radiology, Pochon CHA University, Sungnam, South Korea
^e Department of Diagnostic Radiology, Eulji University Hospital, Daejeon, South Korea

Address correspondence to Jung Yong Ahn, MD, Department of Neurosurgery, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92, Dogok-dong, Kangnamgu, Seoul, 135-720, South Korea; e-mail: jyahn{at}yumc.yonsei.ac.kr

BACKGROUND AND PURPOSE: Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion in intracranial vertebral artery dissections. We describe the efficacy and limitations of this method.

METHODS: Fourteen patients with intracranial vertebral artery dissection were treated with stent placement (10 patients) or stent-assisted coiling (4 patients). Double overlapping stents were deployed in 4 of 10 patients with stent placement alone. Angiographic follow-up at 6 to 12 months was available in 13 patients.

RESULTS: In 13 patients with dissecting aneurysm, immediate angiographic outcomes were complete occlusion (1 patient), nearly complete (2 patients), and incomplete (10 patients). Follow-up angiograms of 12 of these patients showed complete occlusion (6 patients) and incomplete (6 patients; 1 unstable and 5 stable). Complete occlusion rates in follow-up angiograms were superior in double stent placement (75%) or stent-assisted Guglielmi detachable coil (GDC) embolization to stent placement alone (0%). There were no instances of postprocedural ischemic attacks, new neurologic deficits, and no new minor or major strokes before patient discharge. On the modified Rankin scale applied in follow-up, all patients were assessed as functionally improved or of stable clinical status.

CONCLUSIONS: Intracranial vertebral artery dissections were acceptably treated with stent placement or stent-assisted coiling, and the patency could be preserved at follow-up. However, the efficiency of stent placement alone for intracranial vertebral artery dissecting aneurysm was limited. Stent-assisted coil embolization or double stent placements are a viable alternative for complete occlusion of dissecting aneurysms.

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