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Angiographic and clinical outcomes of stent-alone treatment for spontaneous vertebrobasilar dissecting aneurysm

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Abstract

Purpose

Spontaneous vertebrobasilar dissecting aneurysm (VBD) is a very challenging disease with an unpredictable clinical course and controversies on treatment strategy. The present study reports radiological and clinical outcomes of stent-alone treatment (SAT) for VBD.

Methods

Twenty-four VBDs treated with SAT are included in the present study. Clinical and angiographic data were reviewed retrospectively.

Results

A total of 24 lesions in 22 patients with a mean follow-up period of 16.21 months were included. Of the 24 individual lesions, 23 were intracranial vertebral artery lesions and 1 lesion was located in the basilar artery. There were six cases of ruptured dissections with the other cases having various symptoms. The immediate post-SAT angiographic outcomes included 5 lesions with good remodeling over 90% recovery and 19 poorly remodeled lesions. The latest angiographic outcomes included 17 cases of good remodeling (remodeling rate over 90%), 6 cases of poor remodeling (remodeling rate below 70%), and 1 case with morphological aggravation. The overlapping stent technique was used in seven cases and it was significantly associated with good angiographic results. None of the rupture cases underwent re-rupture post SAT. There was one case of a symptomatic complication of a femoral arteriovenous fistula.

Conclusions

The SAT could be a feasible alternative for the treatment of VBD. The overlapping technique was significantly associated with good angiographic outcome. We expect that technological development of the intracranial stent will allow better procedural outcomes of SAT.

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Acknowledgment

We express our special thanks to Dr. Im (Su-Bin Im M.D. Assistant professor, Department of Neurosurgery, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea) who made the conceptual schematic graphics of arterial dissection and hemodynamic change after stent placement.

Notification of conflicts of interest and financial disclosure

The authors report no conflict of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Holy Family Hospital, The Catholic University of Korea, Sosa-dong, Wonmi-gu, Bucheon, Gyeonggi-do, 429-717, Republic of Korea

    Won Ki Yoon, Young Woo Kim, Seong-Rim Kim, Ik Seong Park, Sang Don Kim, Kwang Wook Jo & Min Woo Baik

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  1. Won Ki Yoon
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Correspondence to Min Woo Baik.

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Comment

As the authors discuss in this article, the use of a balloon-mounted stent to treat vertebrobasilar dissections should be performed with great caution as balloon inflation can extend or rupture the dissected segment. In addition, the navigability of these stents may be a limiting factor if the circulation is too tortuous. The authors show good results with these stents, but self-expanding stents approved for use in the intracranial circulation are considered safer and are equally amenable to an overlapping technique to improve chances of parent vessel remodeling and aneurysm stasis. We recommend as a safety measure the use of a balloon guide so that flow arrest can be instituted prior to stent deployment with aspiration prior to reestablishing flow to remove any clots that might be liberated during stent expansion.

Mandy J. Binning, MD and L. Nelson Hopkins, MD

University at Buffalo, State University of New York

Buffalo, New York, USA

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Yoon, W.K., Kim, Y.W., Kim, SR. et al. Angiographic and clinical outcomes of stent-alone treatment for spontaneous vertebrobasilar dissecting aneurysm. Acta Neurochir 152, 1477–1486 (2010). https://doi.org/10.1007/s00701-010-0693-7

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