Original ArticleMagnetic Resonance Imaging Follow-Up of Large or Giant Vertebrobasilar Dissecting Aneurysms After Total Embolization on Angiography
Introduction
Large or giant vertebrobasilar dissecting aneurysms (VBDAs) are rare and clinically challenging, and therapeutic strategies remain controversial.1, 2, 3, 4 Numerous reports discuss successful treatment of VBDAs using endovascular techniques that result in satisfactory arterial lumen outcomes on follow-up angiography.2, 3, 5, 6 However, few reports have assessed the arterial wall evolution of these lesions after endovascular treatment. We asked whether these lesions were considered completely cured only because their lumen was well reconstructed or occluded and whether the arterial wall would return to normal if luminal reconstruction or occlusion was achieved. To address these questions, we report 4 rare cases of large or giant VBDAs treated with endovascular techniques and followed by both 3T high-resolution magnetic resonance imaging (MRI) and angiography. Our aim was to thoroughly evaluate the efficacy of endovascular treatment for large or giant VBDAs from both luminal and arterial wall aspects. To the best of our knowledge, ours is the first report to use 3T high-resolution MRI for follow-up imaging of large or giant VBDAs after endovascular treatment.
Section snippets
Patient Population
This retrospective study was approved by the ethics committee of our institution. Between November 2011 and July 2015, 4 patients had large or giant VBDAs that were successfully treated with endovascular techniques with total embolization of the aneurysms confirmed on follow-up angiography, but the patients had unrelieved or worsened symptoms. These patients had aneurysms with challenging anatomy, and they elected to undergo endovascular treatment rather than open surgery. We evaluated 3T
Results
Initial clinical and radiographic data are summarized in Table 1 and follow-up data are summarized in Table 3.
Discussion
The anatomy associated with VBDAs with compression symptoms related to the brainstem and cranial nerves poses a challenge for open surgery.8 Endovascular treatments, including deconstructive and reconstructive techniques, have emerged as major therapeutic options for such lesions.6, 9 Deconstructive techniques include proximal parent artery occlusion and internal trapping (aneurysm and parent artery occlusion with coils), and reconstructive techniques include stent-assisted coiling and stent
Conclusions
The efficacy of conventional endovascular treatment (e.g., internal trapping with coils, stent-assisted coiling, and stent placement without coils) for large or giant VBDAs is uncertain. Follow-up angiography alone does not adequately predict the outcome. High-resolution MRI is a worthwhile adjunct to follow these lesions.
References (30)
- et al.
Age determination of vessel wall hematoma in spontaneous cervical artery dissection: a multi-sequence 3T cardiovascular magnetic resonance study
J Cardiovasc Magn Reson
(2011) - et al.
Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection
Lancet Neurol
(2015) - et al.
Endovascular treatment of ruptured vertebrobasilar dissecting aneurysms: review of 40 consecutive cases
Neurol India
(2016) The retreatment: indications, technique and results
Eur J Radiol
(2013)- et al.
Continued growth of and increased symptoms from a thrombosed giant aneurysm of the vertebral artery after complete endovascular occlusion and trapping: the role of vasa vasorum. Case report
J Neurosurg
(2003) - et al.
Microsurgical treatment of pediatric intracranial aneurysms: long-term angiographic and clinical outcomes
Neurosurgery
(2010) - et al.
Long-term follow-up study of unruptured vertebral artery dissection: clinical outcomes and serial angiographic findings
J Neurosurg
(2000) - et al.
Partially thrombosed vertebral artery dissecting aneurysm presenting as delayed bulbar compression after lateral medullary infarction
Intern Med
(2015) - et al.
Stent-assisted reconstructive endovascular repair of cranial fusiform atherosclerotic and dissecting aneurysms: long-term clinical and angiographic follow-up
Stroke
(2008) - et al.
Retreatment and outcomes of recurrent intracranial vertebral artery dissecting aneurysms after stent assisted coiling: a single center experience
PLoS One
(2014)
Partially thrombosed intracranial aneurysms: symptoms, evolution, and therapeutic management
Acta Neurochir (Wien)
Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imaging
Stroke
Endovascular strategies for vertebrobasilar dissecting aneurysms
AJNR Am J Neuroradiol
Clinicopathological study of intracranial fusiform and dolichoectatic aneurysms: insight on the mechanism of growth
Stroke
High-resolution double inversion recovery black-blood imaging of cervical artery dissection using 3T MR imaging
AJNR Am J Neuroradiol
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Conflict of interest statement: This work was supported by the National Natural Science Foundation of China Grant Nos. 81301003, 81171079, 81371315, 81471167, and 81220108007 and Special Research Project for Capital Health Development Grant No. 2014-1-1071.
Yisen Zhang and Yanmin Wang are co–first authors.