Clinical and Radiological Outcomes of Vertebral Artery Dissecting Aneurysms Treated with Endovascular Treatments: A 12-year Single-Center Experience

Abstract

We aimed to compare the clinical and radiological outcomes of vertebral artery dissecting aneurysms (VADAs) stratified using different endovascular treatment methods. We retrospectively reviewed 116 patients with VADAs treated at a single tertiary institute between September 2008 and December 2020. We analyzed and compared the clinical and radiological parameters according to different treatment methods. In total, 127 endovascular procedures were performed in 116 patients. We initially treated 46 patients with parent artery occlusion, nine with coil embolization without stent, 43 with single stent with or without coil, 16 with multiple stents with or without coils, and 13 with flow-diverting stent. At the last follow-up (mean 37.8 ± 30.9 months), the complete occlusion rate (85.7%) was higher in the multiple stent group than in the groups that received other reconstructive treatment methods. Moreover, the recurrence (0%) and retreatment (0%) rates were significantly lower in the multiple stent group (p<0.001). The coil embolization-only group showed the highest recurrence (n=5, 62.5%) and incomplete occlusion (n=1, 12.5%) rates. The single-stent group showed higher recurrence (n=9, 22.5%) and retreatment (n=3, 7%) rates. Multivariate logistic regression analyses showed that coil embolization without stent placement (OR=172.76, p=0.002, 95% confidence interval [CI] 6.83-4366.85) was significantly associated with recurrence. At the last follow-up (mean 42.1 ± 37.7 months), we achieved favorable clinical outcomes (mRS ≤ 2) in 106 of 127 patients. When treating VADAs, multiple stent placements may play a key role in achieving favorable long-term radiological outcomes.