Stent-only treatment for unruptured vertebral artery dissecting aneurysms——An analysis of clinical follow-up

Abstract

Objective To investigate the feasibility, efficacy and safety of stent-only treatment for unruptured vertebral artery dissecting aneurysm (uVADA). Methods Clinical data of 36 uVADA patients who received stent-only treatment at Department of Neurosurgery, Huashan Hospital, Fudan University from August 2010 to June 2014 were retrospectively studied. Ten cases were implanted with a single stent and 26 cases with overlapping stents. All cases underwent imaging (DSA, CTA or MRA) and assessment of clinical outcome based on the modified Rankin scale (mRS). Results The surgical success rate was 100%. Twenty-nine patients had varying hemodynamic changes immediately after stent(s) implantation. Minor brain stem infarction occurred only in 1 case during the perioperative period, which presented with numbness of contralateral limbs and was confirmed by MRI scan.Thirty-one cases underwent clinical follow-up. Median follow-up of 23 months (range: 12-58 months) in 31 cases showed that aneurysm completely disappeared in 16 patients, improved in 9 patients, and stable in 5 cases. Thirty patients had good outcome with mRS scores between 0-1. Only 1 patient died from subarachnoid hemorrhage (SAH) 2 months later. Lastly, among the patients treated with overlapping stents, 2 had varying degrees of new stenosis discovered in distal or proximal end of the stent and no obvious sign of posterior circulation ischemia was detected. Conclusions Stent-only treatment for uVADA might lead to good clinical outcome and few complication. Key words: Aneurysm, dissecting; Vertebral artery; Endovascular treatment; Treatment outcome; Stents