Stent Placement for the Treatment of Intracranial Vertebral Artery Dissecting Aneurysms

Abstract

Intracranial vertebral artery (VA) dissecting aneurysms are commonly treated with endovascular parent artery occlusion. However, this procedure cannot be applied to patients with aplastic/hypoplastic contralateral VA or with posterior inferior cerebellar artery (PICA) involved in the dissecting segment. Recently, endovascular treatment using stents for VA dissecting aneurysms has been reported. In this study, we investigated the safety, efficacy, and optimal application of this treatment. Thirteen patients were treated using stents to preserve the patency of the VA, PICA, and anterior spinal artery (ASA). In 6 patients, PICA or ASA was involved in the dissecting segment. Seven patients presented with subarachnoid hemorrhage (SAH), 4 with ischemic symptoms, 1 with headache without SAH, and 1 with incidental discovery. Eleven patients were treated with stent-assisted coil embolization and 2 with stenting only. Stents were successfully deployed in all patients. Of the 11 patients treated with stent-assisted coiling, complete obliteration of the aneurysm was achieved in 5 patients and residual dome filling was present in 5. In the remaining patient, aneurysm rupture occurred during the insertion of the coils, and therefore parent artery occlusion was performed. In 2 patients treated with stenting only, complete obliteration was confirmed by follow-up angiography. Growth of the aneurysmal dilatation occurred in 1 patient, but subsequent SAH was not observed in any patient. Endovascular treatment using stents and coils appears safe and effective, and provides an effective alternative to treating patients with aplasia/hypoplasia of the contralateral VA and some patients with involvement of the origin of PICA or ASA in the dissecting segment.