Treatment of Intracranial Vertebral Artery Dissecting Aneurysms Using Pipeline Embolization Devices : AMulticenter Cohort Study.

Abstract

Intracranial vertebral artery dissecting aneurysm (IVADA) is arare type of aneurysm with high morbidity and mortality. Recently, the application of pipeline embolization devices (PEDs) has been extended to IVADAs. Here, we aim to investigate the safety and effectiveness of PEDs for IVADAs. We retrospectively reviewed the PLUS database to identify patients who had IVADAs and were treated with PEDs from 2014 to 2019 at 14centers across China. Data including patient and aneurysm characteristics, procedure details, angiographic and clinical results, relationship with the ipsilateral posterior inferior cerebellar artery (PICA), and patency of the PICA following PED coverage were analyzed. In this study 52 consecutive patients with 52IVADAs were included. The mean age was 52.33years and 82.7% were male. With amedian follow-up of 10.5months, the complete occlusion rate was 93.8% (45/48) and no recurrence or in-stent stenosis was detected. The total postoperative complication rate and mortality were 11.5% and 1.9%, respectively. Complications occurred in 9.6% (5/52) of patients within 30days after the operation, including ischemic stroke in3 and hemorrhagic stroke in2. Another patient suffered an ischemic stroke at follow-up, 78.8% (41/52) PICAs were covered by PEDs, 1 case (2.4%) had afunctional disability due to PICA occlusion, while 39.0% (16/41) had reduced flow during follow-up but hardly caused any obvious neurological deficits. Patients with IVADA involving PICA had atrend towards more complications (66.7% vs. 51.1%; P = 1). Treating IVADAs with PEDs may be asafe and effective option, with favorable clinical and angiographic outcomes; however, complications associated with this treatment should not be ignored. http://www. gov . Unique identifier: NCT03831672.