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Flow diverter for the treatment of large (> 10 mm) vertebral artery dissecting aneurysms

  • Original Article - Vascular Neurosurgery - Aneurysm
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Objective

To evaluate the outcomes of flow-diverting device (FDD) treatment for large vertebral artery dissecting aneurysms (VADAs).

Methods

This retrospective study evaluated 12 patients with 12 VADAs who were treated using FDD between 2013 and 2020. Clinical and radiographic data, including procedure-related complications and clinical outcomes assessed using the modified Rankin Scale (mRS) at the time of the last follow-up, were collected and reviewed.

Results

All 12 patients had unruptured aneurysms. There were 3 (25%) female and 9 (75%) male patients, and the mean patient age was 54.6 years. The mean size of the aneurysm was 15.9 ± 4.8 mm. The mean follow-up duration was 15.8 months. Single FDD without additional coils was used in all patients. One patient underwent second-line treatment with FDD for recurrence of large VADA after stent-assisted coiling. Immediate follow-up angiography after placement of the FDD demonstrated intra-aneurysmal contrast stasis. There were 2 (17%) patients who had peri-procedural stroke. Angiography at the 6-month follow-up in 10 patients showed favorable occlusion (OKM grade C3 + D). A total of 11 (92%) patients had good clinical outcome (modified Rankin Scale ≤ 2) at the last follow-up. No re-treatment or delayed aneurysm rupture occurred during the follow-up period.

Conclusions

Reconstructive technique with FDD is a feasible and effective modality for the treatment of large VADAs, showing favorable occlusion rate and clinical outcome.

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Abbreviations

VADA:

Vertebral artery dissecting aneurysm

SAC:

Stent-assisted coil embolization

FDD:

Flow-diverting device

DSA:

Digital subtraction angiography

MRA:

Magnetic resonance angiography

PAO:

Parent artery occlusion

OKM:

O’Kelly Marotta grading system

EVT:

Endovascular treatment

SAH:

Subarachnoid hemorrhage

ASA:

Anterior spinal artery

PICA:

Posterior inferior cerebellar artery

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for the English language editing.

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Authors and Affiliations

  1. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Woosung Lee

  2. Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hyun Jin Han, Junhyung Kim, Keun Young Park, Yong Bae Kim & Joonho Chung

  3. Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea

    Chang Ki Jang

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  1. Woosung Lee
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Correspondence to Joonho Chung.

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Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of our Institutional Review Board with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Patient consent

For this type of retrospective study formal consent is not required.

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Comments

The authors retrospectively evaluated their flow-diverting device (FDD) treatment of large vertebral artery dissecting aneurysms (VADA). Although there are several reports concerning FDD treatment of VADAs, they demonstrated relatively good clinical and radiological results using with short-term follow-up study. As they concluded, FDD might be a preferred option for large VADA treatment.

On the other hand, they have experienced two hemorrhagic complications among 12 patients with VADAs treated by FDD. This is not ignorable rate of complication. One patient with peri-procedural SAH might be caused by delivery wire perforation during manipulation of FDD placement. Meticulous handling of the FDD and development of safer device by the manufactory side will reduce this type of complication. In another patient with intraparenchymal hemorrhage, mechanism of the bleeding was not clear. The authors speculated that triple antiplatelet therapy for this particular patient might relate to development of intraparenchymal hemorrhage. Dose reduction of the antiplatelet agents was not clearly determined in each patient. Appropriate management of the antiplatelet agents will be another key point of the successful treatment. Long-term and large cohort study including antiplatelet management will be needed.

Kenji Sugiu,

Okayama city, Japan.

This article is part of the Topical Collection on Vascular Neurosurgery—Aneurysm

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Lee, W., Han, H.J., Kim, J. et al. Flow diverter for the treatment of large (> 10 mm) vertebral artery dissecting aneurysms. Acta Neurochir 164, 1247–1254 (2022). https://doi.org/10.1007/s00701-021-04965-2

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  • DOI: https://doi.org/10.1007/s00701-021-04965-2

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