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Stent alone treatment for dissections and dissecting aneurysms involving the basilar artery
  1. Chuanhui Li,
  2. Youxiang Li,
  3. Chuhan Jiang,
  4. Zhongxue Wu,
  5. Yang Wang,
  6. Xinjian Yang
  1. Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr X Yang, Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No 6, Tiantan Xili, Dongcheng District, Beijing 100050, People's Republic of China; yang-xj{at}163.net

Abstract

Background and purpose: Dissections and dissecting aneurysms involving the basilar artery (BA) are rare lesions with a poor prognosis, and controversies exist on treatment strategy. We describe the clinical presentation, radiologic features, and clinical outcomes of 11 consecutive patients with these lesions, treated using stent alone placement.

Materials and methods 11 patients were studied (10 men, one woman), with a mean age of 51 years (range 30–68 years). Clinical and angiographic data were reviewed retrospectively.

Results It was technically feasible to place stents in all 11 cases, and a multiple stents technique was used in nine patients. Procedure related posterior circulation ischemic complications occurred in two cases. One patient presenting with locked-in syndrome died of a pulmonary embolism 3 months after treatment although the clinical condition was gradually improving after stent placement. In the other eight cases, improvement in initial symptoms or a stable condition was observed on follow-up at 1–48 months. Angiographic follow-up was obtained in nine cases using DSA (n=8) or CT angiography (n=1). Successful occlusion of the aneurysm or dissection sac was noted in two cases, BA occlusion in one case, disappearance of double lumen sign in one case, and delayed retention of contrast medium in one case. For the remaining four patients there was no change in the configuration of the lesions on follow-up angiographic results.

Conclusions Stent alone treatment as a potential and disputable alternative therapeutic option for the treatment of BA dissection and dissecting aneurysms, although technically feasible, was effective in only certain lesions, and this treatment carries substantial risks of complications and a high failure rate. The true effect of this strategy is questionable. A study involving larger populations and a longer follow-up is necessary to evaluate the efficacy of this treatment modality.

  • Aneurysm
  • Angioplasty
  • Dissection
  • Stent

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