Introduction Intracranial vertebral dissecting pseudoaneurysms are a rare, but increasingly recognized, cause of subarachnoid hemorrhage and ischemic stroke. The risks of aneurysm re-rupture and associated morbidity are high. The use of flow diverter stents for the treatment of these aneurysms has not been well studied.
Objective To report our data and provide a summarized review of literature using flow diverter stents for the treatment of intracranial vertebral artery dissecting pseudoaneurysms.
Methods We performed a retrospective analysis of flow diverter stents used for the treatment of intracranial vertebral artery dissecting pseudoaneurysms. Clinical, imaging, procedural, and follow-up data were collected.
Results We identified eight vertebral dissecting pseudoaneurysms in seven patients (5 (71.4%) female; median age 47 years (IQR 46–52)) who had undergone treatment with flow diverter stents. In 4/7 patients (57.1%) the aneurysm had ruptured; however, only one was treated in the acute phase. Median size of the largest diameter of the aneurysm was 6.3 mm (IQR 4.2–8.8), and 7/8 aneurysms (87.5%) were treated with a single flow diverter device. Three aneurysms were concurrently coiled. Angiographic complete occlusion was seen in 6/8 (75%) aneurysms at a median follow-up of 14 months (IQR 7.7–20.2). Two patients had periprocedural strokes with transient neurologic deficits. All patients had a good clinical outcome (modified Rankin Scale score ≤2). There were no re-treatments or aneurysm ruptures during the follow-up period.
Conclusions Our experience suggests that flow diverter stent treatment of intracranial vertebral artery dissecting pseudoaneurysms is safe, and associated with good occlusion rates and favorable clinical outcomes.
- Flow Diverter
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Contributors RC: design of the work, acquisition of data, interpretation of data, drafting of the manuscript. GT: study conception, interpretation of data, critical revision of manuscript. Remaining authors assisted in interpretation of data and critical revision of the manuscript.
Competing interests MB: Codman and Stryker consultant. Clinical Events Committee for the BARREL trial. MSH: Pulsar Inc, Clinical Events Committee. PR: Medtronic Neurovascular—Scientific Advisory Board; Genentech—consultant/honorarium; Nervive Medical—Scientific Advisory Board and stock holder; Perflow Medical—Scientific Advisory Board and stock holder; Stryker Neurovascular—Scientific Advisory Board. GT: Data Safety Monitoring Board for the COMPASS trial.
Ethics approval Institutional review board, Cleveland Clinic.
Provenance and peer review Not commissioned; externally peer reviewed.