Purpose Fusiform dissecting aneurysms involving the dominant vertebral artery with poor collaterals are challenging to treat. This study aimed to evaluate the safety and efficacy of a tunneling technique for reconstructive endovascular treatment of these conditions.

Materials and methods Thirteen patients, 11 men and two women, with a mean age of 54.5 years, each with a fusiform vertebral artery dissecting aneurysm not amenable to internal trapping of the parent artery, underwent reconstructive endovascular treatment using a tunneling technique between Jan 2012 and Dec 2015. The safety, feasibility, and clinical and angiographic outcomes of these procedures were retrospectively evaluated.

Results The average maximum diameter of the fusiform aneurysms was 12.1 mm. Five of them were ruptured. Three aneurysms were treated with a single stent and the remaining ten aneurysms required double stent placement. Treatment was technically successful in all 13 patients, achieving complete occlusion (n=10, 76.9%) and near complete occlusion (n=3, 23.1%). No procedure-related complications occurred in any patient. There were no delayed thromboembolic or hemorrhagic complications during the follow-up period (mean, 19.0 months). Angiographic follow-ups (mean, 9.1 months) showed stable occlusion in 90.9% (10/11) and asymptomatic in-stent occlusion in one patient (9.1%, 1/11). At the end of the observation period (mean, 19.0 months), all patients had excellent clinical outcomes (mRS 0, 92.3%, 12/13), except one (mRS 4), resulting from poor preoperative status.

Conclusion This retrospective study demonstrated that endovascular reconstruction using a tunneling technique was a technically safe, feasible, and clinically effective treatment method for fusiform vertebral artery dissecting aneurysms with ipsilateral dominance.

Disclosures T. Lee: None. J. Ko: None. S. Sung: None.