Article Text
Abstract
Objective Recurrent vertebral artery dissecting aneurysm (VADA) after previous endovascular treatment such as coil embolization or stent-assisted coiling (SAC) is uncommonly encountered. If there is evidence of size change over time or if accompanied by worsening clinical symptoms due to mass effect, further retreatment is mandatory. The aim of this study is to investigate the difference in efficacy and safety between additional SAC and flow diverting stent (FDS) for recurred VADAs.
Method Total 15 recurrent VADAs retreated with SAC (n = 7) and FDS (n = 8) from April 2009 to January 2023 were included. Medical records and radiologic data were retrospectively reviewed to assess efficacy and safety of SAC and FDS.
Result The mean maximal dissection length and depth in each group were as follows, 15.6 (10.7–25.0) mm and 13.9 (6.3–29.4) mm in SAC group; and 15.4 (7.2 - 23.6) mm and 11.0 (3.5 - 23.6) mm of FDS group. Three of 7 cases were achieved immediate successful occlusion in the SAC group, and 4 of 8 cases were observed immediate contrast stagnation in the FDS group. None was occurred procedure-related hemorrhagic or thromboembolic complication in the both groups. In follow-up angiography, however, major recanalization was observed in 4 cases (57.1%) of SAC group and 3 cases (37.5%) of FDS group.
Conclusion Reconstructive interventions have proven safe and effective in recurrent VADA. However, follow-up outcomes of the retreatment for recurrent VADA appear to be worse than those of initial aneurysms, even in the FDS group. Further study with a larger cohort would be needed to confirm these results.
Disclosures Y. Cho: None.