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Case series
Flow diverter treatment of intracranial vertebral artery dissecting pseudoaneurysms
  1. Russell Cerejo,
  2. Mark Bain,
  3. Nina Moore,
  4. Julian Hardman,
  5. Andrew Bauer,
  6. M Shazam Hussain,
  7. Thomas Masaryk,
  8. Peter Rasmussen,
  9. Gabor Toth
  1. Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Gabor Toth, Cerebrovascular Center, Cleveland Clinic, 9500 Euclid Ave, S80, Cleveland, OH 44195, USA; tothg{at}


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.

  • Aneurysm
  • Flow Diverter
  • Dissection

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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.