PT  - JOURNAL ARTICLE
AU  - Joshua S Catapano
AU  - Andrew F Ducruet
AU  - Megan S Cadigan
AU  - Dara S Farhadi
AU  - Neil Majmundar
AU  - Candice L Nguyen
AU  - Jacob F Baranoski
AU  - Tyler S Cole
AU  - D Andrew Wilkinson
AU  - Vance L Fredrickson
AU  - Visish M Srinivasan
AU  - Felipe C Albuquerque
TI  - Endovascular treatment of vertebral artery dissecting aneurysms : a 20-year institutional experience
AID  - 10.1136/neurintsurg-2020-017089
DP  - 2021 Apr 27
TA  - Journal of NeuroInterventional Surgery
PG  - neurintsurg-2020-017089
4099  - http://jnis.bmj.com/content/early/2021/04/26/neurintsurg-2020-017089.short
4100  - http://jnis.bmj.com/content/early/2021/04/26/neurintsurg-2020-017089.full
AB  - Background The ideal treatment for unruptured vertebral artery dissecting aneurysms (VADAs) and ruptured dominant VADAs remains controversial. We report our experience in the management and endovascular treatment of patients with VADAs.Methods Patients treated endovascularly for intradural VADAs at a single institution from January 1, 1999, to December 31, 2019, were retrospectively reviewed. Primary neurological outcomes were assessed using modified Rankin Scale (mRS) scores, with mRS >2 considered a poor neurological outcome. Additionally, any worsening (increase) in the mRS score from the preoperative neurological examination was considered a poor outcome.Results Ninety-one patients of mean (SD) age 53 (11.6) years (48 (53%) men) underwent endovascular treatment for VADAs. Fifty-four patients (59%) presented with ruptured VADAs and 44 VADAs (48%) involved the dominant vertebral artery. Forty-seven patients (51%) were treated with vessel sacrifice of the parent artery, 29 (32%) with flow diversion devices (FDDs), and 15 (17%) with stent-assisted coil embolization (stent/coil). Rates of procedural complications and retreatment were significantly higher with stent/coil treatment (complications 4/15; retreatment 6/15) than with vessel sacrifice (complications 1/47; retreatment 2/47) or FDD (complications 2/29; retreatment 4/29) (p=0.008 and p=0.002, respectively). Of 37 patients with unruptured VADAs treated, only two (5%) had mRS scores >2 on follow-up.Conclusion Endovascular FDD treatment of VADAs appears to be associated with lower retreatment and complication rates than stenting/coiling, although further study is required for confirmation. Endovascular treatment of unruptured VADAs was safe and was associated with favorable angiographic and neurological outcomes.No data are available. There are no additional data to share.