Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery

Clinical article

Tsz Wai Yeung M.B.B.S. 1 , Vincent Lai F.H.K.C.R., F.H.K.A.M. (Radiology) 2 , Hin Yue Lau M.B.Ch.B., F.R.C.R.(U.K.) 1 , Wai Lun Poon F.H.K.C.R., F.H.K.A.M. (Radiology) 1 , Chong Boon Tan F.H.K.C.R., F.H.K.A.M. (Radiology) 1 and Yiu Chung Wong F.H.K.C.R., F.H.K.A.M. (Radiology) 1
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  • 1 Department of Radiology, Tuen Mun Hospital, Tuen Mun, New Territories; and
  • 2 Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong, China
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Object

Use of a flow-diverting device has shown promising short-term results in the management of vertebral artery (VA) dissecting aneurysms, but there is still uncertainty regarding its long-term efficacy and safety. The authors report their initial experience with respect to the potential utility and long-term clinical outcomes of using a flow-diverting device in the treatment of unruptured dissecting VA aneurysms.

Methods

The authors conducted a retrospective review of all cases of unruptured intracranial VA dissecting aneurysms treated at their institution (Tuen Mun Hospital) with a flow-diverting device. They describe the clinical presentations and angiographic features of the cases and report the clinical outcome (with modified Rankin Scale [mRS] scores) at most recent follow-up, as well as results of the latest angiographic assessment, with particular focus on in-stent patency and side-branch occlusion.

Results

A total of 4 aneurysms were successfully obliterated by using flow-diverting devices alone. Two devices were deployed in a telescoping fashion in each of 2 aneurysms, whereas only 1 device was inserted in each of the other 2 aneurysms. No periprocedural complication was encountered. No patient showed any angiographic evidence of recurrence, in-stent thrombosis, or side-branch occlusion in angiographic reassessment at a mean of 22 months after treatment (range 18–24 months). As of the most recent clinical follow-up (mean 30 months after treatment, range 24–37 months), all patients had favorable outcomes (mRS Score 0).

Conclusions

Reconstruction using a flow-diverting device is an attractive alternative in definitive treatment of dissecting VA aneurysms, demonstrating favorable long-term clinical and angiographic outcomes and the ability to maintain parent artery and side-branch patency. It is particularly useful in cases with eloquent side-branch or dominant VA involvement.

Abbreviations used in this paper:mRS = modified Rankin Scale; PICA = posterior inferior cerebellar artery; VA = vertebral artery.

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Contributor Notes

Address correspondence to: Vincent Lai, F.H.K.C.R., F.H.K.A.M. (Radiology), Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Room 406, Block K, 102 Pok Fu Lam Road, Pok Fu Lam, Hong Kong, China. email: vincentlai@hkcr.org.

Please include this information when citing this paper: published online January 20, 2012; DOI: 10.3171/2011.12.JNS111514.

  • 1

    Ahn JY, , Chung SS, , Lee BH, , Kim SH, , Yoon PH, & Joo JY, : Treatment of spontaneous arterial dissections with stent placement for preservation of the parent artery. Acta Neurochir (Wien) 147:265273, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Ahn JY, , Han IB, , Kim TG, , Yoon PH, , Lee YJ, & Lee BH, : Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol 27:15141520, 2006

    • Search Google Scholar
    • Export Citation
  • 3

    Albuquerque FC, , Fiorella DJ, , Han PP, , Deshmukh VR, , Kim LJ, & McDougall CG: Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus 18:2 E3, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Andoh T, , Shirakami S, , Nakashima T, , Nishimura Y, , Sakai N, & Yamada H, : Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987993, 1992

    • Search Google Scholar
    • Export Citation
  • 5

    Anxionnat R, , de Melo Neto JF, , Bracard S, , Lacour JC, , Pinelli C, & Civit T, : Treatment of hemorrhagic intracranial dissections. Neurosurgery 53:289301, 2003

    • Search Google Scholar
    • Export Citation
  • 6

    Chiaradio JC, , Guzman L, , Padilla L, & Chiaradio MP: Intravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: technical case report. Neurosurgery 50:213217, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Coley SC, & Clifton A: Dissecting vertebral artery aneurysm: diagnosis and coil embolization. Br J Radiol 72:408411, 1999

  • 8

    Fiorella D, , Hsu D, , Woo HH, , Tarr RW, & Nelson PK: Very late thrombosis of a pipeline embolization device construct: case report. Neurosurgery 67:3 Suppl Operative E313E314, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Fiorella D, , Woo HH, , Albuquerque FC, & Nelson PK: Definitive reconstruction of circumferential, fusiform intracranial aneurysms with the pipeline embolization device. Neurosurgery 62:11151121, 2008

    • Search Google Scholar
    • Export Citation
  • 10

    Iihara K, , Sakai N, , Murao K, , Sakai H, , Higashi T, & Kogure S, : Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97:259267, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Jin SC, , Kwon DH, , Choi CG, , Ahn JS, & Kwun BD: Endovascular strategies for vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30:15181523, 2009

    • Search Google Scholar
    • Export Citation
  • 12

    Kakino S, , Ogasawara K, , Kubo Y, , Otawara Y, , Tomizuka N, & Suzuki M, : Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion. Surg Neurol 61:185189, 2004

    • Search Google Scholar
    • Export Citation
  • 13

    Kim BM, , Suh SH, , Park SI, , Shin YS, , Chung EC, & Lee MH, : Management and clinical outcome of acute basilar artery dissection. AJNR Am J Neuroradiol 29:19371941, 2008

    • Search Google Scholar
    • Export Citation
  • 14

    Kitanaka C, , Sasaki T, , Eguchi T, , Teraoka A, , Nakane M, & Hoya K: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620627, 1994

    • Search Google Scholar
    • Export Citation
  • 15

    Kitanaka C, , Tanaka J, , Kuwahara M, , Teraoka A, , Sasaki T, & Takakura K, : Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography. J Neurosurg 80:667674, 1994

    • Search Google Scholar
    • Export Citation
  • 16

    Klisch J, , Turk A, , Turner R, , Woo HH, & Fiorella D: Very late thrombosis of flow-diverting constructs after the treatment of large fusiform posterior circulation aneurysms. AJNR Am J Neuroradiol 32:627632, 2011

    • Search Google Scholar
    • Export Citation
  • 17

    Kocaeli H, , Chaalala C, , Andaluz N, & Zuccarello M: Spontaneous intradural vertebral artery dissection: a single-center experience and review of the literature. Skull Base 19:209218, 2009

    • Search Google Scholar
    • Export Citation
  • 18

    Kurata A, , Ohmomo T, , Miyasaka Y, , Fujii K, , Kan S, & Kitahara T: Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22:1118, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Lee JM, , Kim TS, , Joo SP, , Yoon W, & Choi HY: Endovascular treatment of ruptured dissecting vertebral artery aneurysms—long-term follow-up results, benefits of early embolization, and predictors of outcome. Acta Neurochir (Wien) 152:14551465, 2010

    • Search Google Scholar
    • Export Citation
  • 20

    Lemole GM Jr, , Henn J, , Javedan S, , Deshmukh V, & Spetzler RF: Cerebral revascularization performed using posterior inferior cerebellar artery-posterior inferior cerebellar artery bypass. Report of four cases and literature review. J Neurosurg 97:219223, 2002

    • Search Google Scholar
    • Export Citation
  • 21

    Lylyk P, , Cohen JE, , Ceratto R, , Ferrario A, & Miranda C: Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94:427432, 2001

    • Search Google Scholar
    • Export Citation
  • 22

    MacKay CI, , Han PP, , Albuquerque FC, & McDougall CG: Recurrence of a vertebral artery dissecting pseudoaneurysm after successful stent-supported coil embolization: case report. Neurosurgery 53:754761, 2003

    • Search Google Scholar
    • Export Citation
  • 23

    Manabe H, , Hatayama T, , Hasegawa S, , Islam SM, & Suzuki S: Coil embolisation for ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery. Neuroradiology 42:384387, 2000

    • Search Google Scholar
    • Export Citation
  • 24

    Martin AR, , Pablo Cruz J, , Matouk CC, , Md JS, & Marotta TR: The Pipeline flow-diverting stent for exclusion of ruptured intracranial aneurysms with difficult morphologies. Neurosurgery [epub ahead of print] 2011

    • Search Google Scholar
    • Export Citation
  • 25

    Mizutani T, , Kojima H, & Asamoto S: Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54:342348, 2004

    • Search Google Scholar
    • Export Citation
  • 26

    Mokri B, , Houser OW, , Sandok BA, & Piepgras DG: Spontaneous dissections of the vertebral arteries. Neurology 38:880885, 1988

  • 27

    Naito I, , Iwai T, & Sasaki T: Management of intracranial vertebral artery dissections initially presenting without subarachnoid hemorrhage. Neurosurgery 51:930938, 2002

    • Search Google Scholar
    • Export Citation
  • 28

    Narata AP, , Yilmaz H, , Schaller K, , Lovblad KO, & Pereira VM: Flow diverter stent for ruptured intracranial dissecting aneurysm for of vertebral artery. Neurosurgery [epub ahead of print] 2011

    • Search Google Scholar
    • Export Citation
  • 29

    Peluso JPP, , van Rooij WJ, , Sluzewski M, , Beute GN, & Majoie CB: Endovascular treatment of symptomatic intradural vertebral dissecting aneurysms. AJNR Am J Neuroradiol 29:102106, 2008

    • Search Google Scholar
    • Export Citation
  • 30

    Rabinov JD, , Hellinger FR, , Morris PP, , Ogilvy CS, & Putman CM: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24:14211428, 2003

    • Search Google Scholar
    • Export Citation
  • 31

    Sugiu K, , Tokunaga K, , Watanabe K, , Sasahara W, , Ono S, & Tamiya T, : Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms. Neuroradiology 47:158164, 2005

    • Search Google Scholar
    • Export Citation
  • 32

    Taha MM, , Sakaida H, , Asakura F, , Maeda M, , Toma N, & Yamamoto A, : Endovascular management of vertebral artery dissecting aneurysms: review of 25 patients. Turk Neurosurg 20:126135, 2010

    • Search Google Scholar
    • Export Citation
  • 33

    Takikawa S, , Kamiyama H, , Nomura M, , Abe H, & Saitoh H: [Vertebral dissecting aneurysm treated with trapping and bilateral posterior inferior cerebellar artery side-to side anastomosis; case report.]. No Shinkei Geka 19:571576, 1991. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 34

    Uhl E, , Schmid-Elsaesser R, & Steiger HJ: Ruptured intracranial dissecting aneurysms: management considerations with a focus on surgical and endovascular techniques to preserve arterial continuity. Acta Neurochir (Wien) 145:10731084, 2003

    • Search Google Scholar
    • Export Citation
  • 35

    Yoon W, , Seo JJ, , Kim TS, , Do HM, , Jayaraman MV, & Marks MP: Dissection of the V4 segment of the vertebral artery: clinicoradiologic manifestations and endovascular treatment. Eur Radiol 17:983993, 2007

    • Search Google Scholar
    • Export Citation
  • 36

    Yoshimoto Y, & Wakai S: Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28:370374, 1997

    • Search Google Scholar
    • Export Citation
  • 37

    Zhao WY, , Krings T, , Alvarez H, , Ozanne A, , Holmin S, & Lasjaunias P: Management of spontaneous haemorrhagic intracranial vertebrobasilar dissection: review of 21 consecutive cases. Acta Neurochir (Wien) 149:585596, 2007

    • Search Google Scholar
    • Export Citation

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