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

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Patient 1. A and B: Pretreatment frontal (A) and lateral (B) left vertebral arteriograms showing a dissecting aneurysm at the distal intradural portion of the left VA (arrows). C: Follow-up angiogram obtained 24 months after placement of 2 Pipeline embolization devices, demonstrating complete obliteration of the aneurysm and a patent parent artery (arrow).

  • View in gallery

    Patient 2. Left: Pretreatment right vertebral arteriogram showing a dissecting aneurysm at the distal intradural portion of the right VA. Right: Follow-up angiogram obtained 24 months after placement of a Pipeline embolization device, demonstrating complete obliteration of the aneurysm and a patent parent artery.

  • View in gallery

    Patient 3: right VA aneurysm. Left: Pretreatment right vertebral arteriogram showing a dissecting aneurysm at the distal intradural portion of the right VA. Right: Follow-up angiogram obtained 18 months after placement of a Pipeline embolization device, demonstrating complete obliteration of the aneurysm with a patent parent artery.

  • View in gallery

    Patient 3: left VA aneurysm. A: Pretreatment left vertebral arteriogram showing a dissecting aneurysm at the distal intradural portion of the left VA with close proximity to the PICA. B: Left vertebral arteriogram obtained immediately after placement of 2 Pipeline embolization devices, demonstrating satisfactory positioning of the devices with immediate reduction of inflow into the aneurysm sac and stagnation of contrast medium (arrow). C: Follow-up left vertebral arteriogram obtained 18 months after treatment, demonstrating patency of the covered PICA (arrow) with complete obliteration of the aneurysm.

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