Comparison of Clinical and Radiologic Outcomes of Diverse Endovascular Treatments in Vertebral Artery Dissecting Aneurysm Involving the Origin of PICA

• Published in: World neurosurgery 2019-01, Vol.121, p.e22-e31
• Main Authors: Cho, Dong Young, Choi, Jai Ho, Kim, Bum Soo, Shin, Yong Sam
• Format: Article
• Language: English
• Subjects: Endovascular procedure; PICA; Vertebral artery dissection
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.184

To determine clinical and radiologic outcomes of vertebral artery dissecting aneurysms involving posterior inferior cerebellar artery according to different types of endovascular treatment. This study included 18 vertebral artery dissecting aneurysms (6 ruptured and 12 unruptured) involving posterior inferior cerebellar artery treated from January 2009 to December 2016. Treatments were multiple stenting, stent-assisted coil embolization, vertebral artery trapping with vertebral artery–posterior inferior cerebellar artery stenting, and Pipeline embolization. Clinical and radiologic information were obtained from retrospective chart review and radiologic review. Subarachnoid hemorrhage was diagnosed initially in 6 of 18 patients, and infarction was diagnosed initially in 2 patients. Multiple stenting was performed in 4 patients, including 1 (25%) who had cerebellar infarction and 1 (25%) who had recurrence. Stent-assisted coil embolization was performed in 8 patients, including 1 (12.5%) who had postoperative cerebellar infarction and 2 (25%) who had recurrence. Vertebral artery trapping with vertebral artery–posterior inferior cerebellar artery stenting was performed in 4 patients, including 1 (25%) who had postoperative cerebellar infarction. There was no recurrence (0%). Pipeline embolization was performed in 2 patients, including 1 (50%) who had recurrence. There was no postoperative infarction (0%). No subarachnoid hemorrhage occurred during follow-up. Deterioration in modified Rankin Scale score was found only in the stent-assisted coil embolization group (1/8; 12.5%). Vertebral artery trapping with vertebral artery–posterior inferior cerebellar artery stenting showed the lowest rate of aneurysm recurrence with high rate of minor infarction and favorable neurologic outcome. Stent-assisted coil embolization showed high recurrence rates with possible fatal disabling infarction. •VTVPS as treatment of VADA involving PICA shows a low recurrence rate and favorable neurologic outcome.•MS as treatment of VADA involving PICA shows high recurrence rate and favorable neurologic outcome.•SAC as treatment of VADA involving PICA shows high recurrence rate and possible fatal disabling ischemic stroke.