Therapeutic effectiveness of endovascular treatment for vertebral artery dissecting aneurysms

PAN Yizhong; LU Dengfeng; WANG Fei; REN Yubo; TENG Haiying; SUN Xiaoou; CHEN Zhouqing; ZHU Weiwei; WANG Zhong

Abstract：Objective To comprehensively analyze both safety and effectiveness of endovascular treatment for vertebral artery dissecting aneurysms(VADA).Methods Forty-five patients with vertebral artery dissecting aneurysms of intracranial segments who underwent endovascular treatment at the Department of Neurosurgery of the First Affiliated Hospital of Soochow University between January 2020 and December 2022 were retrospectively included,and their general and clinical data were collected.The general data contained age,gender,and vascular risk factors,whereas the clinical data included basic characteristics of the aneurysm,treatment results,follow-up data,etc.Fundamental features of the aneurysm contained length of the aneurysm,location of the dominant side of vertebral artery and its relationship with the ipsilateral posterior inferior cerebellar artery.Follow-up data included imaging data such as CT angiography(CTA)and/or digital subtraction angiography(DSA),as well as clinical prognostic data collected in the outpatient clinics or by telephones.Cerebral angiography was performed 6 months after surgery,followed by imaging and clinical follow-up every 1 to 2 years.Results Among these 45 patients,3 patients received occlusion of the aneurysm-carrying artery,2 patients only underwent stenting,28 patients received stent-assisted spring coil embolization and the remanent 12 patients underwent stenting with dense-mesh stents.Among those who underwent stent-assisted spring coil embolization 2 patients with ruptured VADA(both involved with the posterior inferior cerebral artery)died from aneurysm re-rupture within 1 week after the surgery,the mortality rate being 4.4%.42 patients underwent a 6-month DSA postoperative imaging follow-up ranging from 6 to 12 months,with the median follow-up time being 7 months.Outcomes of the DSA follow-up demonstrated that 38 patients with aneurysm were cured(90.5%)and the other 4 manifested improvement(9.5%).43 patients underwent a 6-month postoperative clinical follow-up,the results of which showed that all of them had favorable prognosis(100%).Conclusion Endovascular treatment functions as a safe and effective choice for patients with VADA,though this conclusion demands further validation in a larger cohort study.