Top

Clinical Neuroradiology

Published in:

01-09-2016 | Original Article

Reconstructive Endovascular Treatment of Spontaneous Symptomatic Large or Giant Vertebrobasilar Dissecting Aneurysms: Clinical and Angiographic Outcomes

Authors: S. Mu, MD, C. Li, MS, X. Yang, MD, Y. Wang, MD, Y. Li, MD, C. Jiang, MD, Z. Wu, MD

Published in: Clinical Neuroradiology | Issue 3/2016

Abstract

Purpose

To investigate the clinical and angiographic outcomes of spontaneous symptomatic large or giant vertebrobasilar dissecting aneurysms (VBDAs) following reconstructive endovascular treatment (EVT) with stent(s).

Methods

We retrospectively identified 21 patients with spontaneous symptomatic large or giant VBDAs who had been treated with reconstructive EVT between September 2009 and September 2013 in our department. There were 20 men and 1 woman, with a mean age of 46.5 years (range: 17–67 years). Clinical and angiographic data were reviewed and evaluated.

Results

Reconstructive EVT with sole stenting (SS, 10 cases) or stent-assisted coiling (SAC, 11 cases) technique was technically feasible in all cases. Angiographic follow-up results confirmed delayed thrombosis of the aneurysm sac in only two of the eight cases after SS, and recurrence of the aneurysm sac in six of the nine cases after SAC. Postoperative complications or poor neurologic outcomes occurred in seven cases (33.3 %). Three patients died after SS, including postoperative subarachnoid hemorrhage in one case and pulmonary embolism in one case. The other patient died soon after SAC, without radiologic result to confirm the causes of death. Other adverse events after treatment include ischemic complication in two cases, intramural hemorrhage in one case, aggravation of initial mass effect in one case. As to the other 14 cases, the post-procedural processes were uneventful and no complication was observed. The condition of them was improved in seven cases (33.3 %), and unchanged in seven cases (33.3 %) during followup.

Conclusions

Reconstructive EVT with traditional intracranial stent(s) for the treatment of large and giant VBDAs carries a high failure rate and substantial risk of complications. The outcome of treating these difficult lesions with traditional intracranial stenting seems questionable and unpredictable.

Steinberg GK, Drake CG, Peerless SJ. Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients. J Neurosurg. 1993;79:161–73.CrossRefPubMed

Drake CG, Peerless SJ. Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992. J Neurosurg. 1997;87:141–62.CrossRefPubMed

Aziz KMA, van Loveren HR, Tew JM, Jr, Chicoine MR. The Kawase approach to retrosellar and upper clival basilar aneurysms. Neurosurgery. 1999;44:1225–36.PubMed

Lawton MT, Daspit PD, Spetzler RF. Technical aspects and recent trends in the management of large and giant midbasilar artery aneurysms. Neurosurgery. 1997;41:513–21.PubMed

Kalani MY, Zabramski JM, Nakaji P, Spetzler RF. Bypass and flow reduction for complex basilar and vertebrobasilar junction aneurysms. Neurosurgery. 2013;72:763–75.CrossRefPubMed

Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi JC, Nagata I. Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg. 2002;97:259–67.CrossRefPubMed

Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM. Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 2003;24:1421–8.PubMed

Leibowitz R, Do HM, Marcellus ML, Chang SD, Steinberg GK, Marks MP. Parent vessel occlusion for vertebrobasilar fusiform and dissecting aneurysms. AJNR Am J Neuroradiol. 2003;24:902–7.PubMed

Meckel S, McAuliffe W, Fiorella D, Taschner CA, Phatouros C, Phillips TJ, Vasak P, Schumacher M, Klisch J. Endovascular treatment of complex aneurysms at the vertebrobasilar junction with flow-diverting stents: initial experience. Neurosurgery. 2013;73:386–94.CrossRefPubMed

10.

van Oel LI van Rooij WJ Sluzewski M Beute GN Lohle PN Peluso JP. Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils. AJNR Am J Neuroradiol. 2013;34:589–95.CrossRefPubMed

11.

Fiorella D, Kelly ME, Albuquerque FC, Nelson PK. Curative reconstruction of a giant midbasilar trunk aneurysm with the pipeline embolization device. Neurosurgery. 2009;64:212–7.CrossRefPubMed

12.

Siddiqui AH, Abla AA, Kan P, Dumont TM, Jahshan S, Britz GW, Hopkins LN, Levy EI. Panacea or problem: flow diverters in the treatment of symptomatic large or giant fusiform vertebrobasilar aneurysms. J Neurosurg. 2012;116:1258–66.CrossRefPubMed

13.

Ertl L, Holtmannspötter M, Patzig M, Brückmann H, Fesl G. Use of flow-diverting devices in fusiform vertebrobasilar giant aneurysms: a report on periprocedural course and long-term follow-up. AJNR Am J Neuroradiol. 2014;35:1346–52.CrossRefPubMed

14.

Phillips TJ, Wenderoth JD, Phatouros CC, Rice H, Singh TP, Devilliers L, Wycoco V, Meckel S, McAuliffe W. Safety of the pipeline embolization device in treatment of posterior circulation aneurysms. AJNR Am J Neuroradiol. 2012;33:1225–31.CrossRefPubMed

15.

Wang Y, Yang X, Youxiang L, Shiqing M, Chuhan J, Zhongxue W, Kocer N. Treatment of symptomatic fusiform aneurysm in basilar artery by stenting following coiling technique. Turk Neurosurg. 2014;24:44–7.PubMed

16.

Fiorella D, Albuquerque FC, Deshmukh VR, Woo HH, Rasmussen PA, Masaryk TJ, McDougall CG. Endovascular reconstruction with the Neuroform stent as monotherapy for the treatment of uncoilable intradural pseudoaneurysm. Neurosurgery. 2006;59:291–300.CrossRefPubMed

17.

Geremia G, Brack T, Brennecke L, Haklin M, Falter R. Occlusion of experimentally created fusiform aneurysms with porous metallic stents. AJNR Am J Neuroradiol. 2000;21:739–45.PubMed

18.

Rhee K, Han MH, Cha SH. Changes of flow characteristics by stenting in aneurysm models: influence of aneurysm geometry and stent porosity. Ann Biomed Eng. 2002;30:894–904.CrossRefPubMed

19.

Mizutani T, Kojima H, Asamoto S. Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery. 2004;54:342–8.CrossRefPubMed

20.

Bai H, Masuda J, Sawa Y, Nakano S, Shirakura R, Shimazaki Y, Ogata J, Matsuda H. Neointima formation after vascular stent implantation. Spatial and chronological distribution of smooth muscle cell proliferation and phenotypic modulation. Arterioscler Thromb. 1994;14:1846–53.CrossRefPubMed

21.

Yoon WK, Kim YW, Kim SD, Park IS, Baik MW, Kim SR. Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection. J Neurosurg. 2008;109:1113–8.CrossRefPubMed

22.

Zhao KJ, Zhao R, Huang QH, Xu Y, Hong B, Fang YB, Li Q, Yang PF, Liu JM, Zhao WY. The interaction between stent(s) implantation, PICA involvement, and immediate occlusion degree affect symptomatic intracranial spontaneous vertebral artery dissection aneurysm (sis-VADA) recurrence after reconstructive treatment with stent(s)-assisted coiling. Eur Radiol. 2014;24:2088–96.CrossRefPubMedPubMedCentral

23.

Zhao KJ, Fang YB, Huang QH, Xu Y, Hong B, Li Q, Liu JM, Zhao WY, Deng BQ. Reconstructive treatment of ruptured intracranial spontaneous vertebral artery dissection aneurysms: long-term results and predictors of unfavorable outcomes. PLoS One. 2013;8:e67169.CrossRefPubMedPubMedCentral

24.

Tamatani S, Ito Y, Abe H, Koike T, Takeuchi S, Tanaka R. Evaluation of the stability of aneurysms after embolization using detachable coils: correlation between stability of aneurysms and embolized volume of aneurysms. AJNR Am J Neuroradiol. 2002;23:762–7.PubMed

25.

Mizutani T, Miki Y, Kojima H, Suzuki H. Proposed classification of nonatherosclerotic cerebral fusiform and dissecting aneurysms. Neurosurgery. 1999;45:253–60.CrossRefPubMed

26.

Mizutani T. A fatal, chronically growing basilar artery: a new type of dissecting aneurysm. J Neurosurg. 1996;84:962–71.CrossRefPubMed

27.

Schubiger O, Valavanis A, Wichmann W. Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging. Neuroradiology. 1987;29:266–71.CrossRefPubMed

28.

Fischer S, Perez MA, Kurre W, Albes G, Bäzner H, Henkes H. Pipeline embolization device for the treatment of intra- and extracranial fusiform and dissecting aneurysms: initial experience and long-term follow-up. Neurosurgery. 2014;75:364–74.CrossRefPubMed

Title: Reconstructive Endovascular Treatment of Spontaneous Symptomatic Large or Giant Vertebrobasilar Dissecting Aneurysms: Clinical and Angiographic Outcomes
Authors: S. Mu, MD
C. Li, MS
X. Yang, MD
Y. Wang, MD
Y. Li, MD
C. Jiang, MD
Z. Wu, MD
Publication date: 01-09-2016
Publisher: Springer Berlin Heidelberg
Published in: Clinical Neuroradiology / Issue 3/2016
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI: https://doi.org/10.1007/s00062-014-0369-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reconstructive Endovascular Treatment of Spontaneous Symptomatic Large or Giant Vertebrobasilar Dissecting Aneurysms: Clinical and Angiographic Outcomes

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2016

Imaging Features of Pilocytic Astrocytoma in Cerebral Ventricles

Trigeminocardiac Reflex During the Endovascular Treatment of Intracranial Vascular Disease: A Report of Two Cases

Fatal Thrombosis of a Flow Diverter due to Ibuprofen-related Antagonization of Acetylsalicylic Acid

Wall Enhancement of the Intracranial Aneurysms Revealed by Magnetic Resonance Vessel Wall Imaging Using Three-Dimensional Turbo Spin-Echo Sequence with Motion-Sensitized Driven-Equilibrium: A Sign of Ruptured Aneurysm?

Intermediate Catheters Reduce the Length of Mechanical Thrombectomy Procedures in Acute Basilar Artery Occlusions

Clot Burden and Collaterals in Anterior Circulation Stroke: Differences Between Single-Phase CTA and Multi-phase 4D-CTA