Overlapping stent-assisted coil embolization for vertebrobasilar dissecting aneurysms: a single-center study

ABSTRACT

Effective treatment strategies for vertebrobasilar dissecting aneurysms (VBDAs) remain controversial due to their high morbidity and mortality. The aim of the present study was to evaluate the efficacy of overlapping stent-assisted coil embolization (OSCE) in VBDA patients. A total of 42 patients with VBDA were retrospectively examined by OSCE from May 2015 to August 2019. Patients’ clinical and radiological parameters were assessed at discharge and during interim follow-up. Safety, technical feasibility and follow-up clinical and imaging observations for therapy were also evaluated retrospectively. The average age of the 42 patients who underwent OSCE was 54 years (range 33 to 74 years). Overlapping stents were successfully implanted in all patients after coil embolism. Overall clinical results were effective (score on a modified Rankin scale from 0 to 2) in all patients. In the meantime, all patients had favorable outcomes when evaluating telephone calls or digital subtractive angiography (DSA) imaging. Among 42 patients, one patient died due to a perioperative rupture. All the remaining 41 patients had a good prognosis during the follow-up telephone call, with a median follow-up of 28 months (range, 2 to 55 months). The total number of DSA recurrences was 20. Subsequent DSA results showed that all aneurysms were completely occluded while in only one case the parent artery of the aneurysm was completely closed. OSCE in VBDAs patients is safe and effective. This technique showed favorable results in clinical and imaging follow-ups for non-ruptured and ruptured VBDAs.

KEYWORDS:

• Overlapping stents
• endovascular treatment
• intracranial aneurysms
• vertebrobasilar dissecting aneurysms

Highlights

1. Therapeutic advances have significantly improved the prognosis of patients with vertebrobasilar dissecting aneurysms (VBDAs).

   1. Overlapping stent-assisted coil embolization in patients with VBDAs was low recurrence rate.

   2. This technique may be a reasonable method for unruptured and ruptured VBDAs.

Data availability

All the data of this study can be obtained in this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Abbreviations

DSA: Digital-subtraction angiography; VBAAs: Vertebrobasilar artery aneurysms; LVIS: Low-profile visualized intraluminal support; mRS: Modified Rankin Scale; SD: Standard deviation

Additional information

Funding

This study was funded by the Scientific Research Project of Health and Family Planning Commission, Heilongjiang Province of China (Grant nos. 2018507).

Notes on contributors

Guangyao Shi

Guangyao Shi: He is a Professor of Radiology and Neurosurgery, and work in Queen Mary college, Nanchang University, Jiang xi Province, People`s Republic of China, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs in China.

Shancai Xu

Shancai Xu, MD: He is a Professor of Radiology and Neurosurgery, and work in department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs, acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.

Ilgiz Gareev

Ilgiz Gareev, MD: He is a Professor of Radiology and Neurosurgery, and work in Bashkir State Medical University, Ufa, Russia. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs in Russia.

Zhiyong Ji

Zhiyong Ji,MD: He is a Professor of Radiology and Neurosurgery, and work in department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs, acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.

Wu Pei

Pei Wu,MD: He is a Professor of Radiology and Neurosurgery, and work in the department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs, acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.

Guang Zhang

Guang Zhang,MD: He is a Professor of Radiology and Neurosurgery, and work in the department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.

Jingtao Qi

Jingtao Qi, MD: He is a Professor of Radiology and Neurosurgery, and work in the third department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs in China.

Rui Chen

Rui Chen: He is a Professor of Radiology and Neurosurgery, and work in the department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs, acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.

Shaodong Liang

Shaodong Liang, MD: He is a Professor of Radiology and Neurosurgery, and work in the department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs, acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.

Yan Gu

Yan Gu: He is a Professor of Radiology and Neurosurgery, and work in the department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs in China.

Chunlei Wang

Chunlei Wang,MD: He is a Professor of Radiology and Neurosurgery, and work in the department of neurosurgery at the first affiliated hospital of Harbin Medical University, Harbin, P.R. China. He is an expert in endovascular surgical management of various cerebrovascular diseases, including intracranial aneurysms, cerebral AVMs, dural AVFs, acute stroke thrombolysis, cervical carotid and vertebral atherosclerotic disease, and intracranial athero-occlusive disease in China.