Endovascular reconstruction of unruptured intradural vertebral artery dissecting aneurysms with the Pipeline embolization device

Anna Luisa Kühn, Peter Kan, Francesco Massari, J. Diego Lozano, Samuel Y. Hou, Mary Howk, Matthew J. Gounis, Ajay K. Wakhloo, Ajit S. Puri

Research output: Contribution to journalReview articlepeer-review

18 Scopus citations

Abstract

Background Dissecting aneurysms of the vertebral artery (VA) are difficult to treat using current surgical and endovascular techniques. Objective To analyze retrospectively the efficacy and safety of flow diverters in the treatment of dissecting aneurysms of the vertebral artery. Methods We identified six patients with six unruptured VA dissecting aneurysms either arising from the V4 or V3-V4 junction that were treated with the Pipeline embolization device (PED) at our institution between July 2012 and February 2015. Among other parameters, technical feasibility of the procedure, procedure-related complications, angiographic results, and clinical outcome were evaluated. Results PED placement was achieved in all cases and immediate angiography follow-up demonstrated intra-aneurysmal contrast stasis with parent artery preservation. A temporary episode of dysarthria was noted in one patient. Major procedure-related complications were not observed. The 6-month follow-up (n=6) demonstrated complete/near-complete aneurysm obliteration in five patients and partial obliteration in one. At the 1-year follow-up (n=5) stable complete aneurysm occlusion was seen in two patients. Two cases showed progression from near complete occlusion and partial occlusion at 6 months to complete occlusion and near complete occlusion. One cases showed unchanged near complete occlusion. No aneurysmal bleeding, in-stent stenosis or thromboembolic complication was seen. National Institutes of Health Stroke Scale and modified Rankin scale scores remained unchanged from admission to discharge. Conclusions Our preliminary experience with the use of PED for the treatment of intradural VA dissecting aneurysms shows promising short-term results, making this technique a feasible and safe treatment option in patients suitable for this approach. However, long-term and larger cohort studies are needed to validate these results.

Original languageEnglish (US)
Pages (from-to)1048-1051
Number of pages4
JournalJournal of neurointerventional surgery
Volume8
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Keywords

  • Aneurysm
  • Dissection
  • Flow Diverter
  • Intervention

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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