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J Neurointerv Surg. 2016 Oct;8(10):1048-51. doi: 10.1136/neurintsurg-2015-012028. Epub 2015 Nov 6.

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

Author information

1
Division of Neuroimaging and Intervention, Department of Radiology and New England Center for Stroke Research, University of Massachusetts, Worcester, Massachusetts, USA.
2
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
3
Stroke and Neurovascular Center of Central California, Santa Barbara, California, USA.

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.

KEYWORDS:

Aneurysm; Dissection; Flow Diverter; Intervention

PMID:
26546600
DOI:
10.1136/neurintsurg-2015-012028
[Indexed for MEDLINE]

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