Stenting for vertebrobasilar dissection: a possible treatment option for nonhemorrhagic vertebrobasilar dissection

It has been reported that stent placement may improve compromised blood flow resulting from vertebrobasilar dissection. In this study the technical feasibility, safety, as well as short-term outcome of stent placement for the treatment of nonhemorrhagic vertebrobasilar dissection was retrospectively investigated.

Ten patients (eight men, two women; age range 36 to 45 years) with nonhemorrhagic vertebrobasilar dissection were treated by stenting. Nine lesions were located at the vertebral artery (VA) (one bilateral case) and two at the basilar artery. Seven patients presented with ischemic symptoms and three with headache. Among the nine VA dissections, eight lesions involved the posterior inferior cerebellar artery (PICA). Angiographic findings included abrupt or irregular vessel narrowing with aneurysmal dilatation in nine lesions and irregular bulbous aneurysmal dilatation in two lesions.

Placement of a stent-within-a-stent was performed in six lesions and single stent in five lesions. Initial treatments were technically successful in all patients. Follow-up was performed using digital subtraction angiography (six patients) or CT angiography (two patients). Successful occlusion or decreased contrast filling of the aneurysm sac was noted in six patients (seven lesions), increased aneurysm sac filling in one patient, and parent artery occlusion in one patient. PICA flow was preserved in all those with follow-up (1 week to 17 months).

Stent placement is technically feasible and safe for the treatment of vertebrobasilar artery dissection, especially for preserving PICA and/or major perforating arteries. However, a study with a larger population and longer follow-up is necessary for validation of the efficacy of this treatment modality.