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Overlapping stent-assisted coil embolization for vertebrobasilar dissecting aneurysms: a single-center study
Guangyao Shi1, Shancai Xu2,3,4, Ilgiz Gareev5
1Queen Mary College, Nanchang University, Nanchang, Jiang Xi Province, People`s Republic of China.
Insights
Overlapping stent-assisted coil embolization (OSCE) is a safe and effective treatment for vertebrobasilar dissecting aneurysms (VBDAs). This technique demonstrates favorable clinical and imaging outcomes in both ruptured and unruptured VBDA cases.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Surgery
Background:
- Vertebrobasilar dissecting aneurysms (VBDAs) present significant treatment challenges due to high morbidity and mortality.
- Current treatment strategies for VBDAs lack definitive consensus.
Purpose of the Study:
- To evaluate the safety and efficacy of overlapping stent-assisted coil embolization (OSCE) for treating VBDAs.
- To assess clinical and radiological outcomes of OSCE in VBDA patients.
Main Methods:
- Retrospective analysis of 42 VBDA patients treated with OSCE between May 2015 and August 2019.
- Assessment of clinical and radiological parameters at discharge and follow-up.
- Evaluation of safety, technical feasibility, and long-term imaging results.
Main Results:
- Successful overlapping stent implantation in all patients.
- All patients achieved effective clinical outcomes (modified Rankin Scale 0-2).
- Favorable outcomes observed in 41 of 42 patients during a median 28-month follow-up; one perioperative death.
- Complete aneurysm occlusion achieved in all cases, with one instance of parent artery closure.
Conclusions:
- Overlapping stent-assisted coil embolization (OSCE) is a safe and effective treatment modality for vertebrobasilar dissecting aneurysms.
- The technique yields favorable clinical and imaging results for both ruptured and non-ruptured VBDAs.
- OSCE offers a promising therapeutic option for complex VBDA cases.
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.
