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Updated: Oct 11, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Target Embolization of Complex Vertebral Artery Dissecting Aneurysm with Endovascular Reconstructive Technique Using
Kenji Fukuda1, Dai Kawano1, Yoshinobu Horio1
1Department of Neurosurgery, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Japan.
Objective:
Detailed vasculature of vertebral artery dissecting aneurysms (VADAs) is often complicated owing to the irregular structure with the intimal flap/double lumen. Our aim was to present an endovascular reconstructive technique with assessment of detailed vasculature and the relationship between dissection and surrounding vessels using cone-beam computed tomography angiography (CBCT-A).
Methods:
The study included 6 cases with complex vertebral artery dissecting aneurysm. Selective digital subtraction angiography initially identified the location and shape of dissection. CBCT-A was then performed with selective injection into the affected vertebral artery. Luminal morphology of the dissection and surrounding arterial anatomy were assessed using CBCT-A.
Results:
CBCT-A clearly demonstrated luminal morphology of the intimal flap/double lumen, the entrance into the pseudolumen, and the entire dissecting segment. Tiny perforator arteries were also identified. In all 6 cases, target coil embolization for the pseudolumen and stent placement using an LVIS stent for the entire dissecting segment were successfully performed with the aid of information obtained from CBCT-A. No complications occurred in the perioperative period, and improvement of dissection was identified in the follow-up period.
Conclusions:
Target embolization of complex vertebral artery dissecting aneurysm with endovascular reconstructive technique with special reference to the detailed anatomy of dissection using CBCT-A would be useful for safe and effective treatment results.
