Triple Stent Therapy for the Treatment of Vertebral Dissecting Aneurysms: Efficacy and Safety

Abstract

Background: There are several treatment modalities for vertebral dissecting aneurysms. The purpose of this study was to evaluate the efficacy and safety of triple stent therapy for intracranial vertebral dissecting aneurysm (VDA).

Methods: Eight patients with 9 VDAs underwent multiple stent insertion therapy. Seven patients who presented with progressive ischemic symptoms and showed changes in follow-up images underwent triple stent insertion therapy, and 1 patient who presented with subarachnoid hemorrhage underwent double stent therapy twice and 1 additional single stent therapy with coil embolization (total 5 stents). Safety, technical feasibility, clinical, and imaging follow-up data for triple stent therapy were retrospectively evaluated.

Results: Triple stent deployment for VDAs was successfully performed in all 9 VDAs without any procedure-related complication. Among them, 8 unruptured VDAs showed near normalization on follow-up imaging studies within 90 days after the procedure. One case of ruptured VDA showed repeated recurrence without new symptoms and delayed normalization after insertion of 5 stents. Seven patients with long-term follow-up (median clinical follow-up, 22.6 months; median imaging follow-up, 17.1 months) showed clinical and imaging improvement without development of new symptoms.

Conclusions: Triple stent therapy for VDAs was safe and effective. This technique showed favorable results in clinical and imaging follow-up for unruptured VDAs, although caution is advised for ruptured VDAs.

Keywords: Multiple stent insertion therapy; Triple stent insertion therapy; Vertebral artery dissection; Vertebral dissecting aneurysm.