Reconstructive endovascular treatment of symptomatic large or giant unruptured vertebrobasilar fusiform aneurysm with LVIS stent-assisted partial coil embolization

Abstract

Objectives: Large or giant vertebrobasilar fusiform aneurysms (VFAs) remain one of the most formidable lesions. The purpose of this study was to evaluate the technical feasibility, clinical and angiographic outcomes of LVIS SACP-SWS technique in patients with large or giant unruptured VFAs. Patients and methods: Eleven patients with large or giant unruptured VFAs underwent LVIS SACP-SWS technique between Jun 2015 and May 2017. Thirty-eight (38) LVIS stents were completely deployed at desired position. Outcomes were evaluated based on the modified Rankin Scale (mRS) score and angiography. Results: The LVIS SACP-SWS was successful without any treatment-related complications in all 11 patients. In regard to clinical outcome, mRS was 3.55 ± 1.29 at pre-operative stage that significantly (p = 0.01) decreased to 1.91 ± 1.92 at last follow-up. The mean decrease in mRS was 1.63 ± 1.69. Near-complete occlusion of dissecting aneurysmal sac (NO) was seen in 5 patients at DSA follow-up and complete occlusion of dissecting aneurysmal sac (CO) was in 4 patients, the remaining patient was re-treated by occluding the V4 segment of right verbal artery. Conclusions: Our results provide an encouraging support for the LVIS stent-assisted coil partial embolization combined with stent-within-a-stent technique. Further studies of the technique as an alternative strategy for treatment of large or giant unruptured VFAs are warranted. Keywords: Unruptured vertebrobasilar fusiform aneurysm, Large, Giant, LVIS stent, Stent-assisted coil, Stent-within-a-stent technique