Endovascular management of ruptured basilar artery dissection with two overlapping Low-profile Visualized Intraluminal Support stents

Abstract

<jats:p> The optimal endovascular treatment method of ruptured basilar artery dissection still remains controversial. We reported a case with ruptured basilar artery dissection involving the left anterior inferior cerebellar artery. The dissecting aneurysm was successfully treated with two overlapping Low-profile Visualized Intraluminal Support stents and the preservation of antegrade blood flow of the anterior inferior cerebellar artery was achieved. Three-month and six-month follow-ups revealed good clinical and angiographic results, although controversies regarding long-term stability remained to be addressed. </jats:p>

Overlapping Stent Placement with Coil Embolization for Ruptured Growing Basilar Artery Dissecting Aneurysm: A Case Report

“…6) Even among studies of stent-only therapy without coil insertion, many studies have reported the use of multipleoverlapping stents (2 to 3 neck bridge stents). 2,8,9) The occlusion rate was significantly higher than in the single stent group. 8) However, neither stent-only nor FD therapies promptly show hemostatic effects.…”

“…In previous studies regarding SAC and stent-only therapy for BADAs, various open-and closed-cell-type stents were used. 5,6,9) Concerning the stent length, it is difficult to determine the accurate extent of dissecting lesions; therefore, long, multiple-overlapping stents may be advantageous for accurately blocking inflow proximal to the site of dissection. 6) In this study, to block inflow proximal to the lesion site, the first stent was inserted into the left VA as a normal proximal blood vessel.…”

“…1,[3][4][5] Recently, reconstructive treatments in which parent vessel blood flow is maintained, such as stent-assisted coiling (SAC), stent-only therapy, and therapy with a flow diverter (FD), have been performed. [1][2][3][4][5][6][7][8][9] In particular, serially growing BADAs are rare, and no treatment method has been established 1,3) although aggressive treatment is recommended for patients with hemorrhage or mass-effect-related progressive deterioration. According to a review in 2015, 3) 15 patients have been reported.…”

“…5) The metal coverage of an Enterprise VRD is 10%, and that of an FD is approximately 30%-35%. 9) Although the flow-diverting effects of neck bridge stents are limited, 4) several studies adopted overlapping stent placement for BADAs in the acute phase of rupture to reduce porosity and increase stent thickness. 5,10) In the present case, contrast enhancement at the site of enlargement reduced with the process of overlapping stent placement, and disappeared when a coil was placed.…”

“…Furthermore, perforating artery/branch occlusion-related ischemic complications and lumen stenosis related to intimal hyperplasia in the chronic phase must be considered. 6,9) Angiography for evaluating the treatment response should be performed at least 1 week after treatment and after 6 months. It is necessary to consider dosereduction to a single antiplatelet drug 6 months after treatment, 2) but it should be carefully determined in patients after the insertion of several stents into thin BA.…”