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  • World Neurosurg · Mar 2021

    Modified Balloon-in-Stent Technique for Circumferential Vertebral Artery Dissecting Aneurysm.

    • Ching-Chang Chen, Chun-Ting Chen, Yu-Hsuan Huang, Po-Chuan Hsieh, Yi-Ming Wu, Mun-Chun Yeap, Yu-Chi Wang, Chien-Hung Chang, and Yi-Chou WangAlvinADepartment of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taipei City, Taiwan..
    • Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taipei City, Taiwan; New Taipei Municipal Tu-Cheng Hospital, New Taipei City, Taiwan. Electronic address: jcchen130@gmail.com.
    • World Neurosurg. 2021 Mar 1; 147: e552-e558.

    BackgroundTreatment for circumferential vertebral artery dissecting aneurysms (VADAs) remains challenging. Stent-assisted coil embolization is the most common treatment technique. However, this approach presents high rates of incomplete occlusion and recurrence, often requiring the addition of second or third stents for reconstruction. A flow diverter may achieve favorable clinical outcomes, but it cannot result in immediate aneurysm occlusion and is limited by strict antiplatelets and expensive price. We report excellent results of a 1-stage modified balloon-in-stent technique for circumferential VADA.MethodsA total of 12 patients were treated with the modified balloon-in-stent technique for VADAs. A homogeneous coil was used to fill the aneurysm sac, followed by deployment of 1 self-expandable stent and in-stent Scepter balloon angioplasty. Clinical presentations, outcomes, and imaging results were evaluated over at least 2 years of follow-up.ResultsOur 12 patients were examined during a mean follow-up period of 36.2 months (range, 2-5 years). The initial symptoms presented included subarachnoid hemorrhage (5 of 12; 41.7%), ischemia (3 of 12; 25.0%), and nonischemia (4 of 12; 33.3%). The modified BIS technique and coil embolization were successful in all patients. No technique-related complications or recanalization occurred during follow-up.ConclusionsWe demonstrated an innovative modified BIS technique to treat circumferential VADA by using a coiling basket followed by the deployment of a self-expandable stent and in-stent Scepter balloon angioplasty. This strategy is safe, feasible, and cost effective and was not associated with recurrence or complications over at least 2 years of follow-up.Copyright © 2020 Elsevier Inc. All rights reserved.

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