• Han San Oh, Jin Woo Bae, Chang-Eui Hong, Kang Min Kim, Dong Hyun Yoo, Hyun-Seung Kang, and Young Dae Cho.
• Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
• Neurosurgery. 2023 Jul 1; 93 (1): 120127120-127.

BackgroundReconstructive strategies for unruptured vertebral artery dissecting aneurysms (VADAs) have increasingly relied on newly developed endovascular devices. However, their clinical performance metrics are seldom reported.ObjectiveTo compare stent-assisted coil embolization (SACE) and flow-diverting stent (FDS) deployment as treatments for unruptured VADAs, focusing on efficacy and safety.MethodsA total of 72 VADAs were submitted to SACE (n = 48) or FDS (n = 24) between April 2009 and September 2021. We reviewed medical records and radiological data to assess efficacy and safety outcomes by method, building an inverse probability of treatment-weighted (IPTW) logistic regression model and conducting survival analyses.ResultsUltimately, 24 aneurysms (33.3%) showed signs of recanalization (major, 14; minor, 10) at 6-month follow-up. Initially determined 6-month rates of overall (SACE, 31.2%; FDS, 41.7%) and major (SACE, 20.8%; FDS, 16.7%) recanalization did not differ significantly by modality; but in the IPTW logistic regression model, adjusted for aneurysm morphology, major recanalization at 6 months was lower for the FDS (vs SACE) subset (odds ratio = 0.196; P = .027). Likewise, the cumulative rate of major recanalization was more favorable for the FDS (vs SACE) subset (hazard ratio = 0.291; P = .048) in IPTW Cox proportional hazards model adjusted for aneurysm morphology. Modality-based assessments of procedural and delayed complications were similar.ConclusionBoth reconstructive VADA interventions are safe and effective by adjusting treatment modality depending on the angioanatomic configuration. However, follow-up data after treatment proved more favorable for FDS deployment than for SACE in limiting major recanalization. Case-controlled studies of more sizeable cohorts are needed for corroboration.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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