Stent-Assisted Coil Embolization for Ruptured Intracranial Dissecting Aneurysms Involving Essential Vessels

BACKGROUND: The optimal treatment strategy for ruptured intracranial dissecting aneurysms involving essential vessels remains controversial. The aim of this study was to review the safety and efficacy of endovascular treatment at our center. METHODS: A total of 11 ruptured intracranial dissecting aneurysms involving branching arteries or arising from a major intracranial vessel without tolerance of parental artery occlusion were treated consecutively using endovascular techniques from January 2013 through December 2017. The lesions involved 4 internal carotid arteries, 2 basilar arteries, 3 vertebral arteries, and 2 posterior cerebral arteries. Clinical outcome and complications were evaluated retrospectively. RESULTS: Nine patients were initially treated by stent-assisted coiling, whereas 2 underwent initial coil embolization followed by stent-assisted coiling. Five patients required additional treatment because of rebleeding in 2 patients and re-expansion of the aneurysm in 3 patients. Anatomic preservation of parental, branching, and perforating arteries was successful in all patients, but thromboembolic complications related to an involved vessel occurred in 1 patient. After a mean follow-up period of 36 months (range, 10-63 months), the clinical outcome was good (modified Rankin scale score 0-2) in 9 patients, whereas 2 patients had a poor outcome (modified Rankin scale: 3 and 5) because of vasospasm-related delayed cerebral infarction. CONCLUSIONS: Careful follow-up is necessary after endovascular coiling for ruptured dissecting aneurysm involving essential vessels. Although additional treatment might be required, stent-assisted coiling could be a less invasive and feasible method for handling these difficult lesions.