Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Interv Neuroradiol. 2022 Apr;28(2):136-141. doi: 10.1177/15910199211025109. Epub 2021 Jun 18.
Stenting of vertebral artery dissecting aneurysms (VADAs) may promote mural apposition of intimal flaps, preserving the patency of injured vessels. Moreover, stent deployment may serve to alter intra-aneurysm flow, inducing saccular thrombus formation, neointimal development, and remodeling of injured vessels. Although an overlapping multistent strategy with coiling has proven successful in this setting, yielding good anatomic and clinical outcomes, coiling may be technically infeasible in some VADAs with unfavorably configured circumferential elevations. Herein, we describe three patients with VADAs for whom coiling was deemed technically problematic. Each underwent double stenting (LVIS within Enterprise), without coil insertion, using local anesthesia. Conventional angiographic follow-up regularly disclosed excellent saccular occlusion and subsequent remodeling of stented arteries. LVIS-within-Enterprise double stenting may be of particular benefit in patients with VADAs, the Enterprise providing outer support to minimize stent bulging (as a fusiform aneurysm) as the inner LVIS reinforces flow diversion.
椎动脉夹层动脉瘤（VADA）的支架置入术可能促进内膜瓣的贴壁，保持受损血管的通畅。此外，支架置入术可能改变瘤内血流，诱导囊状血栓形成、新生内膜形成和受损血管的重塑。尽管在这种情况下，采用重叠多支架技术与线圈填塞已被证明是成功的，可获得良好的解剖学和临床结果，但在一些具有不利的环形隆起的 VADA 中，线圈填塞可能在技术上不可行。在此，我们描述了 3 例 VADA 患者，认为线圈填塞在技术上存在问题。每例患者均在局部麻醉下进行双支架置入术（Enterprise 内的 LVIS），未插入线圈。常规血管造影随访显示，瘤腔闭塞良好，随后支架血管重塑。对于 VADA 患者，LVIS 内 Enterprise 双支架置入术可能特别有益，Enterprise 提供外部支撑以最大程度地减少支架膨出（如梭形动脉瘤），而内部 LVIS 则增强血流分流。
