Current status and prospects of endovascular treatment for intracranial vertebral artery aneurysms: A narrative review.

Intracranial vertebral artery (VA) aneurysms are complex entities. Endovascular treatment (EVT) can be used to treat intracranial VA aneurysms. Nevertheless, managing these lesions with EVT remains challenging. Moreover, the suitability of EVT for every type of intracranial VA aneurysm has not been fully confirmed. Therefore, we conducted a needed review of the current literature and our experience summarizing the current status of and advancements in EVT in the management of intracranial VA aneurysms. In our review, several issues are discussed, including the anatomy and anomalies of the intracranial VA, the classification and natural history of intracranial VA aneurysms, indications and techniques for EVT in the management of intracranial VA aneurysms, and the outcomes of and complications experienced by patients who undergo EVT. A flowchart describing EVT options for dissecting intracranial VA aneurysms derived from the findings of this review and our experience is provided. The key to successful EVT is preservation of the posterior inferior cerebellar artery and avoidance of injury to any brainstem perforators. Currently, intracranial VA reconstruction via flow diverter deployment plays an important role in achieving successful treatment. For appropriate cases, both reconstructive and deconstructive EVT can result in good patient outcomes. However, EVT-related complications should be considered. If management of complex intracranial VA aneurysms with EVT would be expected to disproportionally harm the patient, extracranial-intracranial bypass and aneurysmectomy are often necessary. In addition, new products and techniques that show promise for achieving successful EVT in the management of intracranial VA aneurysms are described.