Endovascular Reconstruction for Treatment of Vertebrobasilar Dolichoectasia: Long-Term Outcomes

BACKGROUND AND PURPOSE: VBD can trigger various clinical symptoms, especially ischemic stroke in the posterior circulation, but there is no effective treatment for their prevention. We aimed to validate the feasibility of coil-assisted stent reconstruction in the vascular lumen for the treatment of VBD and to evaluate its long-term effectiveness in preventing ischemic events.

MATERIALS AND METHODS: Clinical and imaging data of 9 patients with unruptured VBD were reviewed retrospectively. Depending on the length and diameter of the diseased target vessel, multiple LEO and/or Solitaire stents were implanted, assisted by coils.

RESULTS: Stent reconstruction in the vascular lumen was successful in all patients. Procedure-related complications occurred in 1 patient who developed brain stem and cerebellar infarction 8 days after endovascular treatment and died in 4 months. Coil embolization of the nondominant side of the vertebral artery was performed 1 month after the operation in 1 patient who developed partial brain stem and cerebellar infarction leading to hemiplegia. The mean follow-up time of the 8 surviving patients was 20.75 ± 6.90 months. Of the 4 patients with dolichoectasia in the anterior circulation, 2 experienced ischemic events in the anterior circulation. Another patient had sudden death at home 26 months after the operation. The conditions of the remaining 5 patients were stable without deterioration, and in 4, DSA/CTA/MRA suggested improved morphology of the vertebral artery compared with that before the operation.

CONCLUSIONS: Endovascular reconstruction with coil-assisted stent placement or stent placement alone in the vascular lumen for the treatment of VBD is technically feasible and can prevent ischemic events in the territory of stented vessels compared with the natural course, though further studies in larger samples are needed.