Reconstructive vs Deconstructive Endovascular Approach to Intradural Vertebral Artery Aneurysms: A Multicenter Cohort Study

Background: Parent vessel sacrifice (PVS) has been a traditional way of treating complex aneurysms of the intradural vertebral artery (VA). Flow diversion (FD) has emerged as an alternative reconstructive option.

Objective: To compare the long-term clinical and radiographic outcomes of intradural VA aneurysms following PVS or FD.

Methods: We retrospectively reviewed and evaluated 43 consecutive patients between 2009 and 2018 with ruptured and unruptured intradural VA aneurysms treated by PVS or FD. Medical records including clinical and radiological details were reviewed.

Results: A total of 43 intradural VA aneurysms were treated during this period. In the 14 PVS patients, the mean follow-up was 19.5 mo, and 71.4% of cases achieved modified Rankin scale (mRS) ≤2 at the last follow-up. A total of 86.5% of cases achieved complete occlusion. There was a 14.3% (2 cases) mortality rate, 14.3% (2 cases) postoperative ischemic complication rate, and 0% postoperative hemorrhaging rate. Retreatment was required in 1 case (7.1%). In the 29 FD patients, the mean follow-up was 21.8 mo, and 89.7% of cases achieved mRS ≤2 at the final follow-up. There was a 3.2% (1 case) mortality rate, 19.4% (6 cases) of postoperative ischemic complications, and 6.5% (2 cases) of postoperative hemorrhagic complications. Complete occlusion was seen in 86.5% patients. No cases required retreatment. Mortality and complication rates were not significantly different between PVS and PED (Pipeline Embolization Device) groups.

Conclusion: PVS was associated with comparable intraprocedural complications for VA aneurysms as compared to FD in the largest multicenter study to date. Both procedures have good long-term clinical and radiological outcomes.