title: Reconstructive Endovascular Treatment of Spontaneous Symptomatic Large or Giant Vertebrobasilar Dissecting Aneurysms: Clinical and Angiographic Outcomes.
abstract: OBJECTIVE
  To investigate the clinical and angiographic outcomes of spontaneous symptomatic large or giant vertebrobasilar dissecting aneurysms (VBDAs) following reconstructive endovascular treatment (EVT) with stent(s).
  
  
  METHODS
  We retrospectively identified 21 patients with spontaneous symptomatic large or giant VBDAs who had been treated with reconstructive EVT between September 2009 and September 2013 in our department. There were 20 men and 1 woman, with a mean age of 46.5 years (range: 17-67 years). Clinical and angiographic data were reviewed and evaluated.
  
  
  RESULTS
  Reconstructive EVT with sole stenting (SS, 10 cases) or stent-assisted coiling (SAC, 11 cases) technique was technically feasible in all cases. Angiographic follow-up results confirmed delayed thrombosis of the aneurysm sac in only two of the eight cases after SS, and recurrence of the aneurysm sac in six of the nine cases after SAC. Postoperative complications or poor neurologic outcomes occurred in seven cases (33.3 %). Three patients died after SS, including postoperative subarachnoid hemorrhage in one case and pulmonary embolism in one case. The other patient died soon after SAC, without radiologic result to confirm the causes of death. Other adverse events after treatment include ischemic complication in two cases, intramural hemorrhage in one case, aggravation of initial mass effect in one case. As to the other 14 cases, the post-procedural processes were uneventful and no complication was observed. The condition of them was improved in seven cases (33.3 %), and unchanged in seven cases (33.3 %) during follow-up.
  
  
  CONCLUSIONS
  Reconstructive EVT with traditional intracranial stent(s) for the treatment of large and giant VBDAs carries a high failure rate and substantial risk of complications. The outcome of treating these difficult lesions with traditional intracranial stenting seems questionable and unpredictable.
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China.
authors.forename: S
authors.initials: S
authors.lastname: Mu
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China. lichuanhui365@163.com.
authors.forename: C
authors.initials: C
authors.lastname: Li
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China.
authors.forename: X
authors.initials: X
authors.lastname: Yang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China.
authors.forename: C
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, No. 6, Tiantan Xili, 100050, Dongcheng District, Beijing, People's Republic of China.
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D002533:Cerebral Angiography / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult
keywords: Endovascular treatment; Giant; Large; Reconstructive; Stent; Vertebrobasilar dissecting aneurysms