Fusiform aneurysms of the vertebrobasilar arterial trunk: choice of endovascular methods and therapeutic efficacy.

BACKGROUND

Fusiform aneurysms (FUANs) of vertebrobasilar arterial (VBA) trunk are difficult to treat by using current surgical and endovascular techniques. The objective of this study is to compare the efficacy of FUANs of VBA trunk which was treated with various therapeutic modalities including unilateral or bilateral vertebral artery occlusion, trapping of the aneurysm with coils, stent-assistant coiling, or sole stenting.

METHODS

Between 2000 and 2008, 17 patients with FUANs (ranged in size from 8 to 45 mm) of VBA trunk in our hospital underwent endovascular treatment in our hospital. Eleven patients were evaluated by test occlusion with nondetachable silicone balloon or hyperglide balloon, and seven patients in this series passed testing with temporary balloon occlusion, among which four patients showed positive result, and three patients were conducted bilateral VA test occlusion. Finally, nine patients underwent a trapping of the aneurysm by coils, four patients were treated with stent-supported coil embolization, and four patients with nonhemorrhagic FUAN of VBA were treated only by stenting.

RESULTS

The average imaging follow-up was 28 months, with a range from 6 to 48 months. Fourteen (82%) had excellent or good outcome, three (17.6%) had a poor outcome, and one (5.8%) died.

CONCLUSIONS

Management of FUANs of VBA trunk often poses difficult therapeutic problems. In some cases, multiple treatment sessions may be not only safe but also necessary for the effective treatment of these aneurysms to achieve a complete or an acceptable result.