Efficacy, complications and clinical outcome of endovascular treatment for intracranial intradural arterial dissections.

OBJECTIVE: Intracranial intradural dissections are challenging to treat, and published data regarding treatment outcomes remains relatively limited. We retrospectively evaluated our experience with endovascular techniques in the treatment of intracranial intradural dissections, and describe the efficacy and clinical outcomes with treatment.

METHODS: Between January 2003 and December 2011, 23 patients with 23 intracranial intradural arterial dissections underwent endovascular treatment at our institution. Eighteen were treated with coil embolization (14 with parent vessel sacrifice, 4 with aneurysm coiling), 4 with flow diverting stents (Pipeline Embolization Device) and 1 with primary angioplasty and stenting. Treatment indications were subarachnoid hemorrhage (n=16), cerebral ischemia (n=2), headache (n=3), or elective (n=2).

RESULTS: The peri-procedural complication rate was 17.4%, 3 of the 4 cases sustained no serious clinical sequelae. Four deaths unrelated to the procedure occurred in patients with subarachnoid hemorrhage. Angiographic follow-up demonstrated complete occlusion in 8 of 14 surviving cases treated by coil embolization, incomplete occlusion in 2 cases. Four cases were lost to follow-up, but all of these had complete occlusion post-procedure. Successful angiographic outcomes were seen at follow-up in patients treated with flow diverting stents and primary intracranial stenting. Clinical follow-up showed a mRS of 0-1 in 15 (78.9%) of 19 patients, mRS of 2 in 1 patient, mRS of 3 in 1 patient and mRS of 5 in 1 patient. There was no neurological deterioration, re-bleeding or deaths during the follow-up period.

CONCLUSION: Intracranial arterial dissections, particularly those presenting with subarachnoid hemorrhage, are lesions associated with high mortality. They can be effectively managed endovascularly. In our experience, endovascular treatment can be associated with moderate peri-procedural risks.