[Clinical analysis of endovascular strategies in the treatment of vertebrobasilar dissecting aneurysms].

Objective: To evaluate the efficacy and safety of endovascular strategies for vertebrobasilar dissecting aneurysm (VBDA) and analyze advantages and disadvantages of different endovascular methods for the treatment of VBDA through long-term follow-up. Methods: Retrospectively analyzing was used for the clinical information of 45 cases of vertebrobasilar dissecting aneurysms treated with endovascular methods in our department from January 2007 to December 2015. The treatment modalities were classified into reconstructive surgery and destructive surgery that were based on parent artery preservation. Reconstructive surgery included stent-assisted coil embolization (24 patients) and the placement of single or multiple overlapping stents (8 patients). Destructive surgery was coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+ PT, 13 patients). Results: The incidence of perioperative complications was 11.4%, and the mortality associated with these complications was 4.4%. In the patients undergoing reconstructive surgery, one patient suffered from aneurysm rerupture and died, one patient had intraoperative thrombi in the parent artery and resulted in a complete patency after thrombolysis was performed with Tirofiban. Both perioperative complications occurred in patients treated with stent-assisted coil embolization. No complications occurred in patients treated with single or multiple overlapping stents placements. Perioperative brainstem ischemia occurred in three patients who were treated with destructive surgery, and caused one death and two severe disabilities. Clinical outcome evaluations were performed using the Modified Rankin Scale and resulted in the following scores: 0-2 for 41 patients, 3-6 for 4 patients. The prognosis of reconstructive group was better than that of destructive group, with statistical differences ( P <0.05). The incidence of perioperative complications in reconstructive group was lower than that in destructive group, without significant differences ( P >0.05). Conclusions: Endovascular treatment is effective and safe for VBDAs. The incidence of perioperative complication in reconstructive group is lower and the prognosis is better than that in destructive group.