Conventional and old endovascular techniques for vertebral aneurysms still work in the era of flow diversion

Endovascular management for vertebral artery dissecting aneurysms (VADA) is quite intricate which thereby necessitate different strategies per case. Our current study described various optimal strategies available for endovascular management of VADA other than flow diverter (FD). 14 Patients presented with acute SAH and 4 patients with symptoms of mass effect. VADA were classified in 3 groups, viz contralateral vertebral artery is dominant group A (n = 5), co-dominant group B (n = 8) or group C hypoplastic (n = 5). Group A and B (n = 13) was further subdivided into three subtypes depending on location of aneurysm with respect to posterior inferior cerebellar artery (PICA), aneurysm proximal to the PICA, type I (n = 5); involving the PICA, type II (n = 1); and distal to the pica, type III (n = 4). Treatment strategy varied with type whether deconstructive or reconstructive methods using stents and coils in different fashion. Preprocedural angiographic work up delineating the anatomical location of the aneurysm, contralateral vertebral artery dominancy and nearby perforator status along with location of PICA is imperative in selecting the safest and optimal endovascular therapy option.