Endovascular Treatment Strategies for Vertebral Artery Dissection: A Single-Center Experience and Literature Review

Although some vertebral artery dissection (VADs) cases heal naturally, others progress to stroke, necessitating intervention. Endovascular treatment (EVT) has gained prominence as a viable approach for addressing VADs owing to its perceived low risk of procedure-related complications and high effectiveness. In this review, we share our practical experience of this technique by incorporating the indications and methods for VAD treatment via EVT. Our EVT strategies covered the management of both ruptured and selected cases of unruptured VADs. Unruptured cases that require treatment include those complicated by lesions with recurring or progressive ischemia, large dissecting aneurysms with mass effects, early changes in the VAD structure during follow-up, and involvement of the basilar or bilateral vertebral arteries (VAs). In cases of ruptured VADs, we aimed to occlude the site of rupture through either VA occlusion or stent-assisted coiling. For unruptured VADs, the goal is to restore the original blood flow dynamics using a range of stenting techniques. The choice of EVT technique should be made on a case-by-case basis, considering factors such as the patient's presenting symptoms, hemodynamic status, adequacy of collateral blood supply, and anatomical characteristics of the important arteries and perforators.