Clinical and radiographic characteristics of bilateral IVADAs with staged endovascular treatment
| Case no. | Presentation | Side, PICA-involving, ruptured | Configuration | H-H | Admission mRS score | First treatment | Interval time (months) | Second treatment | Last mRS score (months) | ||||||
| Side, treatment | Immediate angiography* | Follow-up angiography* (months) | Complication | Side, treatment | Immediate angiography* | Follow-up angiography* | Complication (months) | ||||||||
| 1 | Acute headache | R, involving, ruptured L, no involving, unruptured | Pearl and string sign Pearl and string sign | Ⅱ | 4 | R, SAC | Near-complete obliteration | Recanalisation (1)→recoiling→stable (7) | – | 1 | L, SAC | Near-complete obliteration | Complete obliteration (6) | – | 1 (7) |
| 2 | Headache | L, no involving, unruptured R, no involving, unruptured | Fusiform Pearl and string sign | – | 1 | R, SAC | Near-complete obliteration | Complete obliteration (3) | – | 3 | L, SAC | Complete obliteration | Complete obliteration (6) | – | 0 (9) |
| 3 | Numbness of limbs | L, no involving, unruptured R, no involving, unruptured | Fusiform Fusiform | – | 2 | L, stent alone | Partial obliteration | Complete obliteration (9) | – | 3 | R, stent alone | Partial obliteration | Complete obliteration (6) | – | 1 (9) |
| 4 | Incidence | L, no involving, unruptured R, no involving, unruptured | Pearl and string sign Pearl and string sign | – | 0 | R, SAC | Complete obliteration | Complete obliteration (9) | – | 3 | L, SAC | Complete obliteration | Complete obliteration (6) | – | 0 (9) |
| 5 | Headache | L, no involving, unruptured R, no involving, unruptured | Pearl and string sign Fusiform | – | 1 | L, SAC | Complete obliteration | Complete obliteration (10) | – | 3 | R, SAC | Near-complete obliteration | Complete obliteration (7) | – | 0 (9) |
| 6 | Headache | L, involving, unruptured R, involving, unruptured | Fusiform Fusiform | – | 1 | L, stent alone | Partial obliteration | Near-complete obliteration (1) | – | 1 | R, stent alone | Partial obliteration | Stable (3) | – | 0 (9) |
| 7 | Dizziness | L, involving, unruptured R, involving, unruptured | Fusiform Fusiform | – | 2 | R, stent alone | Partial obliteration | Complete obliteration (6) | – | 3 | L, stent alone | Partial obliteration | Stable (3) | – | 0 (6) |
| 8 | Headache | R, involving, unruptured L, involving, unruptured | Fusiform Fusiform | – | 1 | L, PED alone | Partial obliteration | Complete obliteration (6) | – | 2.5 | R, PED alone | Partial obliteration | Complete obliteration (3.5) | – | 0 (6) |
| 9 | Dizziness | R, involving, unruptured L, involving, unruptured | Pearl and string sign Fusiform | – | 1 | L, PED alone | Partial obliteration | Complete obliteration (9) | – | 2 | R, PED alone | Partial obliteration | Complete obliteration (7) | – | 0 (9) |
| 10 | Dizziness | R, involving, unruptured L, involving, unruptured | Pearl and string sign Fusiform | – | 1 | R, PED alone | Partial obliteration | Complete obliteration (9) | – | 3 | L, PED alone | Partial obliteration | Complete obliteration (6) | Parent artery occlusion (6) | 0 (9) |
| 11 | Headache | R, no involving, unruptured L, no involving, unruptured | Pearl and string sign Fusiform | – | 1 | R, SAC | Complete obliteration | Complete obliteration (7) | – | 2 | L, PED alone | Partial obliteration | Complete obliteration (6) | – | 0 (8) |
| 12 | Headache | R, no involving, unruptured L, involving, unruptured | Fusiform Fusiform | – | 1 | R, PED alone | Partial obliteration | Complete obliteration (7) | – | 1 | L, PED alone | Partial obliteration | Complete obliteration (6) | – | 0 (7) |
*Angiography results are classified as follows: stable, no interval changes of the dissecting aneurysm in size or shape; complete obliteration, complete occlusion of the dissecting aneurysm sac with reconstruction of the parent artery; near-complete obliteration, neck remnant of the dissecting aneurysm; partial resolution, any opacification of the dissecting aneurysm sac.
H-H, Hunt-Hess; IVADAs, intracranial vertebral artery dissecting aneurysms; L, left; mRS, modified Rankin Scale; PED, Pipeline Embolization Device; PICA, posterior inferior cerebellar artery; R, right; SAC, stent-assisted coiling.