Dual impact of flow diverters on ischemic and hemorrhagic outcomes in vertebral artery dissecting aneurysms presenting with ischemia

Introduction Intracranial vertebral artery dissecting aneurysms (VADA) may manifest as ischemic stroke. Although some individuals stabilize with conservative management, aneurysmal enlargement and recurrent embolic events may still occur, especially in partially thrombosed lesions. The role of flow diversion (FD) in ischemia-onset VADA remains unclear. This study reports the first focused experience evaluating FD in VADA with ischemic onset. Methods Among 119 FD procedures performed between 2022 and 2025, four male individuals were treated for ischemia-onset VADA. All lesions were in the V4 segment, and three showed partial thrombosis. FD was selected for aneurysmal enlargement (four individuals) or recurrent infarction (two individuals). Dual antiplatelet therapy was started at least 7 days before the procedure. Results FD placement was technically successful in all cases, with no complications. Six-month angiography showed O’Kelly–Marotta grade C occlusion in all lesions, indicating effective flow remodeling. No individuals experienced recurrent cerebral infarction or aneurysmal rupture. Conclusion Flow diversion may be a feasible treatment option in selected cases of ischemia-onset VADA. It may reduce the risk of recurrent embolic events and aneurysmal rupture.