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More than 100 conservatively managed nonstroke dissecting vertebrobasilar artery aneurysms were followed on average for 3 years. Ninety-seven percent of patients remained clinically unchanged and the 3 patients who deteriorated clinically had aneurysm enlargement. The natural course of these lesions suggests that acute intervention is not always required and close follow-up without antithrombotic therapy is reasonable. Patients with symptoms due to mass effect or aneurysms of >10 mm may require treatment.

This article presents the authors' experience and long-term follow-up of 6 patients with fusiform and giant aneurysms of the vertebrobasilar system treated with flow-diverting devices. Devices were deployed uneventfully with no periprocedural complications. One year later, 3 patients had recurrent cerebral infarctions and 2 had acute thrombotic in-stent occlusions. Four patients died during the follow-up period. The authors do not intend to treat any more patients in this fashion until they have a better understanding of flow-diverting devices in this setting.