Endovascular Treatment for Ruptured Vertebral Artery Dissecting Aneurysms at the Acute Stage

We analyzed the incidence of ischemic complications after internal trapping for ruptured VA dissecting aneurysms. Between April 2001 and August 2005, nine cases of ruptured VA dissecting aneurysms, five in women, “proximal” or distal (distal type) to the origin of the PICA, were treated by internal trapping in the acute stage after SAH. There were four cases of proximal type and five of distal type. The demographics of the patients were reviewed in the medical charts and radiological findings were evaluated by neuroradiologists. The dissected site was completely obliterated and PICA was preserved in all cases. Follow-up angiography performed five to 19 days after treatment revealed complete obliteration of the aneurysm and patency of the PICA. The incidence of perioprocedural ischemic complications for the PICA-distal type (75%) was higher than that for the PICA-proximal type (20%). Here we retrospectively analyzed and discussed the incidence and mechanisms of ischemic complications.

Download Full-text

One-stage Stent-assisted Coil Embolization for Rupture-side-unknown Bilateral Vertebral Artery Dissecting Aneurysms in an Acute Stage: A Case Report

NMC Case Report Journal ◽

10.2176/nmccrj.cr.2017-0109 ◽

2018 ◽

Vol 5 (2) ◽

pp. 45-49

Author(s):

Mio Terashima ◽

Yoichi Miura ◽

Fujimaro Ishida ◽

Naoki Toma ◽

Tomohiro Araki ◽

...

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Coil Embolization ◽

Acute Stage ◽

One Stage ◽

Dissecting Aneurysms

Download Full-text

P-022 endovascular treatment for symptomatic vertebral artery dissecting aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011917.61 ◽

2015 ◽

Vol 7 (Suppl 1) ◽

pp. A33.2-A34

Author(s):

D Lim ◽

S Ha ◽

J Choi ◽

S Jin

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Dissecting Aneurysms

Download Full-text

Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms

Journal of Cerebrovascular and Endovascular Neurosurgery ◽

10.7461/jcen.2016.18.3.201 ◽

2016 ◽

Vol 18 (3) ◽

pp. 201 ◽

Cited By ~ 2

Author(s):

Jinsol Han ◽

Dong-Jun Lim ◽

Sung-Kon Ha ◽

Jong-Il Choi ◽

Sung-Won Jin ◽

...

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Dissecting Aneurysms

Download Full-text

Endovascular Treatment of Bilateral Intracranial Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Hemorrhage

Operative Neurosurgery ◽

10.1227/neu.0b013e31822ed1f0 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons75-ons81 ◽

Cited By ~ 1

Author(s):

Yong Sam Shin ◽

Byung Moon Kim ◽

Se-Hyuk Kim ◽

Sang Hyun Suh ◽

Chang Woo Ryu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Endovascular Treatment ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Stent Insertion ◽

Treatment Methods ◽

Cerebellar Artery ◽

Endovascular Methods ◽

Dissecting Aneurysms

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

Download Full-text

Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage

Journal of Neurosurgery ◽

10.3171/jns.2003.99.6.0960 ◽

2003 ◽

Vol 99 (6) ◽

pp. 960-966 ◽

Cited By ~ 80

Author(s):

Jun-ichiro Hamada ◽

Yutaka Kai ◽

Motohiro Morioka ◽

Shigetoshi Yano ◽

Tatemi Todaka ◽

...

Keyword(s):

Vertebral Artery ◽

Treatment Options ◽

Posterior Inferior Cerebellar Artery ◽

Acute Stage ◽

The Other ◽

Content Type ◽

Lateral Medullary Syndrome ◽

Detachable Coils ◽

Dissecting Aneurysms ◽

Fine Print

Object. The goal of this study was to implement an algorithm for and assess the multimodal (endovascular and microsurgical) treatment of patients with ruptured dissecting aneurysms of the vertebral artery (VA) during the acute stage. Methods. During a 4-year period, the authors treated 19 ruptured dissecting aneurysms of the VA during the acute stage, within 3 days after the hemorrhage. Factors guiding management decisions were tolerance of the test occlusion and the site of the dissection. The algorithm takes into account these factors to select among treatment options, that is, trapping of the VA with Guglielmi Detachable Coils (GDCs); trapping of the VA and revascularization of the posterior inferior cerebellar artery (PICA); trapping of the VA and VA—posterior cerebral artery (PCA) anastomosis; and trapping of the VA, VA—PCA anastomosis, and revascularization of the PICA. Of the 15 aneurysms without PICA involvement, 14 were treated by trapping of the VA with GDCs and one by trapping of the VA and a VA—PCA bypass. The other four aneurysms with PICA involvement were treated by VA trapping and PICA revascularization. There was no episode of recurrent hemorrhage or ischemia during the posttreatment follow-up period. Although lateral medullary syndrome developed as a permanent complication in one patient, a good recovery was made by the other 18 patients by 6 months after the ictus. Conclusions. The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.

Download Full-text