Subarachnoid hemorrhage due to rupture of vertebral artery dissecting aneurysms: Treatments, outcomes, and prognostic factors

2021 ◽  
Author(s):  
Masaaki Korai ◽  
Yasuhisa Kanematsu ◽  
Izumi Yamaguchi ◽  
Tadashi Yamaguchi ◽  
Yuki Yamamoto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Dissecting Aneurysms

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

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons75-ons81 ◽  
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.

scholarly journals Single-stage endovascular treatment of subarachnoid hemorrhage related to bilateral vertebral artery dissecting aneurysms

2015 ◽  
Vol 22 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Wen-Yuan Zhao ◽  
Kai-Jun Zhao ◽  
Qing-Hai Huang ◽  
Yi Xu ◽  
Bo Hong ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Case Series ◽  
Single Stage ◽  
Neurological Deficits ◽  
Cross Sectional ◽  
Hemodynamic Stress ◽  
Scale Scores ◽  
Acute Subarachnoid Hemorrhage ◽  
Dissecting Aneurysms

Objective Treatment of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage remains challenging as bilateral deconstructive procedures may not be feasible. In this case series, we describe our approach to their management and review the pertinent literature. Method A retrospective review of our prospectively collected database on aneurysms was performed to identify all patients with acute subarachnoid hemorrhage in the setting of bilateral intradural vertebral artery dissections (VAD) encompassing a period from January 2000 and March 2012. Result Four patients (M/F = 2/2; mean age, 51.5 years) were identified. In two cases the site of rupture could be identified by angiographic and cross-sectional features; in these patients deconstructive treatment (proximal obliteration or trapping) of the ruptured site and reconstructive treatment of the unruptured site (using stents and coils) were performed. In the patients in whom the site of hemorrhage could not be determined, bilateral reconstructive treatment was performed. No treatment-related complications were encountered. Modified Rankin scale scores were 0–1 at discharge, and on follow-up (mean 63 months), no recurrence, in-stent thrombosis or new neurological deficits were encountered. Conclusion We believe that single-stage treatment in patients with bilateral VAD is indicated: If the site of hemorrhage can be determined, we prefer deconstructive treatment on the affected site and reconstructive treatment on the non-affected site to prevent increased hemodynamic stress on the unruptured but diseased wall. If the site of dissection cannot be determined, we prefer bilateral reconstructive treatment to avoid increasing hemodynamic stress on the potentially untreated acute hemorrhagic dissection.

scholarly journals Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome

2017 ◽  
Vol 23 (3) ◽  
pp. 240-248 ◽  
Author(s):  
K Urasyanandana ◽  
P Withayasuk ◽  
D Songsaeng ◽  
T Aurboonyawat ◽  
E Chankaew ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Vertebral Artery ◽  
Intracranial Haemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Recurrent Bleeding ◽  
Parent Artery ◽  
Parent Vessel ◽  
Total Occlusion ◽  
First Choice ◽  
Dissecting Aneurysms

Objective Intracranial spontaneous vertebral artery dissecting aneurysms commonly occur in the third to fifth decades of life, and are mostly associated with hypertension. Patients present with intracranial haemorrhage or thromboembolic events. Patients who present with intracranial haemorrhage carry about a 70% risk of recurrent bleeding. Patients with a posterior-inferior cerebellar artery (PICA) or ipsilateral dominant vertebral artery involve selecting which parent vessel could not be sacrificed. Recent reconstructive techniques such as stent-assisted coiling embolisation and flow-diverting stents are effective treatments of choice. Methods Seventeen patients presented subarachnoid haemorrhage and nine patients with other symptoms. Sacrificing the parent vertebral artery was the first choice for surgical or endovascular methods. Endovascular reconstructive treatment by stent-assisted coiling embolisation was indicated in dissecting vertebral artery aneurysms with ipsilateral dominant vertebral artery or PICA involvement. Clinical outcomes were determined using the modified Rankin Score (mRS) at 90 days, with favourable outcomes defined as 0 to 2. Results Of the patients presenting with ruptured aneurysms, 11 (61.1%) had a good clinical outcome, with a mRS of 0–2. Favourable Hunt and Hess grading (65%), mild to moderate GCS (65%) and total occlusion of aneurysms after treatment (65%) were significantly good prognostic factors in patients with ruptured vertebral artery dissecting aneurysms. Conclusion Endovascular parent vessel sacrifice could be the first choice to treat a ruptured vertebral artery dissecting aneurysm. Stent-assisted coiling to preserve the patency of the parent artery and its branches is a promising treatment for vertebral artery dissections.

Successful Treatment of Bilateral Vertebral Artery Dissecting Aneurysms with Subarachnoid Hemorrhage: Report of Three Cases

2012 ◽  
Vol 21 (5) ◽  
pp. 422-427 ◽  
Author(s):  
Takeo Nashimoto ◽  
Tadashi Komata ◽  
Junpei Honma ◽  
Sinya Yamashita ◽  
Yasuhiro Seki ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Successful Treatment ◽  
Dissecting Aneurysms

Flow-Diverting Stent for Ruptured Intracranial Dissecting Aneurysm of Vertebral Artery

Neurosurgery ◽  
2011 ◽  
Vol 70 (4) ◽  
pp. 982-989 ◽  
Author(s):  
Ana Paula Narata ◽  
Hasan Yilmaz ◽  
Karl Schaller ◽  
Karl Olof Lovblad ◽  
Vitor Mendes Pereira
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Dissecting Aneurysm ◽  
Clinical State ◽  
Parent Vessel ◽  
Acute Subarachnoid Hemorrhage ◽  
Complete Exclusion ◽  
Intracranial Dissecting Aneurysm ◽  
Flow Diverting Stent ◽  
Dissecting Aneurysms

Abstract BACKGROUND: The treatment of ruptured dissecting aneurysms of the intracranial vertebral artery (VA) with parent vessel preservation is a challenge for neurosurgeons and interventional neuroradiologists. OBJECTIVE: To propose an indication for flow-diverting treatment for reconstruction of a dissecting VA with acute subarachnoid hemorrhage. METHODS: Two male patients transferred after acute subarachnoid hemorrhage and dissecting aneurysm on the V4 segment of the dominant VA. An occlusion test was not performed because of their poor clinical state. A flow-diverting stent represented by the Pipeline embolization device was suggested to both patients. RESULTS: Three Pipeline embolization devices were deployed in each VA. One dissecting aneurysm was excluded immediately after 3 stents, and 1 patient had complete exclusion demonstrated at the 48-hour control. No morbidity directly related to the procedure was observed. No recanalization and no rebleeding occurred during the 3 months of follow-up. CONCLUSION: A flow-diverting stent may be considered an option to treat ruptured dissecting aneurysms of the VA, providing remodeling of the parent vessel and complete exclusion of the aneurysm.

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