Endovascular Treatment of Ruptured Vertebral Artery Dissection in the Acute Stage

2003 ◽  
Vol 16 (3) ◽  
pp. 306-308 ◽  
Author(s):  
Joji Inamasu ◽  
Yoshiki Nakamura ◽  
Ryoichi Saito ◽  
Yoshiaki Kuroshima ◽  
Keita Mayanagi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Acute Stage ◽  
Artery Dissection

scholarly journals A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection

2019 ◽  
Vol 10 ◽  
pp. 126
Author(s):  
Kiyoshi Tsuji ◽  
Akira Watanabe ◽  
Nobuhiro Nakagawa ◽  
Amami Kato
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
De Novo ◽  
Vertebral Artery Dissection ◽  
Contralateral Side ◽  
Sudden Onset ◽  
Acute Stage ◽  
Artery Dissection ◽  
Lateral Medullary Infarction ◽  
The Right

Background: Vertebral artery dissection (VAD) is an important cause of stroke in young and middle- aged people. Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage in the acute stage of cerebral infarction due to unilateral VAD. Case Description: A 52-year-old man developed sudden-onset left occipital headache, dizziness, dysphagia, and right-sided hemiparesthesia and was admitted to our hospital. Head magnetic resonance imaging on admission showed a left lateral medullary infarction due to the left VAD. At this point, the right vertebral artery was normal. However, on day 9 after onset, he suddenly presented with subarachnoid hemorrhage due to the right VAD. Emergency endovascular treatment was performed for the dissecting aneurysm of the right vertebral artery. The patient’s condition improved gradually after the procedure, and he was discharged with a modified Rankin Scale score of 1. Conclusion: Bilateral occurrence of VAD may be more common than previously believed. Even in cases of unilateral VAD, we need to pay attention to the occurrence of de novo VAD on the contralateral side.

Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

2004 ◽  
Vol 101 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Masaru Yamada ◽  
Takao Kitahara ◽  
Akira Kurata ◽  
Kiyotaka Fujii ◽  
Yoshio Miyasaka
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Delayed Diagnosis ◽  
Acute Stage ◽  
Artery Dissection ◽  
Content Type ◽  
String Structure ◽  
Fine Print

Object. Intracranial vertebral artery (VA) dissection with subarachnoid hemorrhage is notorious for frequent rebleeding and a poor prognosis. Nevertheless, some patients survive with a good final outcome. The factors associated with the prognosis of this disease are not fully understood and appropriate treatment strategies continue to be debated. The authors retrospectively evaluated the clinical features of conservatively treated patients to elucidate the relationship between the clinical and angiographic characteristics of the disease and final outcomes. Methods. This study includes 24 patients who were treated by conservative methods between 1990 and 2000. Conservative treatment was chosen because of delayed diagnosis, poor clinical condition, or anatomical features such as bilateral lesions and contralateral VA hypoplasia. Of nine patients with an admission Hunt and Kosnik Grade I or II, eight had good outcomes (mean follow-up period 8 years and 4 months). All 15 patients with Grade III, IV, or V died and in 10 of these the cause of death was rebleeding. Among the 24 patients, 14 suffered a total of 35 rebleeding episodes; in 10 (71.4%) of these 14 patients rebleeding occurred within 6 hours and in 13 (93%) within 24 hours. Compared with the survivors, there was a female preponderance (0.022) among patients who died. These patients also had significantly shorter intervals between onset and hospital admission (p = 0.0067), a higher admission Hunt and Kosnik grade (p = 0.0001), a higher incidence of prehospitalization (p = 0.0296) and postadmission (p = 0.0029) rebleeding episodes, and a higher incidence of angiographically confirmed pearl-and-string structure of the lesion (p = 0.0049). Conclusions. In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

Endovascular Management of Intracranial Vertebral Artery Dissection: Technical Nuances for the Preservation of Posterior Inferior Cerebellar Artery and Basilar Artery

2020 ◽  
Vol 19 (3) ◽  
pp. 241-248
Author(s):  
Gaurav Gupta ◽  
Donna A Eckstein ◽  
Vinayak Narayan ◽  
Fareed Jumah ◽  
Anthony A DePalma ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Treatment Method ◽  
Neurological Deficits ◽  
Artery Dissection ◽  
Treatment Technique ◽  
Cerebellar Artery

Abstract BACKGROUND The treatment of intracranial vertebral artery dissection (VAD) can be challenging. OBJECTIVE To evaluate the clinical presentation, endovascular treatment techniques, and prognostic outcome of patients diagnosed with intracranial VAD at our institution. METHODS A retrospective analysis of 35 patients who were diagnosed with VAD at our institution over 17-yr period (2001-2017) is presented. A total of 27 patients with a total of 30 affected arteries underwent endovascular treatment, and their outcome was evaluated. RESULTS Of the 35 total patients with VAD, 15 presented with headache, 12 with focal neurological deficits, 2 with neck pain, 2 with dizziness, 1 with syncope, and 3 after trauma. Of the 30 dissected arteries, 18 were treated with deconstruction and 12 were treated with stent reconstruction. Treatment method was determined by the dominance of the affected artery and location relative to the ipsilateral posterior inferior cerebellar artery (PICA) and the basilar artery. Deconstructive techniques were utilized in all cases of hypoplastic artery dissection and the majority of codominant artery dissections, whereas reconstruction was performed on the majority of dominant artery dissections. Rupture did not impact treatment technique. Four patients demonstrated post-treatment infarcts, and another 1 patient died because of intraparenchymal bleed. The remaining 22 patients demonstrated favorable clinical outcome. None of the patients developed recanalization or needed retreatment till the last follow-up. CONCLUSION This study suggests that endovascular treatment of intracranial VAD with deconstruction or stent reconstruction based on the patients anatomy, particularly vessel dominance and location with respect to PICA, is feasible and effective though the revascularization procedures still has its role in selected cases.

Intracranial vertebral artery dissection presenting as subarachnoid hemorrhage: successful endovascular treatment

2001 ◽  
Vol 103 (1) ◽  
pp. 64-68 ◽  
Author(s):  
A. B. Conforto ◽  
Fabio Yamamoto ◽  
E. F. Evaristo ◽  
Paulo Puglia ◽  
J. G. Caldas ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection

scholarly journals Dissecting spontaneous vertebral artery aneurysms (V4). Endovascular Reconstructive techniques with fd stents. Case series

2020 ◽  
Vol 31 (4) ◽  
pp. 305-313
Author(s):  
João Victor Amaro de Souza ◽  
Guilherme Cabral de Andrade ◽  
Alexandre Lescszysnki ◽  
Helvercio F P Alves
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Young Patients ◽  
Case Series ◽  
Arterial Occlusion ◽  
Artery Dissection ◽  
Surgical Morbidity ◽  
Reconstructive Technique

Background: Spontaneous vertebral artery dissection (SVAD) is rare and occurs in young patients with subarachnoid hemorrhage (HSA) or stroke (3 to 5%). Only 11% occur in the V4 segment of VA. Its treatment changed in parallel with the progress of endovascular technology. Material and Methods: Six consecutive cases of dissecting vertebral artery aneurysms V4 are reported. All males with mean age 35 years. Clinical presentation with headache and neckache in all cases, ischemic stroke and SAH one case each. All patients underwent reconstructive endovascular treatment with FD stent, with or without microcoils. Results: All patients were under dual antiplatelet therapy before EVT (Aspirin 200mg and clopidogrel 75mg or ticagrelor 180mg/day). Reconstructive technique was performed with FD stent in two cases, associated of microcoils and “jailing technique” in two cases or multiple telescoping stents in three cases. Occlusion of the aneurysm and arterial permeability were found in long term follow up in 5 cases. In a case of fusiform aneurysm, there was late thrombosis of the telescoped stents and arterial occlusion without clinical repercussion. Conclusion: Due to the high rate of surgical morbidity, endovascular treatment became the first line for this kind of aneurysm. The reconstruction using a flow bypass and device reconstructive technique is an attractive alternative, showing long-term favorable clinical and angiographic outcomes with the ability to maintain patency of the parental and lateral branch arteries.

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