Abstract
Objective: Ruptured vertebral artery dissecting aneurysms (VADA) should be treated promptly because of the high risk of rebleeding. However, it is difficult to treat dissecting aneurysm during the acute stage using microsurgery because of high intracranial pressure or brain edema. Therefore, endovascular treatment of the ruptured VADA may be a better technique. We retrospectively studied the efficacy and outcome of endovascular treatment of ruptured VADA at the acute stage.
Methods: Ten patients with ruptured VADA received endovascular treatment at the acute stage. Eight patients who had dissecting aneurysms were treated by internal trapping of the dissected segment. We performed stent-assisted coiling (SAC) for a case of VADA in contralateral hypoplastic VA and a case of bilateral dissections, ruptured VADA of the right VA and VA dissection of the left VA.
Results: Four patients had good recovery, 3 patients had moderate disability, 2 patients had severe disability, and 1 patient died from initial severe SAH. There was no rebleeding or procedure-related complication. However, one patient who was treated by SAC had ischemic complications post-treatment.
Conclusion: Endovascular treatment of ruptured VADA in the acute stage appears to be safe and effective.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Seo SH, Kim DI, Hong CK, Joo JY (2006) Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent assisted coiling. AJNR Am J Neuroradiol 27:1514–1520
Albuquerque FC, Fiorella DJ, Han PP, Deshmukh VR, Kim LJ, McDougall CG (2005) Endovascular treatment of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus 18:1–6
Chung J, Kim BS, Lee D, Kim TH, Shin YS (2010) Vertebral artery occlusion with vertebral artery-to-posterior inferior cerebellar artery stenting for preservation of the PICA in treating ruptured vertebral artery dissection. Acta Neurochir 153:1489–1492
Kai Y, Hamada JI, Morioka M, Todaka T, Mizuno T, Ushio Y (2003) Endovascular coil trapping for ruptured vertebral artery dissecting aneurysms by using double microcathters technique in that acute stage. Acta Neurochir (Wien) 145:447–451
Leibowitz R, Do HM, Marcellus ML, Chang SD, Steinberg GK, Marks MP (2003) Parent vessel occlusion for vertebrobasilar fusiform and dissecting aneurysms. AJNR Am J Neuroradiol 24:902–907
Mehta B, Burke T, Kole M, Bydon A, Seyfriend D, Malik G (2003) Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms. AJNR Am J Neuroradiol 24:1814–1818
Otawara Y, Ogasawara K, Ogawa A, Kogure T (2002) Dissecting aneurysms of bilateral vertebral arteries with subarachnoid haemorrhage: report of three cases. Neurosurgery 50:1372–1374
Peluso JPP, van Rooij WJ, Sluzewski M, Beute GN, Majoie CB (2008) Endovascular treatment of symptomatic intracranial vertebral dissecting aneurysms. AJNR Am J Neuroradiol 29:102–106
Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ, Chung EC, Koh JS, Shin HC, Choi CS, Won YS (2009) Stent-assited coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. J Neurosurg 111:48–52
Uhl E, Schmid-Elsaesser R, Steiger HJ (2003) Ruptued intracranial dissecting aneurysms: management considerations with a focus on surgical and endovascular techniques to preserve arterial continuity. Acta Neurochir (Wien) 145:1073–1084
Yamada M, Takao K, Kurata A, Fujii K, Miyasaka Y (2004) Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients. J Neurosurg 101:25–30
Yamaura A, Tani E, Yokota M, Nakano A, Fukami M, Kaba K, Matsumoto T (1999) Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils. J Neurosurg 90:853–856
Conflict of Interest
The authors report no conflict of interest concerning the material or methods used in the study.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Wien
About this paper
Cite this paper
Suma, T. et al. (2013). Endovascular Treatment for Ruptured Vertebral Artery Dissecting Aneurysms at the Acute Stage. In: Katayama, Y., Maeda, T., Kuroiwa, T. (eds) Brain Edema XV. Acta Neurochirurgica Supplement, vol 118. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1434-6_52
Download citation
DOI: https://doi.org/10.1007/978-3-7091-1434-6_52
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-1433-9
Online ISBN: 978-3-7091-1434-6
eBook Packages: MedicineMedicine (R0)