Skip to main content
SpringerLink
Log in

Endovascular treatment of ruptured dissecting vertebral artery aneurysms—long-term follow-up results, benefits of early embolization, and predictors of outcome

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Introduction

The purpose of this study was to evaluate the effect of endovascular treatment of ruptured dissecting aneurysms of the vertebral artery, the benefits of early embolization, and the predictors of outcomes.

Clinical material and methods

Between September, 2001 and May, 2009, 25 patients with ruptured vertebral dissecting aneurysms were treated by internal coil trapping (n = 23) or stents (n = 2) in our hospital. There were 14 males and 11 females with a mean age of 45 years (age range, 22–66 years). Dissecting aneurysms were supra-posterior inferior cerebellar artery lesions (n = 16), infra-posterior inferior cerebellar artery lesions (n = 6), or involved the posterior inferior cerebellar artery (n = 3).

Results

Complete occlusion of dissected arterial and aneurysm segments (internal trapping) was achieved in 21 (91.3%) of 23 patients. The two patients with posterior inferior cerebellar artery involvement underwent double stent only placement. Clinical outcomes were favorable in 17 (68%) of 25 patients, 2 (8%) had severe disability, and 6 (24%) patients died. Risk factors that varied with favorable versus unfavorable outcomes were: preoperative Hunt–Hess, World Federation of Neurological Surgeons scale, presence of hydrocephalus, presence of lateral medullary syndrome, presence of low cranial nerve palsy, rebleeding, time of endovascular procedures, and time from admission to procedure. However, univariate Cox analysis confirmed that only low preoperative Hunt–Hess grade predicted favorable clinical outcome. Early embolization did not affect clinical outcome, but reduced the risk of rebleeding and inpatient stay.

Conclusion

In our experience, internal trapping of the dissected segment with a coil was straightforward, applicable to most patients, prevented rebleeding safely and effectively without significant procedural complications, and had a good follow-up outcome. The low Hunt–Hess grade remained predictors of favorable clinical outcomes. The timing of embolization did not significantly affect clinical outcome but early embolization reduces inpatient stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

PICA:

Posterior inferior cerebellar artery

H–H scale:

Hunt and Hess scale

WFNS:

The World Federation of Neurological Surgeons scale

LCN:

Low cranial nerve

LMS:

Lateral medullary syndrome

VADA:

Vertebral artery dissecting aneurysms

GOS:

Glasgow outcome scale

SAH:

Subarachnoid hemorrhage

References

  1. Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Lee BH, 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

    PubMed  CAS  Google Scholar 

  2. Albuquerque FC, Fiorella DJ, Han PP, Deshmukh VR, Kim LJ, McDougall CG (2005) Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus 18:E3

    PubMed  Google Scholar 

  3. Andoh T, Shirakami S, Nakashima T, Nishimura Y, Sakai N, Yamada H, Ohkuma A, Tanabe Y, Funakoshi T (1992) Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987–993, discussion 993

    Article  PubMed  CAS  Google Scholar 

  4. Anxionnat R, de Melo Neto JF, Bracard S, Lacour JC, Pinelli C, Civit T, Picard L (2003) Treatment of hemorrhagic intracranial dissections. Neurosurgery 53:289–300, discussion 300-281

    Article  PubMed  Google Scholar 

  5. Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631

    Article  PubMed  CAS  Google Scholar 

  6. Arnold M, Bousser MG, Baumgartner RW (2007) Prognosis and safety of anticoagulation in intracranial artery dissections in adults. Stroke 38:e140, author reply e141

    Article  PubMed  Google Scholar 

  7. Arnold M, Bousser MG, Fahrni G, Fischer U, Georgiadis D, Gandjour J, Benninger D, Sturzenegger M, Mattle HP, Baumgartner RW (2006) Vertebral artery dissection: presenting findings and predictors of outcome. Stroke 37:2499–2503

    Article  PubMed  Google Scholar 

  8. Bostrom K, Liliequist B (1967) Primary dissecting aneurysm of the extracranial part of the internal carotid and vertebral arteries. A report of three cases. Neurology 17:179–186

    PubMed  CAS  Google Scholar 

  9. de Bray JM, Penisson-Besnier I, Dubas F, Emile J (1997) Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis. J Neurol Neurosurg Psychiatry 63:46–51

    Article  PubMed  Google Scholar 

  10. Dohi K, Kubota M, Hamada H, Kuwabara K, Nishijima Y, Kushihashi T, Matsumoto K (1994) Compression of medulla oblongata by the dissecting aneurysm of the vertebral artery 7 years after its rupture: case report. No Shinkei Geka 22:1067–1070

    PubMed  CAS  Google Scholar 

  11. Fisher CM, Karnes WE, Kubik CS (1961) Lateral medullary infarction—the pattern of vascular occlusion. J Neuropathol Exp Neurol 20:323–379

    Article  PubMed  CAS  Google Scholar 

  12. Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334

    Article  PubMed  CAS  Google Scholar 

  13. Halbach VV, Higashida RT, Dowd CF, Fraser KW, Smith TP, Teitelbaum GP, Wilson CB, Hieshima GB (1993) Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:183–191

    Article  PubMed  CAS  Google Scholar 

  14. Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi JC, Nagata I (2002) Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97:259–267

    Article  PubMed  Google Scholar 

  15. Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K (1994) Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–626, discussion 626–627

    Article  PubMed  CAS  Google Scholar 

  16. Kurata A, Ohmomo T, Miyasaka Y, Fujii K, Kan S, Kitahara T (2001) Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22:11–18

    PubMed  CAS  Google Scholar 

  17. 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

    PubMed  CAS  Google Scholar 

  18. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C (2001) Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94:427–432

    Article  PubMed  CAS  Google Scholar 

  19. Mahmood A, Dujovny M, Torche M, Dragovic L, Ausman JI (1991) Microvascular anatomy of foramen caecum medullae oblongatae. J Neurosurg 75:299–304

    Article  PubMed  CAS  Google Scholar 

  20. Mehta B, Burke T, Kole M, Bydon A, Seyfried D, Malik G (2003) Stent-within-a-stent technique for the treatment of dissecting vertebral artery aneurysms. AJNR Am J Neuroradiol 24:1814–1818

    PubMed  Google Scholar 

  21. Metso TM, Metso AJ, Helenius J, Haapaniemi E, Salonen O, Porras M, Hernesniemi J, Kaste M, Tatlisumak T (2007) Prognosis and safety of anticoagulation in intracranial artery dissections in adults. Stroke 38:1837–1842

    Article  PubMed  CAS  Google Scholar 

  22. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–911, discussion 912-903

    Article  PubMed  CAS  Google Scholar 

  23. Muller BT, Luther B, Hort W, Neumann-Haefelin T, Aulich A, Sandmann W (2000) Surgical treatment of 50 carotid dissections: indications and results. J Vasc Surg 31:980–988

    Article  PubMed  CAS  Google Scholar 

  24. Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM (2003) Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24:1421–1428

    PubMed  Google Scholar 

  25. Rhoton AL Jr (2000) The cerebellar arteries. Neurosurgery 47:S29–S68

    Article  PubMed  Google Scholar 

  26. Sasaki O, Ogawa H, Koike T, Koizumi T, Tanaka R (1991) A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874–882

    Article  PubMed  CAS  Google Scholar 

  27. Schievink WI (2000) The treatment of spontaneous carotid and vertebral artery dissections. Curr Opin Cardiol 15:316–321

    Article  PubMed  CAS  Google Scholar 

  28. Schievink WI (2001) Spontaneous dissection of the carotid and vertebral arteries. N Engl J Med 344:898–906

    Article  PubMed  CAS  Google Scholar 

  29. Schievink WI, Piepgras DG, McCaffrey TV, Mokri B (1994) Surgical treatment of extracranial internal carotid artery dissecting aneurysms. Neurosurgery 35:809–815, discussion 815-806

    Article  PubMed  CAS  Google Scholar 

  30. Thornhill S, Teasdale GM, Murray GD, McEwen J, Roy CW, Penny KI (2000) Disability in young people and adults one year after head injury: prospective cohort study. BMJ 320:1631–1635

    Article  PubMed  CAS  Google Scholar 

  31. Tsukahara T, Wada H, Satake K, Yaoita H, Takahashi A (1995) Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage. Neurosurgery 36:914–919, discussion 919–920

    Article  PubMed  CAS  Google Scholar 

  32. Yamada M, Kitahara T, 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

    Article  PubMed  Google Scholar 

  33. Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188

    Article  PubMed  CAS  Google Scholar 

  34. Yamaura I, 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

    Article  PubMed  CAS  Google Scholar 

  35. Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28:370–374

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Chonbuk National University Hospital & Medical School, Chun-Ju, South Korea

    Jong-Myong Lee & Ha-Young Choi

  2. Department of Neurosurgery, Chonnam National University Hospital & Medical School, 671 Jebongno, Dong-gu, Gwangju, 501-757, Republic of Korea

    Tae-Sun Kim & Sung-Pil Joo

  3. Department of Radiology, Chonnam National University Hospital & Medical School, Gwangju, South Korea

    Woong Yoon

Authors
  1. Jong-Myong Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tae-Sun Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sung-Pil Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Woong Yoon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ha-Young Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tae-Sun Kim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lee, JM., Kim, TS., Joo, SP. et al. Endovascular treatment of ruptured dissecting vertebral artery aneurysms—long-term follow-up results, benefits of early embolization, and predictors of outcome. Acta Neurochir 152, 1455–1465 (2010). https://doi.org/10.1007/s00701-010-0683-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-010-0683-9

Keywords

Search

Navigation