Abstract
The goal of this study was to evaluate the results of endovascular and surgical treatments for ruptured vertebral artery dissecting aneurysms (VADAs) to determine which treatment is preferable. We evaluated the cases of 25 consecutive patients with ruptured VADAs treated in our institution. From 1992 to 1997, five patients were treated surgically. Since 1998, 20 patients with VADAs have been treated with endovascular therapy. The goal of the treatment was to exclude the aneurysm from the circulation. Among the five patients undergoing surgery, three aneurysms were treated with proximal clipping, one with trapping, and one with dome clipping. None of the patients were treated during the acute stage of rupture. Transient complications occurred in two patients. Of the 20 patients treated through the endovascular approach, 15 were treated within 24 h of rupture, but 12 had rebleeding before treatment. Eighteen aneurysms were occluded, along with the affected vertebral artery (VA), by using detachable coils (internal trapping), and one was occluded with the VA preserved. A stent-assisted occlusion of one aneurysm was done in a patient who had a contralateral hypoplastic VA. In both groups, the outcome of each patient depended greatly on the patient’s condition before treatment and whether there was rebleeding. No posttreatment bleeding occurred. All procedures were effective, but endovascular treatment was less invasive and easier to use during the acute stage of subarachnoid hemorrhage. Although this report does not describe a controlled study, we found that endovascular treatment is preferable for treating ruptured VADAs in the acute stage.
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References
Berger MS, Wilson CB (1991) Intracranial dissecting aneurysms of the posterior circulation: report of six cases and review of the literature. J Neurosurg 61:882–894
Friedman AH, Drake CG (1984) Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334
Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K (1994) Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:620–627
Kurata A, Ohmoto T, Miyasaka Y, Fujii K, Kan S, Kitahara T (2001) Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. Am J Neuroradiol 22:11–18
Lylyk P, Ceratto R, Hurvitz D, Basso A (1998) Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report. Neurosurgery 43:385–388
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
Manabe H, Hatayama T, Hasegawa S, Islam SMD, Suzuki S (2000) Coil embolization for ruptured vertebral artery dissection distal to the origin of the posterior inferior cerebellar artery. Neuroradiology 42:384–387
Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913
Yamaura I, Tani E, Yokota M, Nakano A, Fukami N, 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
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
Yamaura A, Watanabe Y, Saeki N (1990) Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188
Yamaura A, Toshimoto T, Hashimoto N, Ono J (1998) Nationwide study of nontraumatic intracranial arterial dissection: treatment and its results. Surg Cerebr Stroke 26:87–95
Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631
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
Hunt WE, Kosnik EJ (1974) Timing and perioprative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89
Jennett B, Bond M (1975) Assessment of outcome after severe brain damage: A practical scale. Lancet 1:480–484
Sugiu K, Takahashi K, Muneta K, Ohmoto T (2004) Rebleeding of a vertebral artery dissecting aneurysm during stent-assisted coil embolization: a pitfall of the “stent and coil” technique. Surg Neurol 61:365–370
Mizutani T, Kojima H, Asamoto S (2004) Healing process for cerebral dissecting aneurysms presenting with subarachnoid hemorrhage. Neurosurgery 54:342–348
Kitanaka C, Morimoto T, Sasaki T, Takakura K (1992) Rebleeding from vertebral artery dissection after proximal clipping. Case report. J Neurosurg 77:466–468
Benndorf G, Herbon U, Sollmann WP, Campi A (2001) Treatment of a ruptured dissecting vertebral artery aneurysm with double stent placement: case report. Am J Neuroradiol 22:1844–1848
Horowitz MB, Purdy PD (2000) The use of stents in the management of neurovascular disease: a review of historical and present status. Neurosurgery 46:1335–1343
Lanzino G, Wakhloo AK, Fessler RD, Hartney ML, Guterman LR, Hopkins LN (1999) Efficacy and current limitations of intravascular stents for intracranial internal carotid, vertebral, and basilar artery aneurysms. J Neurosurg 91:538–546
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Sugiu, K., Tokunaga, K., Watanabe, K. et al. Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms. Neuroradiology 47, 158–164 (2005). https://doi.org/10.1007/s00234-005-1341-4
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DOI: https://doi.org/10.1007/s00234-005-1341-4