Endovascular treatment for ruptured vertebral artery dissecting aneurysms at the acute stage

• Published in: Acta neurochirurgica. Supplement Vol. 118; p. 273
• Main Authors: Suma, Takeshi, Shibuya, Tadashi, Kutsuna, Nobuo, Takada, Yoshiyuki, Matsuzaki, Toshinori, Nakamura, Shin, Hirayama, Teruyasu, Katayama, Yoichi
• Format: Journal Article
• Language: English
• Published: Austria 2013
• Subjects: Adult; Aged; Aneurysm, Dissecting - complications; Aneurysm, Dissecting - surgery; Coronary Angiography; Embolization, Therapeutic - methods; Female; Humans; Male; Middle Aged; Postoperative Care; Retrospective Studies; Stents; Treatment Outcome; Vertebral Artery Dissection - complications; Vertebral Artery Dissection - surgery
• ISSN: 0065-1419
• DOI: 10.1007/978-3-7091-1434-6_52

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. 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. 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. Endovascular treatment of ruptured VADA in the acute stage appears to be safe and effective.