Endovascular Parent Artery Occlusion of Ruptured Vertebral Artery Dissecting Aneurysms

• Published in: Journal of Neuroendovascular Therapy Vol. 6; no. 2; pp. 98 - 104
• Main Authors: NONAKA, Senshu, OISHI, Hidenori, SUGA, Yasuo, YAMAMOTO, Munetaka, YOSHIDA, Kensaku, ARAI, Hajime
• Format: Journal Article
• Language: English
• Published: The Japanese Society for Neuroendovascular Therapy 2012
• Subjects: clinical outcome; endovascular treatment; posterior inferior cerebellar artery; ruptured vertebral artery dissecting aneurysm
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.6.98

Objectives: In recent years, endovascular treatment, especially parent artery occlusion, has become a first-line treatment for ruptured vertebral artery dissecting aneurysms (VADAs). This study reports the outcomes of endovascularly treated ruptured VADAs. Methods: The subjects comprised 50 patients who underwent endovascular parent artery occlusion of ruptured VADAs between 2004 and 2011 (29 men, 21 women; mean age, 50.7 years [range, 28-74 years]). Hunt and Hess (H/H) grades just prior to endovascular treatment were grade 1 in 4 patients (8.0%), grade 2 in 8 (16.0%), grade 3 in 14 (28.0%), grade 4 in 9 (18.0%), and grade 5 in 15 (30.0%). Clinical outcomes were assessed using the Glasgow Outcome Scale. Locations of dissecting aneurysms relative to the ipsilateral posterior inferior cerebellar artery (PICA) were proximal type in 3 patients (6.0%), distal type in 25 (50.0%), PICA-involved type in 6 (12.0%), and non-PICA type in 16 (32.0%). Results: Forty-two patients (84.0%) underwent internal trapping, and the remaining 8 patients (16.0%) underwent proximal occlusion. One patient rebled during the diagnostic angiography before the coil embolization procedure. There were no procedure-related complications. Clinical outcomes at discharge were good recovery in 26 patients (52.0%), moderate disability in 4 (8.0%), severe disability in 10 (20.0%), vegetative survival in 4 (8.0%), and death in 6 (12.0%). Notably, 41.5% of the patients with an H/H grade of 4 to 5 had a good clinical outcome. Conclusions: This study shows that endovascular parent artery occlusion for ruptured VADAs is feasible and safe.