Endovascular Parent Artery Occlusion of Ruptured Vertebral Artery Dissecting Aneurysms
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...
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| Published in | Journal of Neuroendovascular Therapy Vol. 6; no. 2; pp. 98 - 104 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
The Japanese Society for Neuroendovascular Therapy
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1882-4072 2186-2494 |
| DOI | 10.5797/jnet.6.98 |
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| Abstract | 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. |
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| AbstractList | [Abstract] 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. 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. |
| Author | YOSHIDA, Kensaku NONAKA, Senshu YAMAMOTO, Munetaka ARAI, Hajime OISHI, Hidenori SUGA, Yasuo |
| Author_xml | – sequence: 1 fullname: YOSHIDA, Kensaku organization: Department of Neurosurgery, Tokyo Metropolitan Hiroo Hospital – sequence: 1 fullname: ARAI, Hajime organization: Department of Neurosurgery, Juntendo University School of Medicine – sequence: 1 fullname: NONAKA, Senshu organization: Department of Neurosurgery, Juntendo University School of Medicine – sequence: 1 fullname: OISHI, Hidenori organization: Department of Neurosurgery, Juntendo University School of Medicine – sequence: 1 fullname: YAMAMOTO, Munetaka organization: Department of Neurosurgery, Juntendo University School of Medicine – sequence: 1 fullname: SUGA, Yasuo organization: Department of Neurosurgery, Juntendo University School of Medicine |
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| Cites_doi | 10.5137/1019-5149.JTN.2790-09.0 10.3171/jns.1991.75.6.0874 10.3171/jns.2002.97.2.0259 10.1097/00006123-200001000-00038 10.1227/00006123-199212000-00001 10.3171/jns.2003.99.6.0960 10.2335/scs1987.18.1_50 10.3171/jns.1992.76.4.0571 10.1097/00006123-199505000-00003 10.1055/s-0030-1269873 |
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| References | 4) Dohi K, Kubota M, Hamada H, et al: Compression of medulla oblongata by the dissecting aneurysm of the vertebral artery seven 7 years after its rupture: case report. No Shinkei Geka 22:1067-1070, 1994. 7) Kamiyama H, Nomura M, Abe H, et al: Diagnosis of intracranial dissecting aneurysms. Surg Cereb Stroke 18:50-56, 1990. 6) Iihara K, Sakai N, Murao K, et al: Dissecting aneurysm of vertebral artery: a management strategy. J Neurosurg 97:259-267, 2002. 11) Nakai Y, Yanaka K, Meguro K, et al: Rebleeding from dissecting vertebral aneurysm after endovascular proximal occlusion: case report. Neurosurg Lett (Tokyo) 9:21-24, 1999. 15) Sasaki O, Ogawa H, Koike T, et al: A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874-882, 1991. 2) Andoh T, Shirakami S, Nakashima T, et al: Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987-993, 1992. 8) Kim MJ, Chung J, Kim SL, et al: Stenting from the vertebral artery to the posterior inferior cerebellar artery. AJNR 33:348-352, 2012. 1) Aoki N, Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 10:22-27, 1990 14) Sadato A, Maeda S, Hayakawa M, et al: Endovascular treatment of vertebral artery dissection using stents and coils: its pitfall and technical considerations. Minim Invasive Neurosurg 53:243-249, 2010. 16) Shibuya M, Suzuki Y, Sugita K, et al: Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. J Neurosurg 76:571-577, 1992. 3) Chung J, Kim BS, Lee D, et al: 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 152:1489-1492, 2010. 12) Ono J, Hirai S, Kobayashi E, et al: Early management of ruptured arterial dissection in the vertebrobasilar system: analysis of the cases with subsequent rupture. Neurosurg Emerg 8:30-34, 2003. 13) Rabinov J, Hellinger F, Morris P, et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR 24:1421-1428, 2003. 10) Mizutani T, Aruga T, Kirino T, et al: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905-913, 1995. 18) Yasui T, Komiyama M, Nishikawa M, et al: Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature. Neurosurgery 46:196-200, 2000. 17) Taha M, Sakaida H, Asakura F, et al: Endovascular management of vertebral artery dissecting aneurysms: review of 25 patients. Turk Neurosurg 20:126-135, 2010. 9) Kurata A, Ohmomo T, Miyasaka Y, et al: Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR 22:11-18, 2001. 5) Hamada J, Kai Y, Morioka M, et al: Multimodal treatment of ruptured dissecting aneurysm of the vertebral artery during acute stage. J Neurosurg 99:960-966, 2003. 11 12 13 14 15 1 2 3 4 5 6 7 8 9 10 |
| References_xml | – reference: 3) Chung J, Kim BS, Lee D, et al: 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 152:1489-1492, 2010. – reference: 5) Hamada J, Kai Y, Morioka M, et al: Multimodal treatment of ruptured dissecting aneurysm of the vertebral artery during acute stage. J Neurosurg 99:960-966, 2003. – reference: 16) Shibuya M, Suzuki Y, Sugita K, et al: Effect of AT877 on cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Results of a prospective placebo-controlled double-blind trial. J Neurosurg 76:571-577, 1992. – reference: 17) Taha M, Sakaida H, Asakura F, et al: Endovascular management of vertebral artery dissecting aneurysms: review of 25 patients. Turk Neurosurg 20:126-135, 2010. – reference: 12) Ono J, Hirai S, Kobayashi E, et al: Early management of ruptured arterial dissection in the vertebrobasilar system: analysis of the cases with subsequent rupture. Neurosurg Emerg 8:30-34, 2003. – reference: 13) Rabinov J, Hellinger F, Morris P, et al: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR 24:1421-1428, 2003. – reference: 4) Dohi K, Kubota M, Hamada H, et al: Compression of medulla oblongata by the dissecting aneurysm of the vertebral artery seven 7 years after its rupture: case report. No Shinkei Geka 22:1067-1070, 1994. – reference: 2) Andoh T, Shirakami S, Nakashima T, et al: Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987-993, 1992. – reference: 6) Iihara K, Sakai N, Murao K, et al: Dissecting aneurysm of vertebral artery: a management strategy. J Neurosurg 97:259-267, 2002. – reference: 18) Yasui T, Komiyama M, Nishikawa M, et al: Subarachnoid hemorrhage from vertebral artery dissecting aneurysms involving the origin of the posteroinferior cerebellar artery: report of two cases and review of the literature. Neurosurgery 46:196-200, 2000. – reference: 10) Mizutani T, Aruga T, Kirino T, et al: Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905-913, 1995. – reference: 11) Nakai Y, Yanaka K, Meguro K, et al: Rebleeding from dissecting vertebral aneurysm after endovascular proximal occlusion: case report. Neurosurg Lett (Tokyo) 9:21-24, 1999. – reference: 7) Kamiyama H, Nomura M, Abe H, et al: Diagnosis of intracranial dissecting aneurysms. Surg Cereb Stroke 18:50-56, 1990. – reference: 1) Aoki N, Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 10:22-27, 1990 – reference: 9) Kurata A, Ohmomo T, Miyasaka Y, et al: Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR 22:11-18, 2001. – reference: 15) Sasaki O, Ogawa H, Koike T, et al: A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874-882, 1991. – reference: 14) Sadato A, Maeda S, Hayakawa M, et al: Endovascular treatment of vertebral artery dissection using stents and coils: its pitfall and technical considerations. Minim Invasive Neurosurg 53:243-249, 2010. – reference: 8) Kim MJ, Chung J, Kim SL, et al: Stenting from the vertebral artery to the posterior inferior cerebellar artery. AJNR 33:348-352, 2012. – ident: 1 – ident: 14 doi: 10.5137/1019-5149.JTN.2790-09.0 – ident: 10 – ident: 12 doi: 10.3171/jns.1991.75.6.0874 – ident: 4 doi: 10.3171/jns.2002.97.2.0259 – ident: 15 doi: 10.1097/00006123-200001000-00038 – ident: 2 doi: 10.1227/00006123-199212000-00001 – ident: 3 doi: 10.3171/jns.2003.99.6.0960 – ident: 5 doi: 10.2335/scs1987.18.1_50 – ident: 13 doi: 10.3171/jns.1992.76.4.0571 – ident: 7 doi: 10.1097/00006123-199505000-00003 – ident: 6 – ident: 9 – ident: 11 doi: 10.1055/s-0030-1269873 – ident: 8 |
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| Title | Endovascular Parent Artery Occlusion of Ruptured Vertebral Artery Dissecting Aneurysms |
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