J Cerebrovasc Endovasc Neurosurg.  2017 Dec;19(4):268-275. 10.7461/jcen.2017.19.4.268.

Endovascular Treatments for Ruptured Intracranial Vertebral Artery Dissecting Aneurysms: Experience in 16 Patients

• Lee M
• Park IS
• Lee KH
• Park H
• Lee CH
• Han JW

• KMID: 2401779
• DOI: http://doi.org/10.7461/jcen.2017.19.4.268

Abstract

OBJECTIVE
Intracranial vertebral artery dissecting aneurysms are rare lesions that are considered an important cause of spontaneous subarachnoid hemorrhage. We report our decade-long experience in treating ruptured intracranial vertebral artery dissecting aneurysms.
MATERIALS AND METHODS
This retrospective single-center study included 21 consecutive patients between February 2005 and March 2015. Their clinical features included radiologic finding at the initial examination, treatment modality, functional outcome at the last follow-up, mortality, and radiologic outcome at more than 6 months after the initial treatment.
RESULTS
All 16 aneurysms were treated endovascularly; aneurysm trapping was performed in 9 patients and vascular reconstruction was performed in 7 patients. For 6 aneurysms involving the posterior inferior cerebellar artery (PICA), the modalities of treatment were aneurysm trapping in 3 patients and vascular reconstruction in 3 patients. The mean duration of follow-up was 29 months (range, 6-70 months). Five patients expired, indicating a mortality rate of 31%. In surviving patients, the unfavorable outcome rate (modified Rankin Scale [mRS] > 2) was 36%. The overall mean mRS for survivors was 1.8. Angiographic follow-up in 11 survivors at 13 months, (range, 6-46 months) revealed recanalization of the aneurysm in one patient.
CONCLUSIONS
Ruptured intracranial vertebral artery dissecting aneurysm is associated with poor functional outcome and high mortality. More immediate treatments are needed due to the high rebleeding rate in this disease condition. Endovascular treatment may be a useful option for ruptured intracranial vertebral artery dissecting aneurysms.

Keyword

Dissecting aneurysm; Endovascular; Subarachnoid hemorrhage; Vertebral artery

MeSH Terms

Aneurysm
Aneurysm, Dissecting*
Arteries
Follow-Up Studies
Humans
Mortality
Retrospective Studies
Subarachnoid Hemorrhage
Survivors
Vertebral Artery*

Figure

• 

  Fig. 1 Angiogram of a 48-year-old female who presented with ruptured right intracranial VA dissecting aneurysm. Anteroposterior (A) and lateral (B) angiograms of the right VA reveal a string sign and fusiform aneurysm formation distal to the PICA. Anteroposterior (C) and lateral (D) angiograms of the VA obtained after telescopic stents and coil embolization demonstrating complete occlusion of the dissecting aneurysm. VA = vertebral artery; PICA = posterior inferior cerebellar artery.

• 

  Fig. 2 Images of a 55-year-old man who presented with ruptured left intracranial VA dissecting aneurysm. Anteroposterior (A) and lateral (B) angiograms of the right VA reveal a string sign and fusiform aneurysm formation distal to the PICA. Working view (C), (D) angiogram of the VA obtained after stent-assisted coil embolization demonstrating complete occlusion of the dissecting aneurysm. Anteroposterior (E) and lateral (F) angiograms of the right VA show recanalization at the previous treatment site after 7 months. VA = vertebral artery; PICA = posterior inferior cerebellar artery.

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