Abstract
Dissecting vertebrobasilar aneurysms are challenging to treat, and standard treatment modalities remain controversial. We retrospectively evaluated our experience using endovascular techniques to treat these aneurysms. From February 1997 to December 2007, 42 patients with intradural vertebrobasilar dissecting aneurysms underwent endovascular treatment. Twenty-nine patients had ruptured aneurysms, and 13 patients had unruptured dissecting aneurysms. The endovascular modalities for vertebrobasilar dissecting aneurysms were the following: 1) trapping (n = 30), 2) proximal occlusion (n = 3), 3) stent with coil (n = 6), and 4) stent alone (n = 3). Seventeen of the 29 patients with ruptured vertebrobasilar dissecting aneurysms had successful outcomes without procedural complications following endovascular treatment. Procedure-related complications were the following: 1) rebleeding (n = 3), 2) posterior inferior cerebellar artery (PICA) territory infarction (n = 6), 3) brain stem infarction (n = 2), and 4) thromboembolism-related multiple infarctions (n = 1). Clinical outcomes were favorable in 32 patients (76.1%). There were 3 (7.1%) procedure-related mortalities due to rebleeding, and 1 (2.4%) non-procedure-related mortality due to pneumonia sepsis. All 13 patients with unruptured vertebrobasilar dissecting aneurysms had favorable clinical and radiologic outcomes without procedure-related complications. Endovascular procedures for treatment of unruptured symptomatic dissecting aneurysms resulted in favorable outcomes. Ruptured vertebrobasilar dissecting aneurysms are associated with a high risk of periprocedural complications. Risks can be managed by using appropriate endovascular techniques according to aneurysm location, configuration, and relationship with the PICA.
Highlights
AND PURPOSE: Dissecting vertebrobasilar aneurysms are challenging to treat, and standard treatment modalities remain controversial
Risks can be managed by using appropriate endovascular techniques according to aneurysm location, configuration, and relationship with the posterior inferior cerebellar artery (PICA)
Increased understanding of vertebrobasilar dissecting aneurysms, along with advances in diagnostic modalities, has resulted in such aneurysms being regarded as more common causes of subarachnoid hemorrhage (SAH) and ischemic stroke than previously considered.[1,2]
Summary
From February 1997 to December 2007, 42 patients with intradural vertebrobasilar dissecting aneurysms underwent endovascular treatment. Between February 1997 and December 2007, 2843 aneurysms were treated by using either endovascular or surgical approaches in our institution. During this period, 47 patients with vertebrobasilar dissecting aneurysms were treated. 47 patients with vertebrobasilar dissecting aneurysms were treated Five of those patients underwent a direct surgical treatment and were excluded from the present analysis. Patients who returned to work with no neurologic deficits (GOS 4 or 5) were considered to have favorable outcomes. Patients with any neurologic deficit who were unable to work or required some level of assistance in their daily living (GOS 2 or 3) were considered to have poor outcomes.
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