Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms

OBJECTIVE: Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs. MATERIALS AND METHODS: Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture. RESULTS: Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either. CONCLUSION: Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.

Growing Thrombosed Dissecting Aneurysm of the Vertebral Artery after Endovascular Proximal Artery Occlusion: the Role of the Vasa Vasorum / 신경중재치료의학

Proximal artery occlusion is one of several treatment methods for ruptured vertebral artery dissecting aneurysm (rVADA). However, that treatment may be incomplete and the risk of rebleeding should not be ignored. By contrast, mass effect, such as symptoms and signs of brain stem compression, ensuing after that treatment and rVADA occlusion, has not been reported in English literature. We experienced such a rare case of brain stem compression ensuing 3 months after VADA occlusion by endovascular proximal artery occlusion. To reduce the mass effect, surgery was performed with surgical specimen processed histologically. The clinical and radiological data of the case, its probable mechanism, and histological findings will be described and discussed here.