Endovascular treatment of vertebral artery dissections and pseudoaneurysms

Abstract

Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography. In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second). Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.

Long-Term Follow Up of Antegrade Recanalization of Vertebral Artery Dissecting Aneurysm After Internal Trapping -Case Report-

“…4,6,7,[9][10][11]18,[23][24][25]29) Internal trapping of the parent artery is considered to be the best treatment for VA dissecting aneurysm if the collateral blood flow is sufficient to allow sacrifice of the parent vessel without neurological deficit. 7,9,20,23,29) In the present case, we believed that emergent endovascular treatment was not applicable because of the patient's poor condition.…”

“…1,13,26,27) Most dissections rebleed during the acute phase, 1,13,26,27) so emergent surgical internal trapping of the parent artery is recommended. 4,6,7,[9][10][11]20,23,29) However, the rate of rebleeding decreases during the chronic stage because of the spontaneous resolution of the dissecting walls of the VA. 14,15,19) Antegrade recanalization in the parent artery occasionally occurs after internal trapping. 2,8,12,22,29) However, additional treatment for recanalized dissecting lesions may be unnecessary during the chronic stage because of spontaneous resolution of the affected vessels during the chronic stage.…”

Acute Occlusion and Recanalization of Vertebral Artery Dissection After Subarachnoid Hemorrhage: Usefulness of Bilateral Simultaneous Vertebral Angiography and Basiparallel Anatomic Scanning-Magnetic Resonance Imaging

“…10,14,17) Endovascular occlusion has been accepted as a safe, minimally invasive, and reliable treatment for ruptured dissecting aneurysms. 3,6,7,14,18) Occlusion of the entire affected area is the most ideal and most complete treatment for such lesions. 14) Several studies suggest that the radiographic findings of a ruptured VA dissection indicate dynamic changes in acute stage.…”

Aneurisma dissecante de artéria vertebral intracraniana fenestrada submetido ao tratamento endovascular: relato de caso

“…O primeiro relato de lesão dissecante arterial é do ano de 1915 7 .Em revisão da literatura de 1924 a 1983 1 , foi observado HSA através de punção lombar em apenas 7 dos 36 casos, não havendo referência de traumatismo em nenhum destes. Outros autores relatam, com freqüência pouco maior, casos de dissecção da artéria vertebral associado com HSA [2][3][4][5][6][8][9][10][11][12][13] , embora não haja, em nenhum deles, associação com traumatismo crâ-nio-cervical. Do ponto de vista angiográfico, essas lesões passaram a ser identificadas a partir de 1959 através de sinais como: retenção de meio de contraste 14 , sinal do duplo lúmen 15 , sinal da roseta 16 e sinal do barbante ("string sign") 17 .…”