Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage

Hamada, Jun-ichiro; Kai, Yutaka; Morioka, Motohiro; Yano, Shigetoshi; Todaka, Tatemi; Ushio, Yukitaka

doi:10.3171/jns.2003.99.6.0960

Cited by 99 publications

(103 citation statements)

References 19 publications

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“…During the past 10 years, there have been a significant number of investigations into the feasibility of this technique [1][2][3][4][5][6][7][8][9][10]. Some articles have described the stability of occlusions treated with detachable coils and the efficacy of providing protection against VAD recurrence and consequent bleeding [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Conventional surgical treatment includes trapping the aneurysm, proximal ligation of the vertebral artery (VA ), or wrapping the aneurysm. Previous reports have suggested that endovascular parent artery occlusion is a safe and effective treatment for VAD [1][2][3][4][5][6][7][8][9][10]. Although some case series have reported on the feasibility of stent replacement, endovascular internal trapping has been performed in most of the cases.…”

Section: Introductionmentioning

confidence: 99%

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Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

et al. 2012

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2 Abstract PurposePrevious reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping. MethodsA total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale. ResultsForty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data were obtained for 61 patients (83.6%). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74%). Cranial nerve paresis (CNP) was observed in 6 patients (8.21%), spinal cord infarction in 2 patients(2.74%) and a perforating artery ischemia was diagnosed in 7 patients (9.59%); all patients with CNP and 5 of the patients with partial Wallenberg syndrome experienced only temporary symptoms; 2 of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores. ConclusionsThe results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases., both within 3months after tnitial treatment without rupture. CNP were observed in 8.21%, perforating ischemia in 9.59%, and spinal cord infarction in 2.74%. The former two are temporaly, while the last can be a factor that affect mRS. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

et al. 2012

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“…Kitanaka et all reported that a very high rate of postoperative complication with major causes of disability were attributable to lower cranial nerve palsy and associated condition as prolonged intubation and tube feeding [2,5,6]. Vertebral artery recanalization by antegrade flow, coil compactation, coil loop migration, intra-stent thrombosis and distal thrombembolism have been also reported as complications of endovascular treatments.…”

Section: Discussionmentioning

confidence: 99%

Endovascular coil oclusion of spontaneous ruptured vertebral artery dissecting aneurysm

Chiriac¹,

Ion²,

Dobrin³

et al. 2017

Romanian Neurosurgery

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Spontaneous dissecting aneurysm of vertebral artery is known as a rare pathological condition causing a subarachnoid hemorrhage in the posterior circulation. The treatment of ruptured vertebral artery dissecting aneurysms is still an important subject of debates in the literature. We present a particular case of ruptured vertebral artery dissecting aneurysms that was treated by only endovascular Guglielmi detachable coils occlusion. A brief review of technical possibilities of treatment of these types of vascular lesions, with their advantages and disadvantages are discussed.

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“…4,12) Therefore, surgical repair of the lesion is best performed in the acute stage. 4,5) However, several treatment strategies have been proposed for ruptured VA dissecting aneurysm associated with occlusion of the parent artery. Medical treatment of a patient with occlusion of the affected artery 4 months after the onset resulted in no rebleeding for 16 months after the first ictus.…”

Section: Discussionmentioning

confidence: 99%

Ruptured Vertebral Artery Dissecting Aneurysm Followed by Spontaneous Acute Occlusion and Early Recanalization-Case Report-

Endo

Otawara

Ogasawara

et al. 2005

Neurol. Med. Chir.(Tokyo)

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A 47-year-old man presented with a ruptured vertebral artery dissecting aneurysm manifesting as subarachnoid hemorrhage followed by acute occlusion and early recanalization of the affected artery. Cerebral angiography 2 hours after the onset of the symptom showed pearl-and-string sign in the right vertebral artery. Serial angiography showed that the affected artery was occluded at 12 hours but was recanalized on the 4th day. The dissecting aneurysm was resected with side-to-side anastomosis between the bilateral posterior inferior cerebellar arteries. Postoperative cerebral angiography demonstrated disappearance of the lesion and patency of the right posterior inferior cerebellar artery via the anastomosis. Histological examination of the lesion showed hematoma between the media and adventitia, disrupting the internal elastica and intima. Acute occlusion and early recanalization of the affected artery may occur in ruptured vertebral artery dissecting aneurysms. Serial neurological and neuroradiological examinations are essential to decide the timing and method of treatment.

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Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage

Abstract: The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.

Cited by 99 publications

References 19 publications

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

Endovascular coil oclusion of spontaneous ruptured vertebral artery dissecting aneurysm

Ruptured Vertebral Artery Dissecting Aneurysm Followed by Spontaneous Acute Occlusion and Early Recanalization-Case Report-

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