Rebleeding from intracranial dissecting aneurysm in the vertebral artery.

Abstract

We describe two patients with rebleeding from intracranial vertebral artery dissecting aneurysms during the acute stage. One patient had excellent results after emergency surgery. A review of recent reports including 60 patients with this disorder revealed a rebleeding rate of 30%, mostly during the acute stage. This suggests that a ruptured dissecting aneurysm in the vertebral artery is at risk for rebleeding during the acute stage, similar to a saccular aneurysm in the same location. (Stroke 1990;21:1628-1631)

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

“…However, we should have chosen emergent endovascular treatment, since most subsequent ruptures from VA dissecting aneurysms are known to occur within 1 week and to result in death. 1,13) Previous studies have also demonstrated that the overall outcome of severe cases of ruptured VA dissecting aneurysms treated with emergent internal trapping was satisfactory. 7,23) Recanalization of the parent arteries may occur after internal trapping.…”

“…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.…”

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

“…1,6,10,14,16) Rebleeding most often occurs during the acute phase in patients with ruptured aneurysms and is thought to be the strongest prognostic factor for a poor outcome. 1,10,14,17,20) To prevent fatal rebleeding, very early treatment for the ruptured VA dissecting aneurysm is required. 10,14,17) Endovascular occlusion has been accepted as a safe, minimally invasive, and reliable treatment for ruptured dissecting aneurysms.…”

“…1,10,14,17,20) To prevent fatal rebleeding, very early treatment for a ruptured VA dissecting aneurysm is required. 10,14,17) On the other hand, some cases of VA dissecting aneurysms have been followed by spontaneous acute occlusion and early recanalization.…”

Internal Trapping of a Ruptured Vertebral Artery Dissecting Aneurysm Followed by Recanalization of the Trapped Vertebral Artery Without Aneurysm Recurrence -Case Report-

“…2,6,7,9,12) Previously, the endovascular treatment of choice for ruptured VA dissecting aneurysms was proximal occlusion of the affected VA, 3,5,12,15) but this was not any more effective than proximal clipping to prevent rerupture. 1,4,11,14,15) Thus, embolization of both the aneurysm and the affected VA (internal trapping) is now the treatment of choice. 2,7,9,13) We treated a patient with a ruptured VA dissecting aneurysm by internal trapping, resulting in recanalization of the affected artery without recurrence of the aneurysm.…”