The Efficacy of Coil Embolization at the Dissection Site of Ruptured Dissecting Vertebral Aneurysms

Abstract

<jats:p> Proximal occlusion of the parent artery has been widely used for treatment of vertebral dissecting ruptured aneurysms, but this does not always completely prevent re-rupture. In this series, the efficacy of occlusion at the dissection site using detachable coils was compared with proximal balloon occlusion. </jats:p><jats:p> Over a five year period, 25 patients suffering from subarachnoid hemorrhage with dissecting vertebral aneurysms were treated by endovascular surgery. The first three of these 25 patients were treated with proximal balloon occlusion of the parent artery. The remainder underwent platinum coil occlusion at the affected site as early as possible after the diagnosis. </jats:p><jats:p> In two of the three cases treated with proximal balloon occlusion, clipping or coating surgery were added because of progressive dissection. In all 22 cases of coil embolization, the intervention was successfully performed without complication. In one case with a dissection involving bilateral vertebral arteries, minor rebleeding from a contralateral dissection occurred after embolization. In the other 21 cases, rebleeding was not apparent (clinical follow-up: mean 24 months). Radiological findings showed complete occlusion of the dissection site and patency of the non affected artery (follow-up: mean ten months). </jats:p><jats:p> We conclude that detachable platinum coil embolization at the dissection site is more effective than proximal occlusion for treatment of ruptured vertebral dissecting aneurysms because of immediate cessation of blood flow to the dissection site. However, in cases with bilateral dissections or hypoplastic contralateral vertebral arteries, preceding bypass surgery or stent treatment to preserve the affected vertebral artery may be needed. </jats:p>

Clinical and Angiographic Follow-Up of Stent-Only Therapy for Acute Intracranial Vertebrobasilar Dissecting Aneurysms

“…Various endovascular methods have been used to treat the VBDA, which include proximal occlusion of the parent artery, internal coil obliteration or trapping of the dissected segment of the parent artery, stent-assisted coiling, stent-only therapy with single or multiple stents, and covered stent. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] However, for the VBDA not suitable for deconstructive treatments that occludes the parent artery, the appropriate treatment method has not been well established. In patients who had basilar dissecting aneurysms or dominant vertebral dissecting aneurysms with poor collaterals, internal coil trapping cannot be applied.…”

“…Most ruptured VBDAs can be treated by deconstructive treatments, which sacrifice the parent artery to obliterate the dissecting aneurysm. [1][2][3][4] However, how to manage a ruptured VBDA, which is not suitable for deconstructive treatment, is not well established. Also, there has been controversy on how to manage an unruptured VBDA.…”

Characteristics and endovascular treatment of intracranial vertebral artery aneurysms

“…[8] No perioperative complications in 14 patients treated either with stent placement or stentassisted coiling by Ahn and colleagues. In this study, in six of the 12 patients, follow-up angiograms at 6-12 …”

“…[4][5][6][7] The continuous advances in endovascular techniques have provided multimodalities in the management of VA aneurysms and established the safety and feasibility of endovascular treatment. [2,[8][9][10][11][12][13][14] But, the number of subjects studied in these studies is small, and most do not include characteristics of VA aneurysms and unruptured VA aneurysms.…”

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.…”