Treatment of Hemorrhagic Intracranial Dissections

Abstract

EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

Dissection of the Posteroinferior Cerebellar Artery: Clinical Characteristics and Long-Term Follow-Up in Five Cases

“…Dissecting aneurysm of the PICA carries a 24% risk of rebleeding in the acute phase, associated with a high mortality rate [23]. Presence of a pseudoaneurysm substantially increases the risk of early rebleeding [24, 25] and early intervention is essential. Even though early intervention seems essential to avoid rebleeding, the prognosis of these lesions is mainly correlated with the clinical state on admission.…”

“…Although some authors [26] have written that patients with intracranial dissections with ischemic symptoms are also at risk for subsequent SAH, conservative management with medical therapy is considered as the most appropriate therapeutic plan, above all, if no pseudoaneurysm has been observed on the angiogram. This medical treatment includes anticoagulants or antiplatelet drugs, but no randomized trials or reliable comparisons of the two treatments are available.…”

“…This treatment [7, 10, 12, 24] has shown effectiveness to avoid rebleeding [7, 10, 12], and because endovascular procedures do not involve manipulation of the brain stem, cranial nerves or cerebellar tissue, the complications noted previously may be avoided.…”

Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms

“…PICA, posterior inferior cerebellar artery; SD, standard deviation; aneurysm size was measured by the maximum diameter of the aneurysm. and that occlusion of the parent artery is an effective VBDA treatment, especially for ruptured VBDAs [17][18][19][20]. However, complete occlusion of the parent artery may result in brain ischemia or infarction due to poor blood supply.…”

Endovaskulärer Verschluss der A. basilaris zur Behandlung dissektionsbedingter und dysplastischer fusiformer Aneurysmen

“…Generell kann bei intrakraniellen Gefäßdissektionen der Coil-Verschluss des betroffenen Gefäßsegmentes bei ausreichender Kollateralisation heute als die beste Behandlungsstrategie angesehen werden [3,13]. Bei dissektionsbedingten Aneurysmen der A. vertebralis hat sich diese Behandlungstechnik bewährt, insbesondere wenn der Abgang der A. cerebelli inferior posterior nicht betroffen ist [35].…”