Conservative treatment of ruptured vertebrobasilar dissecting aneurysm

Abstract

Ruptured vertebrobasilar dissecting aneurysm is usually treated surgically because rebleeding negatively affects outcome. However, the risk of rebleeding decreases markedly once several hours have passed from the initial bleeding. Moreover, surgery-related complications are not rare. We describe seven patients with ruptured vertebrobasilar dissecting aneurysm. To prevent rebleeding during the acute stage, we treated all seven patients conservatively with fentanyl instead of emergency surgery. During the follow-up period (mean 20 months), no patient suffered rebleeding. Conservative treatment with fentanyl administration may be a good option for management of ruptured vertebrobasilar dissecting aneurysm during the acute stage.

Successful Treatment of Bilateral Vertebral Artery Dissecting Aneurysms with Subarachnoid Hemorrhage: Report of Three Cases

“…Ono et al 14 reported that VADA with a pearl and string sign on angiography tends to rebleed. However, contrary to the above reports, 5 out of 7 patients in Hashimoto et al's series 16 revealed pearl and string signs on angiography. Furthermore, in our series, cases 1 and 3 were in poor Hunt and Kosnik grades, and in case 2, pearl and string signs were apparent in the bilateral VAs.…”

“…13 Other authors even suggest that surgical treatment in the chronic stage is not necessary for the same reasons. 14,15 In addition, Hashimoto et al 16 report that complete sedation using fentanyl and strict blood pressure control during the acute stage may prevent rebleeding instead of performing emergency surgery. Considering these reasons, conservative treatment may be a good option for management of ruptured VADA.…”

Hemodynamic Management of Subarachnoid Hemorrhage

“…Likewise, in a series of 25 patients who were treated endovascularly with Guglielmo detachable coils, systemic heparin, and induced hypertension up to a range of systolic blood pressure of 195-250 mm Hg, there were no instances of rebleeding or rupture, even in the presence of partial aneurysm obliteration [40]. Hashimoto and colleagues reported the risk of rebleeding of vertebrobasilar dissecting aneurysms managed with conservative treatment and did not observe re-ruptures over a 20-month period [41].…”

Treatment of intracranial vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery origin

“…reported on a prospective cohort of 7 patients managed nonoperatively with sedation using fentanyl and blood pressure control using diltiazem or nicardipine, and none suffered from rebleeding in a mean 20-month follow-up time frame. [16] However, this strategy is fraught with risk. While stratification attempts have yielded intriguing results,[40] it remains challenging to identify patients with a low chance of rebleeding.…”