Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients

Abstract

In our series of preselected patients, poor admission neurological grade, rebleeding episode(s), and lesions with a pearl-and-string structure were predictive of poor outcomes. Our findings indicate that patients with these characteristics may be candidates for aggressive attempts to prevent rebleeding during the acute stage. Patients without these characteristics may be good candidates for conservative treatment, especially those who survive the acute phase without rebleeding.

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

“…13,26,27) In the present case, the lesion was not confirmed by direct surgery or pathological examination. We also did not perform three-dimensional CT angiography or MR angiography before 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.…”

Endovascular Treatment of Symptomatic Intradural Vertebral Dissecting Aneurysms

“…When vertebrobasilar dissections occur with SAH, the risk of recurrent hemorrhage is extremely high (30% to 70%) 7,8 and prompt treatment is indicated. In a study by Yamada et al 9 of 24 conservatively treated patients with ruptured vertebral dissecting aneurysms, 14 (58%) experienced a total of 35 rebleeding episodes. Of these 14 patients, 13 died and 11 of these deaths were directly attributable to rebleeding.…”

Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage

“…Other surgical and endovascular approaches have been reported with mixed results. 23,28,31,32,[38][39][40][41] As such, the PED should be considered a treatment option in blister aneurysms. In our series, there were 16 nonsaccular aneurysms.…”