Recurrent Subarachnoid Hemorrhage from Untreated Ruptured Vertebrobasilar Dissecting Aneurysms

Abstract

The clinical characteristics of vertebrobasilar dissecting aneurysms occurring with subarachnoid hemorrhage (SAH) were reviewed in 42 patients, with particular focus on the time, incidence, and outcome in association with subsequent rupture. Twenty-nine patients underwent 31 surgical procedures, and the remaining 13 patients were managed without surgery. Surgical details included 19 proximal vertebral artery obliterations (including 1 case of endovascular surgery using balloon occlusion), 9 trappings, 1 wrapping, 1 bleb clipping, and 1 bleb clipping combined with wrapping. Surprisingly, subsequent rupture occurred in 30 (71.4%) of the 42 patients. Excluding one patient with postoperative rupture, 29 patients suffered a subsequent rupture in the unsecured stage. Of these 29 patients, 19 were operated on after the subsequent rupture and 10 were not operated on because of deteriorated clinical condition (9 patients) or anatomic considerations (1 patient). Of the 30 patients that suffered a subsequent rupture, 14 died. Twelve of the deaths were directly related to the second episode of rupture. Of the 12 patients who did not suffer a subsequent rupture, 10 underwent operations and there were no operative deaths. Only one patient died as the result of the initial critical SAH. The mortality (46.7%) of the patients with subsequent rupture was significantly higher (P < 0.05) than that (8.3%) of the patients without subsequent rupture. Seventeen (56.7%) of the 30 subsequent ruptures occurred within 24 hours after the first SAH, and 24 (80%) occurred within the first week. Six (66.7%) of the 9 patients operated on within 24 hours after the first SAH and 11 (68.8%) of the 16 patients operated on within a week suffered preoperative subsequent ruptures.(ABSTRACT TRUNCATED AT 250 WORDS)

Traumatic Aneurysm of the Callosomarginal Artery-Cortical Artery Junction from Penetrating Injury by Scissors

“…In contrast, after a few weeks (in the subacute stage), the wall of a TICA is presumed to be more stable because the aneurysm wall contains fibroblasts and other elements that strengthen and encapsulate the wall16). However, the rerupture rate for pseudoaneurysms or dissecting aneurysms is much higher in the acute stage19). Therefore, a delayed operation strategy entails a risk of rerupture.…”

The Interaction between Stent(s) Implantation, PICA Involvement, and Immediate Occlusion Degree Affect Symptomatic Intracranial Spontaneous Vertebral Artery Dissection Aneurysm (sis-VADA) Recurrence after Reconstructive Treatment with Stent(s)-Assisted Coiling

“…Intracranial vertebral artery dissection (VAD) has emerged as a leading cause of subarachnoid haemorrhage (SAH) and ischemic stroke of the posterior circulation, particularly in young to middle-aged adults [1, 2]. Once the vertebral artery trunk undergoes aneurismal dilatation, a so-called dissection aneurysm forms, increasing the risk of fatal bleeding in the future [3].…”

Recanalization of a ruptured vertebral artery dissecting aneurysm after occlusion of the dilated segment only

“…A high incidence of rebleeding is seen during the acute phase, particularly within 24 h from onset, and is associated with high morbidity and mortality rates. [6] Early surgical treatment has therefore been recommended.…”