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

Nashimoto, Takeo; Komata, Tadashi; Honma, Junpei; Yamashita, S.; Seki, Yasuhiro; Kurashima, Akihiko; Saito, Takafumi

doi:10.1016/j.jstrokecerebrovasdis.2010.10.003

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…Though there are some case reports of favorable outcomes with trapping the ruptured side and waiting for the spontaneous resolution of the contralateral unruptured dissecting aneurysm 31,32 or using bilateral conservative treatment, 29 long-term outcomes are still unknown and patients should be followed carefully. Staged bilateral occlusion for vertebrobasilar VADAs has been reported 11,35 as having a favorable outcome, but it cannot be tolerated in many cases of bilateral VADAs if the patients do not have sufficient flow from the posterior communicating artery.…”

Section: Discussionmentioning

confidence: 99%

Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Ota¹,

Tanikawa²,

Eda³

et al. 2016

JNS

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OBJECTIVE Bilateral vertebral artery dissecting aneurysms (VADAs) have a poor prognosis because progressive enlargement of the aneurysms compresses the brainstem or causes subarachnoid hemorrhage. The trapping of 1 vertebral artery (VA) places increased hemodynamic stress on the contralateral VA and may lead to enlargement and rupture. Therefore, management strategies are controversial. This study describes a radical treatment for bilateral VADAs using bypass surgery. METHODS Seven patients with bilateral VADAs were included. Three patients were treated by trapping of 1 VA via coiling or clipping at another hospital; the previously treated VA in 1 patient and the contralateral untreated VA in 2 patients subsequently enlarged. The other 4 patients presented without previous intervention and progressive enlargement of the aneurysms. RESULTS The post-coil embolization patients underwent V-posterior cerebral artery (PCA) bypass and trapping. The other 4 patients underwent VA reconstruction via V-V or V-V bypass, with contralateral trapping on a separate day in 3 patients and observation in 1 patient. Perioperative complications included 1 case of cerebrospinal fluid leakage for which the patient required an additional operation, 1 case of dysphagia and facial palsy due to sigmoid sinus thrombosis, and 1 case of dysphagia. The long-term outcomes of these patients were favorable. CONCLUSIONS Patients with bilateral VADAs require treatment on both sides. If VA trapping is performed first, the treatment options for the other side are limited to V-PCA bypass and trapping. This procedure is effective; however, it is also invasive and technically difficult. In cases of bilateral VADAs in which it is feasible to reconstruct 1 side, the best approach is to begin by reconstructing the VA that appears technically easiest, followed by trapping of the contralateral VADA. This strategy allows enough time to suture vessels because contralateral reverse flow is maintained.

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Section: Discussionmentioning

confidence: 99%

Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Ota¹,

Tanikawa²,

Eda³

et al. 2016

JNS

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“…It is common in the middle-aged, mostly 40-50 years. Ruptured VADA patients presented with severe SAH usually show disastrous neurological results and a high occurrence rate of rebleeding 4)7)8). Mizutani et al retrospectively analyzed 42 patients with re-bleeding triggered by the ruptured VADA and discovered that 40.5% of re-bleeding occurred within 24 hours and that 57.1% occurred one week following the initial hemorrhage,7) so that after the diagnosis is confirmed, the treatment for ruptured VADA should be performed as soon as possible to prevent re-bleeding.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms

Han

Lim

et al. 2016

J Cerebrovasc Endovasc Neurosurg

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ObjectiveVertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs.Materials and MethodsBetween July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture.ResultsClinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either.ConclusionEndovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.

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“…VADA is frequently ruptured due to severe SAH with catastrophic neurological outcomes and a high incidence rate of recurrent haemorrhage ( 1 , 2 , 15 ). Mizutani et al retrospectively analysed 42 patients with recurrent haemorrhage caused by the rupture of VADA and revealed that 40.5% of recurrent haemorrhages occurred within 24 h and that 57.1% occurred one week following the first haemorrhage ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

Endovascular interventional therapy and classification of vertebral artery dissecting aneurysms

Wang

Zhao

Hao

et al. 2014

Experimental and Therapeutic Medicine

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The current study aimed to summarise the clinical features and classifications of vertebral artery dissecting aneurysms (VADAs) to optimise strategies for endovascular interventional therapy. The clinical features and results of 31 inpatients with VADA were retrospectively analysed. The aneurysms were classified according to their location and association between the aneurysm and posterior inferior cerebellar artery (PICA), and into subtypes according to the developmental state of the contralateral vertebral artery. Different endovascular interventional therapy strategies were selected for each classification. Three types of aneurysm with two subtypes each were identified. An aneurysm located distally to the PICA was termed type I (10/31 patients). Aneurysms with a contralateral vertebral artery were denoted as subtype a (type Ia, 6/31 patients) and aneurysms with hypoplasia of the contralateral vertebral artery were denoted as subtype b (type Ib, 4/31 patients). An aneurysm located at the origin of the PICA was termed type II (13/31 patients), with seven cases classified as IIa and six cases as IIb. An aneurysm located proximally to the PICA was termed type III (8/31 patients), with five cases classified as IIIa and three cases as IIIb. Among the 31 patients, 18 received stent-assisted coiling, two received coiling, 10 received coiling with parent artery occlusion and one patient received conservative treatment. Among the 31 patients with VADA, 21 were occluded completely, nine were partially occluded and one was not occluded. One patient developed a coma following coiling; however, the other 30 patients recovered well. Thus, the classification of an aneurysm based on its location and the developmental state of the contralateral vertebral arteries appears to be an effective and safe approach for the selection of appropriate endovascular interventional therapy strategies.

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

Cited by 13 publications

References 18 publications

Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Radical treatment for bilateral vertebral artery dissecting aneurysms by reconstruction of the vertebral artery

Endovascular Treatment of Symptomatic Vertebral Artery Dissecting Aneurysms

Endovascular interventional therapy and classification of vertebral artery dissecting aneurysms

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