Vertebrobasilar Dissecting Aneurysms: Clinical, Neuroradiologic Characteristics And Strategy Of Endovascular Management

Object To restrospectively analyse the major radiological and clinical features of vertebrobasilar dissecting aneurysms and look for their relationship. To make the reasonable preoperative plan of endovascular management on the basis of our experiences in patients with vertebrobasilar dissecting aneurysms and the analysis of curative effects and influential factors. Methods Gathering 58 cases(masculine 35 examples, feminine 23 examples) of illness medical history materials, with vertebrobasilar dissecting aneurysms, to analyse their clinical manifestations, the dangerous factors and their characteristics of MRI, CT/CTA and DSA. 51 examples patients carry on interventional therapies. The surgical methods include stent-assited coiling technology, pure stent technology, blocked parent artery technology, coil embolisation for dissecting aneurysms technology, and ONYX embolism technology. 46 examples carry on clinical- and-image follow-up visits, the analysis of their curative effects and influential factors of different endovascular methods .Result In 58 examples , 45 examples(77.6%) onste with the hemorrhagic symptoms;the performances for ischemic symptoms are only 5 examples (8.6%);the left 8 examples (13.8%) display nonspecific symptoms, among which 6 examples (10.3%)accompany the oculomotor, and abducent nerve paralysis. The hemorrhagic patients all ranked according to H&H graduation: I level of 8 examples (17.8%), II level of 32 examples (71.0%), III level of 2 examples (4.4%), IV level of 3 examples (6.8%), and V level of 0 examples (0%).58patients have made the head CT inspections in front of the surgery: manifesting SAH (26 examples in suprasellar cistern, 35 examples in cistern of lateral sulcus , 41 examples in cistema ambiens, 3 examples breaking into the fourth encephalocoele, 3 examples manifesting intracranial hemorrhage associated with SAH (1 example manifesting hemorrhagic in cerebellum, 2 examples manifesting hemorrhagic brain stem) and 2 examples manifesting cerebellar infarctions;14 patients manifest aneurysmal expansions in preoperative CTA. 25 patients have made the head MRI inspections in front of the surgery : 1 example manifesting " double lumen " sign , 2 examples manifesting"intimal flap" , 1 example manifesting "intramural hematoma" , 17 examples manifesting mass effects, 4 examples manifesting cerebral infarction;11 patients have made the head MRA inspections in front of the surgery, mainly manifesting aneurysmal expansions, in which 4 examples associated with proximal stenosis. 58 patients have made the DSA inspections: 39 examples manifesting irregular aneurysmal expansions in 45 hemorrhagic patients, 4 examples manifesting segmented stenosis, 1 examples manifesting"pear and string sign", 1 examples manifesting "double lumen";in the whole 5 ischemic patients , 2 examples show proximal aneurysmal expansions with distal occlusion of vertebral artery, and 2 examples show amphi-aneurysmal expansions with stenosis between them, 1 examples show "string" sign;the Others in 8 examples patients display for aneurysmal expansions . In addition , 10 patients accompany other positional aneurysms ( 5 examples with posterior cerebral artery aneurysms, 3 examples with posterior communicating aneurysms and 2 examples with internal carotid aneurysms out of cranium) and 1 patient accompanied occipitalAVM. The accompanied dangerous factors include: with hypertension histories of 14 examples(24. 1%), smoking histories of 6 examples (10.4%);diabetes histories of 4 examples (6.9%);iatrogenic wound history of one example(1.7%) . This group using the interventional therapies in 51 patients includes: 33 examples using stent-assited coiling technology , 8 examples using pure stent technology , 1 example using ONYX embolisation technology , 2 examples using coil embolisation for dissecting aneurysms technology and 7 examples using coil embolisation for parent artery technology. The stents implanted in the patients include 17 coronary stents and 24 self-expandable stents. After surgery, instantly angiography demonstrates compact embolisms of dissecting aneurisms in 27 examples;Partial embolisms in 7 examples;complete occlusions of parent-artery in 7 examples;in 7 examples purely implanted stents, the dissecting aneurysms still develop in which the blood flow slowed down. 46 examples patients carry on clinical-and-image follow-up visits. Clinical follow-up visits: 43 examples patients get complete rehabilitation;2 examples patients have the mild oculomotor nerve paralysis;1 examples have mild headaches. 7 patients carried on MRA to make follow-up visits : the dissecting aneurismal body reduces in one patient using coiling the parent-artery in stent technology;the dissecting aneurismal body reduces in 2 patients using stent-assisted coiling technology;2 patients using stent-assisted coiling technology have not seen the obvious changes;one patient using stent-assisted coiling technology has seen the dissecting aneurismal body expand to recur;the dissecting aneurismal body does not develop in one patient using blocked parent artery technology , the patients all do not see-fresh infarctions .DSA follow-up visits: 4 blocked parent-arteries examples have not been seen the recanal ization , the dissectinganeurisms have not seen the stagnation of contrast medium. Among 7 patients with pure stent technology, one patient implanted the double BX stents had carved in , with the parent-artery occlusion;2 examples implanted into LEO stents, in which one patient has been seen the dissecting aneurysm reduced with the single implanted and the other has kept stable with the double implanted;the left 4 implanted Neuroform stents : 2 examples keeping the dissecting aneurysm stable with the double implanted, 2 examples' dissecting aneurysm reduced with the single implanted. One example using ONYX pouring into dissecting aneurysm, the aneurysm showed compact embolism, and appeared healing line. One example using coil embolisation for dissecting aneurysms technology has seen the parent-artery unobstructed and further formed the thrombus. DSA follow-ups for 33 patients using stent-assited coiling technology: 26 examples compactly embolismed do not recur;in 5 examples partially embolismed, 2 patients formed the thrombus, the aneurysm has not seen the development;one example has seen the aneurysm reduce and the thrombus further form.;one example is stable, and one example expand to recur;In 2 examples loosely embolismed, one is stable, the other reduces, conclusions Vertebrobasilar dissecting aneurysm because of its natural medical history has become one kind of highly dangerous vessel pathological lesion. The specific image performance of vertebrobasilar dissecting aneurysm and its clinical manifestation have a close correlation. Regarding vertebrobasilar dissecting patient, especially having the rehemorrhagic risk, in appraised his/her the whole body condition , endovascular management should be fast-run as soon as possible. To formulate reasonable treatment strategy according to the union of image study and the clinical manifestation, choose the suitable endovascular methods and materials affect theprognosis of the vertebrobasilar dissecting aneurysm .directly.