Clinical Study Of Endovascular Treatment For Dissecting Aneurysms In Vertebral Artery

Objective:To discuss the Individualized therapy and to summarize the most appropriate therapeutic regimens in different kind of dissecting aneurysms in vertebral artery.Methods:Clinical data and follow-up state of27patients with dissecting aneurysms in vertebral artery between2003.1.1and2013.8.1in401hospital were analyzed retrospectively.Results:17cases of dissecting vertebral artery aneurysms were treated by occlusion skill in our study, occluding the dissecting aneurysm and parent artery with coils. The follow-up ranged from12to36months.14cases were determined to clinical cure.1case died of relapse2months after the first operation.1case appeared dizziness uncomfortable, and1case shown as Wallenberg syndrome.10cases of dissecting vertebral artery aneurysms were treated by stent skill, stent only or coil embolism combine stent implantation. Symptoms improved significantly in9cases.1case with single stent relapsed in1th month follow up, although retreated with parent artery occluding, the patient died of brainstem failure in its8th month followup.Conclusions:Endovascular treatment for vertebral artery dissecting aneurysm has been widely recognized as its first chioce. Individualized therapy is closely related with prognosis based on the symptom, the morphology and position of aneurysm, the circulation of the parent artery. To occlude the dissecting aneurysm and parent artery with coils for the prevention of rehemorrhage was effective. Most of the aneurysms seated distal to PICA would achieve clinical cure with rare complications. However, ischemia or infarction of the medulla oblongata should be considered when the aneurysms seated proximal to PICA. The stent skill is now changing the directions of vertebral artery dissecting aneurysm treatment. But the stent application is more complicated and requires perioperative anticoagulation, antiplatelet interventions and long-term postoperative anticoagulation therapy, also still rebleeding cases reported in literature, the longterm efficiency remains further followup.