Ruptured Dissecting Aneurysm Of Vertebral Artery:Endovascular Treatment And Outcome A Single Center Retrospective Study

BACKGROUND AND OBJECTIVE:Ruptured vertebral artery dissecting aneurysms (VAD) is a life threatening disease. VAD presenting with subarachnoid hemorrhage need a prompt treatment because of the high mortality rate. Treatment of VAD depends on its size and location with respect to posterior inferior cerebellar artery (PICA). To better understand endovascular treatment of ruptured VAD, we collected the patient’s clinical information, evaluated treatment modality and post-procedure outcome.MATERIALS AND METHODS:From February2010to December2012,37patients with ruptured VAD received endovascular treatment. Patient demographics, aneurysm size, location, clinical presentation (Hunt and Hess grading), clinical outcome (mRS) were evaluated. Treatment and outcome of endovascular modalities for bifurcation and non-bifurcation dissecting aneurysm was analyzed.RESULTS:In the37patients (25males and12females), VAD were confirmed by Digital subtraction angiography (DSA).19underwent endovascular embolizaion of vertebral artery and18underwent stent assisted coiling (SAC). Post-procedure clinical outcome were assessed with mRS:one in29cases, two in4cases, four in1case, and five in3cases. In post procedure angiography,35(94.58%) aneurysm was completely occluded,2(5.42%) aneurysm was near completely occluded. There were3(8.11%) cases of procedure related complication.2(5.41%) patients died and1(2.70%) patient attempting to SAC, coil could not be deployed.CONCLUSION: Vertebral artery dissections are treated with internal trapping of VAD segment for tolerable balloon test occlusion. In intolerable cases, stent assisted coiling was the best treatment option in our setting. But in bifurcation aneurysm, SAC is preferred to protect PICA. Our experience of endovascular trapping and stent assisted coiling is safe and effective for the treatment of vertebral artery dissecting aneurysm. Surgically challenging VAD is easily accessible with better prognosis and less invasiveness by endovascular techniques. However its long term outcome and prognosis should be further studied in large population.