Turkish Neurosurgery 2010 , Vol 20 , Num 2
Endovascular Management of Vertebral Artery Dissecting Aneurysms: Review of 25 Patients
Mahmoud M. TAHA1, Hiroshi SAKAIDA2, Fumio ASAKURA3, Masayuki MAEDA4, Naoki TOMA5, Akitaka YAMAMOTO6, Kenji KAWAGUCHI7, Satoshi MATSUSHIMA8, W TAKI9
1Department of Neurosurgery, Zagazig University, Zagazig, Egypt
2,3,5,6,7,8,9Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan
4Department of Radiology, Mie University Graduate School of Medicine, Tsu, Japan
DOI : 10.5137/1019-5149.JTN.2790-09 AIM: Management of Vertebral Artery (VA) dissections remains controversial. The clinical and angiographic variables of VA dissections were evaluated to demonstrate the safety and efficacy of endovascular intervention in treatment of VA dissecting aneurysms.

MATERIAL and METHODS: 25 patients with 27 VAdissecting aneurysms were treated with endovascular intervention during the last 10 years.17 patients were admitted with subarachnoid hemorrhage. 23 aneurysms treated using destructive endovascular trapping, while reconstructive techniques were used in 3 aneurysms treated with stent-assisted coiling and one aneurysm treated with false lumen embolization.

RESULTS: The right VA was involved in 14 patients, the left VA in 9 patients, while 2 patients had bilateral VA dissection. The pearl and string sign was the commonest angiographic sign in 12 aneurysms. Perioperative complications included; rebleeding in one patient, symptomatic brain stem infarction in two patients and silent cerebellar ischemic lesion in one patient. Afavorable outcome was evident more in patients with unruptured VA dissection (100%) versus (76.5%) in patients presented with SAH.

CONCLUSION: The endovascular technique should be individualized according to the clinical status of the patient, angiographic variables, condition of the posterior circulation and the available supplies. Keywords : Vertebral artery, Dissecting aneurysm, Coiling, Stent, Rebleeding, Endovascular management

Corresponding author : Mahmoud M. Taha, mahmoudlotfy1972@yahoo.co.uk