Endovascular management of vertebral artery dissecting aneurysms: review of 25 patients.
OBJECTIVE
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.


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.


CONCLUSIONS
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.
Taha
Mahmoud M
MM
Department of Neurosurgery, Zagazig University, Zagazig, Egypt. mahmoudlotfy1972@yahoo.co.uk
Sakaida
Hiroshi
H
Asakura
Fumio
F
Maeda
Masayuki
M
Toma
Naoki
N
Yamamoto
Akitaka
A
Kawaguchi
Kenji
K
Matsushima
Satoshi
S
Taki
W
W
D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000453:epidemiology; D014711:Vertebral Artery / Q000000981:diagnostic imaging*; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*