Patients with subarachnoid haemorrhage from vertebrobasilar dissection: treatment with stent-in-stent technique.
BACKGROUND
Vertebrobasilar dissection is an uncommon cause of subarachnoid haemorrhage (SAH) that carries a high risk for early repeat haemorrhage. The need for rapid treatment of this disease entity is without question; however, the best method for treatment is still undetermined. Here, we present our results using the stent-in-stent technique, without coiling, for these patients and propose that it is a viable treatment strategy.


METHODS
We identified in our local database for neurointerventional therapy, between 1st October 2000 and 1st January 2014, 93 patients with potential subarachnoid haemorrhage secondary to vertebrobasilar pathology. After review of the clinical notes and imaging, 15 were found to have presented with subarachnoid haemorrhage and treated with stents alone. All dissections were spontaneous with no history of preceding trauma. The ages ranged between 46 and 71 years (mean 61 years).


RESULTS
All patients presented with Fischer grade 4 SAH and had a visible pseudoaneurysm. The pre-operative GCS varied with two patients scoring 3, one patient scoring 6 and the remaining 12 patients scoring 8 or above. All cases were subjected to stent-in-stent treatment alone. We did not experience any intra-procedural complications. In our series, eight patients had full recovery with a Glasgow Outcome Scale (GOS) of 5, three had moderate disability (GOS 4), one had severe disability (GOS 3), and three patents died, one patient from stent thrombosis or re-bleeding and two from their initial SAH.


CONCLUSIONS
The stent-in-stent technique represents a viable reconstructive endovascular surgical technique with a low risk of intra-procedural complication and post-operative repeat haemorrhage.
Department of Neuroradiology, The Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden, bhogalweb@aol.com.
Pervinder
P
Bhogal
Patrick A
PA
Brouwer
Åsa Kuntze
ÅK
Söderqvist
Marcus
M
Ohlsson
Tommy
T
Andersson
Staffan
S
Holmin
Michael
M
Söderman
D000368:Aged; D017130:Angioplasty; D001488:Basilar Artery; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*