title: Single-stage endovascular treatment of subarachnoid hemorrhage related to bilateral vertebral artery dissecting aneurysms.
abstract: OBJECTIVE
  Treatment of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage remains challenging as bilateral deconstructive procedures may not be feasible. In this case series, we describe our approach to their management and review the pertinent literature.
  
  
  METHODS
  A retrospective review of our prospectively collected database on aneurysms was performed to identify all patients with acute subarachnoid hemorrhage in the setting of bilateral intradural vertebral artery dissections (VAD) encompassing a period from January 2000 and March 2012.
  
  
  RESULTS
  Four patients (M/F = 2/2; mean age, 51.5 years) were identified. In two cases the site of rupture could be identified by angiographic and cross-sectional features; in these patients deconstructive treatment (proximal obliteration or trapping) of the ruptured site and reconstructive treatment of the unruptured site (using stents and coils) were performed. In the patients in whom the site of hemorrhage could not be determined, bilateral reconstructive treatment was performed. No treatment-related complications were encountered. Modified Rankin scale scores were 0-1 at discharge, and on follow-up (mean 63 months), no recurrence, in-stent thrombosis or new neurological deficits were encountered.
  
  
  CONCLUSIONS
  We believe that single-stage treatment in patients with bilateral VAD is indicated: If the site of hemorrhage can be determined, we prefer deconstructive treatment on the affected site and reconstructive treatment on the non-affected site to prevent increased hemodynamic stress on the unruptured but diseased wall. If the site of dissection cannot be determined, we prefer bilateral reconstructive treatment to avoid increasing hemodynamic stress on the potentially untreated acute hemorrhagic dissection.
authors.affiliation: Changhai Hospital, Second Military Medical University Shanghai, China.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Zhao
authors.affiliation: Changhai Hospital, Second Military Medical University Shanghai, China.
authors.forename: Kai-Jun
authors.initials: KJ
authors.lastname: Zhao
authors.affiliation: Changhai Hospital, Second Military Medical University Shanghai, China.
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Huang
authors.affiliation: Changhai Hospital, Second Military Medical University Shanghai, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Changhai Hospital, Second Military Medical University Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hong
authors.affiliation: Changhai Hospital, Second Military Medical University Shanghai, China chstroke@163.com.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000328:Adult; D019412:Anatomy, Cross-Sectional; D017542:Aneurysm, Ruptured; D002533:Cerebral Angiography; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications / Q000473:pathology / Q000601:surgery*
keywords: Subarachnoid hemorrhage; aneurysms; endovascular treatment