title: Comparison of Endovascular Treatments of Ruptured Dissecting Aneurysms of the Intracranial Internal Carotid Artery and Vertebral Artery with a Review of the Literature.
abstract: OBJECTIVE
  Subarachnoid hemorrhage (SAH) caused by rupture of an internal carotid artery (ICA) or vertebral artery (VA) dissecting aneuryesm is rare. Various treatment strategies have been used for ruptured intracranial dissections. The purpose of this study is to compare the clinical and angiographic characteristics and outcomes of endovascular treatment for ruptured dissecting aneurysms of the intracranial ICA and VA.
  
  
  METHODS
  The authors retrospectively reviewed a series of patients with SAH caused by ruptured intracranial ICA and VA dissecting aneurysms from March 2009 to April 2014. The relevant demographic and angiographic data were collected, categorized and analyzed with respect to the outcome.
  
  
  RESULTS
  Fifteen patients were identified (6 ICAs and 9 VAs). The percentage of patients showing unfavorable initial clinical condition and a history of hypertension was higher in the VA group. The initial aneurysm detection rate and the percentage of fusiform aneurysms were higher in the VA group. In the ICA group, all patients were treated with double stent-assisted coiling, and showed favorable outcomes. In the VA group, 2 patients were treated with double stent-assisted coiling and 7 with endovascular trapping. Two patients died and 1 patient developed severe disability.
  
  
  CONCLUSIONS
  Clinically, grave initial clinical condition and hypertension were more frequent in the VA group. Angiographically, bleb-like aneurysms were more frequent in the ICA group and fusiform aneurysms were more frequent in the VA group. Endovascular treatment of these aneurysms is feasible and the result is acceptable in most instances.
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Byoun
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Hyeong Joong
authors.initials: HJ
authors.lastname: Yi
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Kyu Sun
authors.initials: KS
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Hyoung Joon
authors.initials: HJ
authors.lastname: Chun
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Yong
authors.initials: Y
authors.lastname: Ko
authors.affiliation: Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea.
authors.forename: Koang Hum
authors.initials: KH
authors.lastname: Bak
keywords: Dissecting aneurysm; Endovascular treatment; Internal carotid artery; Subarachnoid hemorrhage; Vertebral artery