ABSTRACT
Introduction: Dissecting aneurysms of the vertebral artery are associated with a high incidence of rebleeding and mortality if untreated. Current endovascular alternatives to surgery are being evaluated. Materials and Methods: We conducted a retrospective review of our experience with endovascular as well as surgical treatments of dissecting vertebral artery aneurysms in 6 patients. Three patients were treated with a combination of coils in the proximal artery and aneurysm sac; 1 with a combination of coils and balloon; and 2 with aneurysm clipping surgery. All patients were treated with the primary intention of coil deposition within the aneurysm sac and proximal vertebral artery. No proximal flow arrest was used. Anticoagulation was given during and after the procedure. Results: Technical success was achieved in all patients, and there was no post-procedural neurological deficit. Follow-up for a mean of 40 months (range, 7 to 64) confirmed the clinical stability of symptoms, as well as the cessation of flow to the aneurysm. Conclusions: Endovascular treatment of vertebral artery dissections is a viable alternative to surgery in the appropriate setting. It has the benefit of being minimally invasive, allowing concomitant balloon testing as well as retaining the option to convert to surgery.
Dissecting aneurysms of the vertebral artery often present with subarachnoid haemorrhage.1 A high mortality occurs with rupture.2 Currently, the treatment options for vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage (SAH) are still controversial and include trapping of the aneurysms with or without bypass as well as proximal occlusion, performed either traditionally via open surgery or through endovascular means. The retrospective results and clinical follow-up of endovascular therapy with coils in 3 patients, a combination of coils and balloons in 1 and surgery in 2 patients are presented.
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