Endovascular treatment of ruptured intracranial vertebral artery dissection aneurysms

LIU Xin; LIU Min; XU Rui; ZHANG Hong

Abstract：Objective To explore the feasibility ,safety ,and effect of different endovascular strategies in treating rup‐tured intracranial vertebral artery dissection aneurysms .Methods A total of 17 patients with 17 ruptured intracranial ver‐tebral artery dissection aneurysms (VADAs) were treated by endovascular embolization between January 2009 and March 2014 .9 patients with PICA‐proximal VADAs were treated by deconstructive technique .Guglielmi detachable coils were used to embolize the aneurysm lumen .Mechanical coils were used to embolize the parent artery .2 patients with PICA‐in‐volving VADAs and 6 patients with PICA‐distal VADAs were treated by reconstructive technique .Single stent‐assisted coil embolization technique was used to treat 6 VADAs and double stent–assisted coil embolization technique was used to 2 VADAs .Immediate obliteration grade was evaluated after treatment ,imaging and clinical follow up were performed to e‐valuate the treatment effect .Results All the VADAs were successfully treated by deconstructive or reconstructive tech‐nique without bleeding ,thrombogenesis ,and any other complications .The VADAs of the 9 patients who accepted decon‐structive treatment were all immediate complete obliteration .1 patient suffered from the affected side auricle pain ,1 pa‐tient had double vision ,both symptoms turned better after symptomatic treatment in 1 week .Abducens nerve paralysis was observed in 1 patient and disappeared 2 months later without treatment .For the 8 patients who accepted reconstruc‐tive treatment ,2 VADAs were immediate complete obliteration ,6 VADAs were near‐complete obliteration .The imaging and clinical manifestations were satisfying during the 6‐36 month follow‐up .Conclusion Endovascular treatment of rup‐tured intracranial VADAs according to the location of the PICA is safe and effective .