Endovascular Management of Vertebrobasilar Dissecting Aneurysms

摘要: BACKGROUND AND PURPOSE: Several approaches to the treatment of dissecting aneurysms vertebrobasilar system have been used. We evaluated our endovascular experience, which includes trapping and proximal occlusion. METHODS: Thirty-five patients with intradural presented institution between 1992 2002. Twenty-six were treated by means two surgery. In group, 14 in a supra-posterior inferior cerebellar artery (PICA) location, three these extended junction on initial angiogram. Ten located an infra-PICA or no antegrade flow was seen PICA anterior spinal artery. Two at preserved branch. Twelve lesions trapping; another initially occlusion techniques, eventually required procedures. Follow-up images obtained within 1 year 24 patients. Mean follow-up for 3.5 years. RESULTS: Initial treatments technically successful without complication all 26 examinations showed complete cure 19 One patient died global ischemia after presenting as Hunt Hess grade 5 subarachanoid hemorrhage. recurrent hemorrhages occurred group; one died, other underwent procedure. developed contralateral vertebral dissection hours aneurysm dominant brain stem infarct. Another probable vasospasm, last unknown cause month treatment. had recanalization despite procedure, both further Mortality rate 20% group (including surgically), four five deaths occurring during hospital course. 50% six untreated who available follow-up. CONCLUSION: Dissecting remain high-risk because their natural history. They can be managed methods according configuration, collateral circulation, time presentation. Trapping results better prevention rehemorrhage. Proximal achieve manipulation affected segment when more direct stent placement cannot performed.