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Endovascular Strategies for Vertebrobasilar Dissecting Aneurysms

Endovascular Strategies for Vertebrobasilar Dissecting Aneurysms This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1621v1 30/8/1518 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Jin, S.-C. Articles by Kwun, B.-D. Search for Related Content PubMed PubMed Citation Articles by Jin, S.-C. Articles by Kwun, B.-D. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 30:1518-1523, September 2009 © 2009 American Society of Neuroradiology INTERVENTIONAL Endovascular Strategies for Vertebrobasilar Dissecting Aneurysms S.-C. Jin a , D.H. Kwon a , C.-G. Choi b , J.S. Ahn a and B.-D. Kwun a a From the Departments of Neurological Surgery (S.-C.J., D.H.K., J.S.A., B.-D.K.) b Radiology (C.-G.C.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Please address correspondence to Do Hoon Kwon, MD, Asan Medical Center, 388-1, Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea; e-mail: ykwon@amc.seoul.kr BACKGROUND AND PURPOSE: Dissecting vertebrobasilar aneurysms are challenging to treat, and standard treatment modalities remain controversial. We retrospectively evaluated our experience using endovascular techniques to treat these aneurysms. MATERIALS AND METHODS: From February 1997 to December 2007, 42 patients with intradural vertebrobasilar dissecting aneurysms underwent endovascular treatment. Twenty-nine patients had ruptured aneurysms, and 13 patients had unruptured dissecting aneurysms. The endovascular modalities for vertebrobasilar dissecting aneurysms were the following: 1) trapping ( n = 30), 2) proximal occlusion ( n = 3), 3) stent with coil ( n = 6), and 4) stent alone ( n = 3). RESULTS: Seventeen of the 29 patients with ruptured vertebrobasilar dissecting aneurysms had successful outcomes without procedural complications following endovascular treatment. Procedure-related complications were the following: 1) rebleeding ( n = 3), 2) posterior inferior cerebellar artery (PICA) territory infarction ( n = 6), 3) brain stem infarction ( n = 2), and 4) thromboembolism-related multiple infarctions ( n = 1). Clinical outcomes were favorable in 32 patients (76.1%). There were 3 (7.1%) procedure-related mortalities due to rebleeding, and 1 (2.4%) non-procedure-related mortality due to pneumonia sepsis. All 13 patients with unruptured vertebrobasilar dissecting aneurysms had favorable clinical and radiologic outcomes without procedure-related complications. CONCLUSIONS: Endovascular procedures for treatment of unruptured symptomatic dissecting aneurysms resulted in favorable outcomes. Ruptured vertebrobasilar dissecting aneurysms are associated with a high risk of periprocedural complications. Risks can be managed by using appropriate endovascular techniques according to aneurysm location, configuration, and relationship with the PICA. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

Endovascular Strategies for Vertebrobasilar Dissecting Aneurysms

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Publisher
American Journal of Neuroradiology
Copyright
Copyright © 2010 by the American Society of Neuroradiology.
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A1621
Publisher site
See Article on Publisher Site

Abstract

This Article Free to Access Figures Only Full Text Full Text (PDF) All Versions of this Article: ajnr.A1621v1 30/8/1518 most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Jin, S.-C. Articles by Kwun, B.-D. Search for Related Content PubMed PubMed Citation Articles by Jin, S.-C. Articles by Kwun, B.-D. Hotlight (NEW!) What's Hotlight? American Journal of Neuroradiology 30:1518-1523, September 2009 © 2009 American Society of Neuroradiology INTERVENTIONAL Endovascular Strategies for Vertebrobasilar Dissecting Aneurysms S.-C. Jin a , D.H. Kwon a , C.-G. Choi b , J.S. Ahn a and B.-D. Kwun a a From the Departments of Neurological Surgery (S.-C.J., D.H.K., J.S.A., B.-D.K.) b Radiology (C.-G.C.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Please address correspondence to Do Hoon Kwon, MD, Asan Medical Center, 388-1, Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea; e-mail: ykwon@amc.seoul.kr BACKGROUND AND PURPOSE: Dissecting vertebrobasilar aneurysms are challenging to treat, and standard treatment modalities remain controversial. We retrospectively evaluated our experience using endovascular techniques to treat these aneurysms. MATERIALS AND METHODS: From February 1997 to December 2007, 42 patients with intradural vertebrobasilar dissecting aneurysms underwent endovascular treatment. Twenty-nine patients had ruptured aneurysms, and 13 patients had unruptured dissecting aneurysms. The endovascular modalities for vertebrobasilar dissecting aneurysms were the following: 1) trapping ( n = 30), 2) proximal occlusion ( n = 3), 3) stent with coil ( n = 6), and 4) stent alone ( n = 3). RESULTS: Seventeen of the 29 patients with ruptured vertebrobasilar dissecting aneurysms had successful outcomes without procedural complications following endovascular treatment. Procedure-related complications were the following: 1) rebleeding ( n = 3), 2) posterior inferior cerebellar artery (PICA) territory infarction ( n = 6), 3) brain stem infarction ( n = 2), and 4) thromboembolism-related multiple infarctions ( n = 1). Clinical outcomes were favorable in 32 patients (76.1%). There were 3 (7.1%) procedure-related mortalities due to rebleeding, and 1 (2.4%) non-procedure-related mortality due to pneumonia sepsis. All 13 patients with unruptured vertebrobasilar dissecting aneurysms had favorable clinical and radiologic outcomes without procedure-related complications. CONCLUSIONS: Endovascular procedures for treatment of unruptured symptomatic dissecting aneurysms resulted in favorable outcomes. Ruptured vertebrobasilar dissecting aneurysms are associated with a high risk of periprocedural complications. Risks can be managed by using appropriate endovascular techniques according to aneurysm location, configuration, and relationship with the PICA. Home Subscribe Author Instructions Submit Online Search the AJNR Archives Feedback Help Copyright © 2010 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Sep 1, 2009

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