Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of Endovascular Treatments of Ruptured Dissecting Aneurysms of the Intracranial Internal Carotid Artery and Vertebral Artery with a Review of the Literature

  • Byoun, Hyoung Soo (Department of Neurosurgery, Seoul National University Bundang Hospital) ;
  • Yi, Hyeong Joong (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Choi, Kyu Sun (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Chun, Hyoung Joon (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Ko, Yong (Department of Neurosurgery, Hanyang University Medical Center) ;
  • Bak, Koang Hum (Department of Neurosurgery, Hanyang University Medical Center)
  • Received : 2016.03.20
  • Accepted : 2016.05.16
  • Published : 2016.09.01
Download PDF
⟨ Previous Next ⟩

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. Conclusion : 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.

Keywords

References

  1. Ahn JY, Chung SS, Lee BH, Kim SH, Yoon PH, Joo JY, et al. : Treatment of spontaneous arterial dissections with stent placement for preservation of the parent artery. Acta Neurochir (Wien) 147 : 265-273; discussion 273, 2005 https://doi.org/10.1007/s00701-004-0436-8
  2. Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Lee BH, et al. : Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol 27 : 1514-1520
  3. Albuquerque FC, Fiorella DJ, Han PP, Deshmukh VR, Kim LJ, McDougall CG : Endovascular management of intracranial vertebral artery dissecting aneurysms. Neurosurg Focus 18 : E3, 2005
  4. Anxionnat R, de Melo Neto JF, Bracard S, Lacour JC, Pinelli C, Civit T, et al. : Treatment of hemorrhagic intracranial dissections. Neurosurgery 53 : 289-300; discussion 300-301, 2003 https://doi.org/10.1227/01.NEU.0000073417.01297.93
  5. Fischer S, Perez MA, Kurre W, Albes G, Bazner H, Henkes H : Pipeline embolization device for the treatment of intra- and extracranial fusiform and dissecting aneurysms : initial experience and long-term follow-up. Neurosurgery 75 : 364-374; discussion 374, 2014 https://doi.org/10.1227/NEU.0000000000000431
  6. Gonzalez AM, Narata AP, Yilmaz H, Bijlenga P, Radovanovic I, Schaller K, et al. : Blood blister-like aneurysms : single center experience and systematic literature review. Eur J Radiol 83 : 197-205, 2014 https://doi.org/10.1016/j.ejrad.2013.09.017
  7. Hamada J, Kai Y, Morioka M, Yano S, Todaka T, Ushio Y : Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage. J Neurosurg 99 : 960-966, 2003 https://doi.org/10.3171/jns.2003.99.6.0960
  8. Kashiwazaki D, Ushikoshi S, Asano T, Kuroda S, Houkin K : Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection. Neuroradiology 55 : 201-206, 2013 https://doi.org/10.1007/s00234-012-1114-9
  9. Kim BC, Kwon OK, Oh CW, Bang JS, Hwang G, Jin SC, et al. : Endovascular internal carotid artery trapping for ruptured blood blister-like aneurysms : long-term results from a single centre. Neuroradiology 56 : 211-217, 2014 https://doi.org/10.1007/s00234-014-1317-3
  10. Kim BM, Shin YS, Kim SH, Suh SH, Ihn YK, Kim DI, et al. : Incidence and risk factors of recurrence after endovascular treatment of intracranial vertebrobasilar dissecting aneurysms. Stroke 42 : 2425-2430, 2011 https://doi.org/10.1161/STROKEAHA.111.617381
  11. Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K : Intracranial vertebral artery dissections : clinical, radiological features, and surgical considerations. Neurosurgery 34 : 620-626; discussion 626-627, 1994 https://doi.org/10.1227/00006123-199404000-00008
  12. Kocaeli H, Chaalala C, Andaluz N, Zuccarello M : Spontaneous intradural vertebral artery dissection : a single-center experience and review of the literature. Skull Base 19 : 209-218, 2009 https://doi.org/10.1055/s-0028-1114296
  13. Kurata A, Ohmomo T, Miyasaka Y, Fujii K, Kan S, Kitahara T : Coil embolization for the treatment of ruptured dissecting vertebral aneurysms. AJNR Am J Neuroradiol 22 : 11-18, 2001
  14. Lee BH, Kim BM, Park MS, Park SI, Chung EC, Suh SH, et al. : Reconstructive endovascular treatment of ruptured blood blister-like aneurysms of the internal carotid artery. J Neurosurg 110 : 431-436, 2009 https://doi.org/10.3171/2008.7.JNS08257
  15. Meckel S, Singh TP, Undren P, Ramgren B, Nilsson OG, Phatouros C, et al. : Endovascular treatment using predominantly stent-assisted coil embolization and antiplatelet and anticoagulation management of ruptured blood blister-like aneurysms. AJNR Am J Neuroradiol 32 : 764-771, 2011 https://doi.org/10.3174/ajnr.A2392
  16. Meling TR, Sorteberg A, Bakke SJ, Slettebo H, Hernesniemi J, Sorteberg W : Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage : treatment and outcome. J Neurosurg 108 : 662-671, 2008 https://doi.org/10.3171/JNS/2008/108/4/0662
  17. Mizutani T : Subarachnoid hemorrhage associated with angiographic "stenotic" or "occlusive" lesions in the carotid circulation. Surg Neurol 49 : 495-503; discussion 503-504, 1998 https://doi.org/10.1016/S0090-3019(96)00363-1
  18. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T : Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36 : 905-911; discussion 912-913, 1995 https://doi.org/10.1227/00006123-199505000-00003
  19. Mohammadian R, Taheraghdam AA, Sharifipour E, Mansourizadeh R, Pashapour A, Shimia M, et al. : Endovascular treatment of intracranial artery dissection : clinical and angiographic follow-up. Neurol Res Int 2013 : 968380, 2013
  20. Nakatomi H, Nagata K, Kawamoto S, Shiokawa Y : Ruptured dissecting aneurysm as a cause of subarachnoid hemorrhage of unverified etiology. Stroke 28 : 1278-1282, 1997 https://doi.org/10.1161/01.STR.28.6.1278
  21. Ohkuma H, Nakano T, Manabe H, Suzuki S : Subarachnoid hemorrhage caused by a dissecting aneurysm of the internal carotid artery. J Neurosurg 97 : 576-583, 2002 https://doi.org/10.3171/jns.2002.97.3.0576
  22. Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM : Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24 : 1421-1428, 2003
  23. Sakata N, Takebayashi S, Kojima M, Masawa N, Suzuki K, Takatama M : Pathology of a dissecting intracranial aneurysm. Neuropathology 20 : 104-108, 2000 https://doi.org/10.1046/j.1440-1789.2000.00275.x
  24. Sim SY, Chung J, Shin YS : Are blood blister-like aneurysms a specific type of dissection? A comparative study of blood blister-like aneurysms and ruptured mizutani type 4 vertebral artery dissections. J Korean Neurosurg Soc 56 : 395-399, 2014 https://doi.org/10.3340/jkns.2014.56.5.395
  25. Sugiu K, Tokunaga K, Watanabe K, Sasahara W, Ono S, Tamiya T, et al. : Emergent endovascular treatment of ruptured vertebral artery dissecting aneurysms. Neuroradiology 47 : 158-164, 2005 https://doi.org/10.1007/s00234-005-1341-4
  26. Taha MM, Sakaida H, Asakura F, Maeda M, Toma N, Yamamoto A, et al. : Endovascular management of vertebral artery dissecting aneurysms : review of 25 patients. Turk Neurosurg 20 : 126-135, 2010
  27. Takemoto K, Abe H, Uda K, Inoue T : Surgical treatment of intracranial VA dissecting aneurysm. Acta Neurochir Suppl 107 : 51-56, 2010
  28. Uhl E, Schmid-Elsaesser R, Steiger HJ : Ruptured intracranial dissecting aneurysms : management considerations with a focus on surgical and endovascular techniques to preserve arterial continuity. Acta Neurochir (Wien) 145 : 1073-1083; discussion 1083-1084, 2003 https://doi.org/10.1007/s00701-003-0122-2
  29. van Oel LI, van Rooij WJ, Sluzewski M, Beute GN, Lohle PN, Peluso JP : Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils. AJNR Am J Neuroradiol 34 : 589-595, 2013 https://doi.org/10.3174/ajnr.A3255
  30. Yamada M, Kitahara T, Kurata A, Fujii K, Miyasaka Y : Intracranial vertebral artery dissection with subarachnoid hemorrhage : clinical characteristics and outcomes in conservatively treated patients. J Neurosurg 101 : 25-30, 2004 https://doi.org/10.3171/jns.2004.101.1.0025
  31. Yamaura A, Watanabe Y, Saeki N : Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72 : 183-188, 1990 https://doi.org/10.3171/jns.1990.72.2.0183
  32. Yonekawa Y, Zumofen D, Imhof HG, Roth P, Khan N : Hemorrhagic cerebral dissecting aneurysms : surgical treatments and results. Acta Neurochir Suppl 103 : 61-69, 2008

Cited by

  1. Clinical Study on Complications of Intracranial Ruptured Aneurysm Embolization by Stent-Assisted Coil vol.24, pp.None, 2016, https://doi.org/10.12659/msm.911773
  2. Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage? vol.20, pp.2, 2016, https://doi.org/10.7461/jcen.2018.20.2.87
  3. Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms vol.32, pp.5, 2016, https://doi.org/10.1177/1971400919861406