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Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. Clinical article

 Sang Hyun Suh  ;  Byung Moon Kim  ;  Sung Il Park  ;  Dong Ik Kim  ;  Yong Sam Shin  ;  Eui Jong Kim  ;  Eun Chul Chung  ;  Jun Seok Koh  ;  Hyun Cheol Shin  ;  Chun Sik Choi  ;  Yu Sam Won 
 JOURNAL OF NEUROSURGERY, Vol.111(1) : 48-52, 2009 
Journal Title
Issue Date
Adult ; Aged ; Cerebral Angiography ; Embolization, Therapeutic/instrumentation* ; Embolization, Therapeutic/methods* ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Intracranial Aneurysm/therapy* ; Male ; Middle Aged ; Retrospective Studies ; Stents* ; Treatment Outcome ; Vertebral Artery Dissection/diagnostic imaging ; Vertebral Artery Dissection/therapy*
ruptured dissecting aneurysm ; vertebrobasilar artery ; endovascular treatment ; stent-assisted coil embolization ; stent-within-a-stent technique
OBJECT: A ruptured dissecting aneurysm of the vertebrobasilar artery (VBA-DA) is a well-known cause of acute subarachnoid hemorrhage (SAH) with a high rate of early rebleeding. Internal trapping of the parent artery, including the dissected segment, is one of the most reliable techniques to prevent rebleeding. However, for a ruptured VBA-DA not suitable for internal trapping, the optimal treatment method has not been well established. The authors describe their experience in treating ruptured VBA-DAs not amenable to internal trapping of the parent artery with stent-assisted coil embolization (SAC) followed by a stent-within-a-stent (SWS) technique. METHODS: Eleven patients-6 men and 5 women with a mean age of 48 years and each with a ruptured VBA-DA not amenable to internal trapping of the parent artery-underwent an SAC-SWS between November 2005 and October 2007. The feasibility and clinical and angiographic outcomes of this combined procedure were retrospectively evaluated. RESULTS: The SAC-SWS was successful without any treatment-related complications in all 11 patients. Immediate posttreatment angiograms revealed complete obliteration of the DA sac in 3 patients, near-complete obliteration in 7, and partial obliteration in 1. One patient died as a direct consequence of the initial SAH. All 10 surviving patients had excellent clinical outcomes (Glasgow Outcome Scale Score 5) without posttreatment rebleeding during a follow-up period of 8-24 months (mean follow-up 15 months). Angiographic follow-up at 6-12 months after treatment was possible at least once in all surviving patients. Nine VBA-DAs showed complete obliteration; the other aneurysm, which had appeared partially obliterated immediately after treatment, demonstrated progressive obliteration on 2 consecutive follow-up angiography studies. There was no in-stent stenosis or occlusion of the branch or perforating vessels. CONCLUSIONS: The SAC-SWS technique seems to be a feasible and effective reconstructive treatment option for a ruptured VBA-DA. The technique may be considered as an alternative therapeutic option in selected patients with ruptured VBA-DAs unsuitable for internal trapping of the parent artery.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
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