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Endovascular treatment of bilateral intracranial vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage

 Shin, Yong Sam  ;  Kim, Byung Moon  ;  Kim, Se-Hyuk  ;  Suh, Sang Hyun  ;  Ryu, Chang Woo  ;  Koh, Jun Seok  ;  Kim, Dong Ik  ;  Kim, Dong Joon 
 NEUROSURGERY, Vol.70(1 Suppl Operative) : 75-81, 2012 
Journal Title
Issue Date
Adult ; Aneurysm, Ruptured/diagnosis ; Aneurysm, Ruptured/diagnostic imaging ; Aneurysm, Ruptured/surgery* ; Blood Vessel Prosthesis Implantation/instrumentation ; Blood Vessel Prosthesis Implantation/methods* ; Diagnosis, Differential ; Embolization, Therapeutic/instrumentation ; Embolization, Therapeutic/methods* ; Endovascular Procedures/instrumentation ; Endovascular Procedures/methods* ; Female ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Subarachnoid Hemorrhage/diagnosis ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/surgery* ; Vertebral Artery Dissection/diagnosis ; Vertebral Artery Dissection/diagnostic imaging ; Vertebral Artery Dissection/surgery*
Dissecting aneurysm ; Subarachnoid hemorrhage ; Vertebral artery
BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Ik(김동익)
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
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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