Subarachnoid Hemorrhage Due to Rupture of Vertebral Artery Dissecting Aneurysms: Treatments, Outcomes, and Prognostic Factors
| Autor: | Nobuaki Yamamoto, Tadashi Yamaguchi, Kenji Shimada, Yasushi Takagi, Junichiro Satomi, Yasuhisa Kanematsu, Mami Hanaoka, Masaaki Korai, Takeshi Miyamoto, Kazuhito Matsuzaki, Yuki Yamamoto, Izumi Yamaguchi, Koichi Satoh |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Vertebral artery Aneurysm Ruptured 03 medical and health sciences 0302 clinical medicine medicine.artery Humans Medicine Surgical treatment Aged Retrospective Studies Aged 80 and over Vertebral Artery Dissection business.industry Mortality rate Treatment method Middle Aged Subarachnoid Hemorrhage Prognosis medicine.disease Surgery Dissecting Aneurysms Treatment Outcome Posterior inferior cerebellar artery 030220 oncology & carcinogenesis Neurology (clinical) business Ligation 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | World Neurosurgery. 152:e86-e93 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2021.05.018 |
| Popis: | Background Mortality rate after subarachnoid hemorrhage due to rupture of vertebral artery dissecting aneurysms (VADAs) is high; endovascular coil trapping is the first-line therapy to prevent rerupture. To select optimal treatments, the positional relationship between the VADA and posterior inferior cerebellar artery (PICA) and the morphology of the contralateral vertebral artery must be considered, and outcome predictors of different treatment methods and their possible complications must be identified. Methods We retrospectively studied 44 patients with ruptured VADAs who had undergone endovascular or surgical treatment. VADA morphology was assessed on conventional preoperative angiograms, and VADAs were categorized based on their site in relation to the PICA. VADA site, treatment method, and complications were used to identify prognostic factors. Results The sites of the 44 VADAs were PICA-proximal (n = 3), PICA-distal (n = 22), PICA-absent (n = 7), and PICA-involved (n = 12). Treatments included internal coil trapping (n = 30), proximal coil occlusion (n = 5), and stent placement (n = 3); surgical flow alteration via an occipital artery–PICA bypass and ligation at the proximal vertebral artery and the PICA origin was performed in 6 patients. Periprocedural rebleeding was associated with a poor outcome. Internal coil trapping prevented the rerupture of PICA-proximal and PICA-absent VADAs, and flow alteration prevented rerupture of PICA-involved VADAs; there were no complications directly attributable to these procedures. Conclusions Periprocedural rebleeding was a poor prognostic factor. Internal trapping of PICA-proximal and PICA-absent VADAs and flow alteration in PICA-involved VADAs prevented rerupture. |
| Databáze: | OpenAIRE |
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