Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome
| Autor: | Pattarawit Withayasuk, K Urasyanandana, Dittapong Songsaeng, Anchalee Churojana, Thaweesak Aurboonyawat, Ekawut Chankaew |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Adolescent Vertebral artery dissection Vertebral artery Treatment outcome 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Aneurysm medicine.artery medicine Humans cardiovascular diseases Aged Aged 80 and over Vertebral Artery Dissection medicine.diagnostic_test business.industry Intracranial Aneurysm Middle Aged Subarachnoid Hemorrhage Prognosis medicine.disease Cerebral Angiography Surgery Dissecting Aneurysms Treatment Outcome medicine.anatomical_structure Female Radiology Tomography X-Ray Computed business Cerebellar artery 030217 neurology & neurosurgery Cerebral angiography |
| Zdroj: | Interventional Neuroradiology. 23:240-248 |
| ISSN: | 2385-2011 1591-0199 |
| DOI: | 10.1177/1591019917691252 |
| Popis: | Objective Intracranial spontaneous vertebral artery dissecting aneurysms commonly occur in the third to fifth decades of life, and are mostly associated with hypertension. Patients present with intracranial haemorrhage or thromboembolic events. Patients who present with intracranial haemorrhage carry about a 70% risk of recurrent bleeding. Patients with a posterior-inferior cerebellar artery (PICA) or ipsilateral dominant vertebral artery involve selecting which parent vessel could not be sacrificed. Recent reconstructive techniques such as stent-assisted coiling embolisation and flow-diverting stents are effective treatments of choice. Methods Seventeen patients presented subarachnoid haemorrhage and nine patients with other symptoms. Sacrificing the parent vertebral artery was the first choice for surgical or endovascular methods. Endovascular reconstructive treatment by stent-assisted coiling embolisation was indicated in dissecting vertebral artery aneurysms with ipsilateral dominant vertebral artery or PICA involvement. Clinical outcomes were determined using the modified Rankin Score (mRS) at 90 days, with favourable outcomes defined as 0 to 2. Results Of the patients presenting with ruptured aneurysms, 11 (61.1%) had a good clinical outcome, with a mRS of 0–2. Favourable Hunt and Hess grading (65%), mild to moderate GCS (65%) and total occlusion of aneurysms after treatment (65%) were significantly good prognostic factors in patients with ruptured vertebral artery dissecting aneurysms. Conclusion Endovascular parent vessel sacrifice could be the first choice to treat a ruptured vertebral artery dissecting aneurysm. Stent-assisted coiling to preserve the patency of the parent artery and its branches is a promising treatment for vertebral artery dissections. |
| Databáze: | OpenAIRE |
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