Endovascular Surgery using Stents for Vertebral Artery Dissecting Aneurysms and a Review of the Literature

S. Suzuki; A. Kurata; K. Iwamoto; K. Sato; J. Niki; T. Miyazaki; M. Yamada; H. Oka; K. Fujii; S. Kan

doi:10.1055/s-2008-1073172

min - Minimally Invasive Neurosurgery, Inhaltsverzeichnis

Minim Invasive Neurosurg 2008; 51(4): 193-198
DOI: 10.1055/s-2008-1073172

Original Article

Endovascular Surgery using Stents for Vertebral Artery Dissecting Aneurysms and a Review of the Literature

S. Suzuki¹ , A. Kurata¹ , K. Iwamoto¹ , K. Sato¹ , J. Niki¹ , T. Miyazaki¹ , M. Yamada¹ , H. Oka¹ , K. Fujii¹ , S. Kan²

¹Department of Neurosurgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
²Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan

Abstract

The treatment of dissecting aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) or presenting with hypoplasia of the contralateral VA is controversial. We describe our experience with 4 ruptured and 2 unruptured VA dissecting aneurysms and discuss the efficacy of endovascular surgery using stents. All patients were male; their mean age was 50.7 years. According to World Federation of Neurological Surgeons (WFNS) grading, 3 of the ruptured aneurysms were grade V, the other was grade I. All patients were successfully treated using stents; in 5 we also coil-embolized the aneurysmal lumen. One aneurysm was treated by the placement of 2 stents covering the dissection site; there was a danger of aneurysmal rupture during coil embolization. No technical complications were encountered although one patient suffered minor rebleeding 5 days post-treatment. Delayed vasospasm occurred in 4 cases. According to the Glasgow Outcome Scale (GOS), at 3 months after treatment 2 patients had made a good recovery, one was moderately disabled, one suffered severe disability, and 2 had died. One death each was due to acute myocardial and brain stem infarction. Endovascular surgery using stents may be a useful treatment in patients in poor condition who manifest dissecting VA aneurysms involving the PICA or hypoplasia of the contralateral VA, especially in the acute period after rupture.

Key words

vertebral artery dissecting aneurysm - PICA involvement - endovascular surgery - stenting

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Correspondence

S. SuzukiMD

Department of Neurosurgery

Kitasato University School of Medicine

1-15-1 Kitasato

Sagamihara

228-8555 Kanagawa

Japan

Telefon: +81/42/778 93 37

Fax: +81/42/778 77 88

eMail: ssachio@med.kitasato-u.ac.jp