Endovascular treatment of vertebral artery dissections and pseudoaneurysms

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  • 1 Departments of Radiology and Neurological Surgery, University of California Hospitals, San Francisco, California
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✓ Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography.

In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second).

Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.

  • 1.

    Adams HP Jr, , Aschenbrener CA, & Kassell NF, et al: Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 39:773776, 1982 Adams HP Jr, Aschenbrener CA, Kassell NF, et al: Intracranial hemorrhage produced by spontaneous dissecting intracranial aneurysm. Arch Neurol 39:773–776, 1982

    • Search Google Scholar
    • Export Citation
  • 2.

    Alom J, , Matias-Guiu J, & Padró L, et al: Spontaneous dissection of intracranial vertebral artery: clinical recovery with conservative treatment. J Neurol Neurosurg Psychiatry 49:599600, 1986 (Letter) Alom J, Matias-Guiu J, Padró L, et al: Spontaneous dissection of intracranial vertebral artery: clinical recovery with conservative treatment. J Neurol Neurosurg Psychiatry 49:599–600, 1986 (Letter)

    • Search Google Scholar
    • Export Citation
  • 3.

    Aoki N, & Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:16281631, 1990 Aoki N, Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631, 1990

    • Search Google Scholar
    • Export Citation
  • 4.

    Barton CW: Subarachnoid hemorrhage presenting as acute chest pain: a variant of le coup de poignard. Ann Emerg Med 17:977978, 1988 Barton CW: Subarachnoid hemorrhage presenting as acute chest pain: a variant of le coup de poignard. Ann Emerg Med 17:977–978, 1988

    • Search Google Scholar
    • Export Citation
  • 5.

    Barton JW, & Margolis MT: Rotational obstruction of the vertebral artery at the atlantoaxial joint. Neuroradiology 9:117120, 1975 Barton JW, Margolis MT: Rotational obstruction of the vertebral artery at the atlantoaxial joint. Neuroradiology 9:117–120, 1975

    • Search Google Scholar
    • Export Citation
  • 6.

    Berger MS, & Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882894, 1984 Berger MS, Wilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:882–894, 1984

    • Search Google Scholar
    • Export Citation
  • 7.

    Bradac GB, , Kaernbach A, & Bolk-Weischedel D, et al: Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature. Neuroradiology 21:149154, 1981 Bradac GB, Kaernbach A, Bolk-Weischedel D, et al: Spontaneous dissecting aneurysm of cervical cerebral arteries. Report of six cases and review of the literature. Neuroradiology 21:149–154, 1981

    • Search Google Scholar
    • Export Citation
  • 8.

    Brown B, & Tissington Tatlow W: Radiographic studies of the vertebral arteries in cadavers. Effects of position and traction on the head. Radiology 81:8088, 1963 Brown B, Tissington Tatlow W: Radiographic studies of the vertebral arteries in cadavers. Effects of position and traction on the head. Radiology 81:80–88, 1963

    • Search Google Scholar
    • Export Citation
  • 9.

    Caplan LR, , Baquis GD, & Pessin MS, et al: Dissection of the intracranial vertebral artery. Neurology 38:868877, 1988 Caplan LR, Baquis GD, Pessin MS, et al: Dissection of the intracranial vertebral artery. Neurology 38:868–877, 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Caplan LR, , Zarins CK, & Hemmati M: Spontaneous dissection of the extracranial vertebral arteries. Stroke 16:10301038, 1985 Caplan LR, Zarins CK, Hemmati M: Spontaneous dissection of the extracranial vertebral arteries. Stroke 16:1030–1038, 1985

    • Search Google Scholar
    • Export Citation
  • 11.

    Chiras J, , Marciano S, & Vega Molina J, et al: Spontaneous dissecting aneurysm of the extracranial vertebral artery (20 cases). Neuroradiology 27:327333, 1985 Chiras J, Marciano S, Vega Molina J, et al: Spontaneous dissecting aneurysm of the extracranial vertebral artery (20 cases). Neuroradiology 27:327–333, 1985

    • Search Google Scholar
    • Export Citation
  • 12.

    De-Broucker T, , Amazan C, & Forys E, et al: Dissection d'une artère vertébrale au décours d'une séance de gymnastique. Presse Med 19:176, 1990 (Letter) De-Broucker T, Amazan C, Forys E, et al: Dissection d'une artère vertébrale au décours d'une séance de gymnastique. Presse Med 19:176, 1990 (Letter)

    • Search Google Scholar
    • Export Citation
  • 13.

    Fisher CM: Unusual vascular events in the territory of the posterior cerebral artery. Can J Neurol Sci 13:17, 1986 Fisher CM: Unusual vascular events in the territory of the posterior cerebral artery. Can J Neurol Sci 13:1–7, 1986

    • Search Google Scholar
    • Export Citation
  • 14.

    Fisher CM, , Ojemann RG, & Roberson GH: Spontaneous dissection of cervico-cerebral arteries. Can J Neurol Sci 5:919, 1978 Fisher CM, Ojemann RG, Roberson GH: Spontaneous dissection of cervico-cerebral arteries. Can J Neurol Sci 5:9–19, 1978

    • Search Google Scholar
    • Export Citation
  • 15.

    Fox C, & Lavin M: Vertebral artery dissection resulting in locked-in syndrome. J Neurosci Nurs 5:287289, 1991 Fox C, Lavin M: Vertebral artery dissection resulting in locked-in syndrome. J Neurosci Nurs 5:287–289, 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    Friedman AH: Traumatic injury of neck and intracranial vessels. Contemp Neurosurg 12:26, 1990 Friedman AH: Traumatic injury of neck and intracranial vessels. Contemp Neurosurg 12:26, 1990

    • Search Google Scholar
    • Export Citation
  • 17.

    Friedman AH, & Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325334, 1984 Friedman AH, Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334, 1984

    • Search Google Scholar
    • Export Citation
  • 18.

    Frumkin LR, & Baloh RW: Wallenberg's syndrome following neck manipulation. Neurology 40:611615, 1990 Frumkin LR, Baloh RW: Wallenberg's syndrome following neck manipulation. Neurology 40:611–615, 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Fujiwara S, , Fujii K, & Nishio S, et al: Long term results of wrapping of intracranial ruptured aneurysms. Acta Neurochir 103:2729, 1990 Fujiwara S, Fujii K, Nishio S, et al: Long term results of wrapping of intracranial ruptured aneurysms. Acta Neurochir 103:27–29, 1990

    • Search Google Scholar
    • Export Citation
  • 20.

    Goto K, , Halbach VV, & Hardin CW, et al: Permanent inflation of detachable balloons with a low-viscosity hydrophilic polymerizing system. Radiology 169:787790, 1988 Goto K, Halbach VV, Hardin CW, et al: Permanent inflation of detachable balloons with a low-viscosity hydrophilic polymerizing system. Radiology 169:787–790, 1988

    • Search Google Scholar
    • Export Citation
  • 21.

    Halbach VV, , Higashida RT, & Dowd CF, et al: Management of vascular perforations that occur during neurointerventional procedures. Am J Neuroradiol 12:319329, 1991 Halbach VV, Higashida RT, Dowd CF, et al: Management of vascular perforations that occur during neurointerventional procedures. Am J Neuroradiol 12:319–329, 1991

    • Search Google Scholar
    • Export Citation
  • 22.

    Halbach VV, , Higashida RT, & Hieshima GB: Treatment of vertebral arteriovenous fistulas. Am J Neuroradiol 8:11211128, 1987 Halbach VV, Higashida RT, Hieshima GB: Treatment of vertebral arteriovenous fistulas. Am J Neuroradiol 8:1121–1128, 1987

    • Search Google Scholar
    • Export Citation
  • 23.

    Hart RG: Vertebral artery dissection. Neurology 38:987989, 1988 Hart RG: Vertebral artery dissection. Neurology 38:987–989, 1988

  • 24.

    Hart RG, & Easton JD: Dissections of cervical and cerebral arteries. Neurol Clin 1:155182, 1983 Hart RG, Easton JD: Dissections of cervical and cerebral arteries. Neurol Clin 1:155–182, 1983

    • Search Google Scholar
    • Export Citation
  • 25.

    Hieshima GB, , Mehringer CM, & Grinnell VS, et al: Emergency occlusive techniques. Surg Neurol 9:293302, 1978 Hieshima GB, Mehringer CM, Grinnell VS, et al: Emergency occlusive techniques. Surg Neurol 9:293–302, 1978

    • Search Google Scholar
    • Export Citation
  • 26.

    Higashida RT, , Halbach VV, & Dowd CF, et al: Intracranial aneurysms: treatment with detachable balloons: results in 215 cases. Radiology 178:663671, 1991 Higashida RT, Halbach VV, Dowd CF, et al: Intracranial aneurysms: treatment with detachable balloons: results in 215 cases. Radiology 178:663–671, 1991

    • Search Google Scholar
    • Export Citation
  • 27.

    Hinse P, , Thie A, & Lachenmayer L: Dissection of the extracranial vertebral artery: report of four cases and review of the literature. J Neurol Neurosurg Psychiatry 54:863869, 1991 Hinse P, Thie A, Lachenmayer L: Dissection of the extracranial vertebral artery: report of four cases and review of the literature. J Neurol Neurosurg Psychiatry 54:863–869, 1991

    • Search Google Scholar
    • Export Citation
  • 28.

    Hugenholtz H, , Pokrupa R, & Montpetit VJA, et al: Spontaneous dissecting aneurysm of the extracranial vertebral artery. Neurosurgery 10:96100, 1982 Hugenholtz H, Pokrupa R, Montpetit VJA, et al: Spontaneous dissecting aneurysm of the extracranial vertebral artery. Neurosurgery 10:96–100, 1982

    • Search Google Scholar
    • Export Citation
  • 29.

    Jabre A: Subintimal dissection of the vertebral artery in subluxation of the cervical spine. Neurosurgery 29:912915, 1991 Jabre A: Subintimal dissection of the vertebral artery in subluxation of the cervical spine. Neurosurgery 29:912–915, 1991

    • Search Google Scholar
    • Export Citation
  • 30.

    Krieger L, , Leibold M, & Bruckmann H: Dissections of the vertebral artery following cervical chiropractic manipulations. Dtsch Med Wochenschr 115:580583, 1990 Krieger L, Leibold M, Bruckmann H: Dissections of the vertebral artery following cervical chiropractic manipulations. Dtsch Med Wochenschr 115:580–583, 1990

    • Search Google Scholar
    • Export Citation
  • 31.

    Linden D, , Steinke W, & Schwartz A, et al: Spontaneous vertebral artery dissection initially mimicking myocardial infarction. Stroke 23:10211023, 1992 Linden D, Steinke W, Schwartz A, et al: Spontaneous vertebral artery dissection initially mimicking myocardial infarction. Stroke 23:1021–1023, 1992

    • Search Google Scholar
    • Export Citation
  • 32.

    Mahmood A, , Dujovny M, & Torche M, et al: Microvascular anatomy of foramen caecum medullae oblongatae. J Neurosurg 75:299304, 1991 Mahmood A, Dujovny M, Torche M, et al: Microvascular anatomy of foramen caecum medullae oblongatae. J Neurosurg 75:299–304, 1991

    • Search Google Scholar
    • Export Citation
  • 33.

    Mas JL, , Bousser MG, & Hasboun D, et al: Extracranial vertebral arterv dissections: a review of 13 cases. Stroke 18:10371047, 1987 Mas JL, Bousser MG, Hasboun D, et al: Extracranial vertebral arterv dissections: a review of 13 cases. Stroke 18:1037–1047, 1987

    • Search Google Scholar
    • Export Citation
  • 34.

    Mas JL, , Henin D, & Bousser MG, et al: Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. Neurology 39:512515, 1989 Mas JL, Henin D, Bousser MG, et al: Dissecting aneurysm of the vertebral artery and cervical manipulation: a case report with autopsy. Neurology 39:512–515, 1989

    • Search Google Scholar
    • Export Citation
  • 35.

    Matsumoto K, , Saijo T, & Kuyama H, et al: Hemifacial spasm caused by a spontaneous dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 74:650652, 1991 Matsumoto K, Saijo T, Kuyama H, et al: Hemifacial spasm caused by a spontaneous dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 74:650–652, 1991

    • Search Google Scholar
    • Export Citation
  • 36.

    Mokri B, , Houser OW, & Sandok BA, et al: Spontaneous dissections of the vertebral arteries. Neurology 38:880885, 1988 Mokri B, Houser OW, Sandok BA, et al: Spontaneous dissections of the vertebral arteries. Neurology 38:880–885, 1988

    • Search Google Scholar
    • Export Citation
  • 37.

    Mueller S, & Sahs AL: Brain stem dysfunction related to cervical manipulation. Report of three cases. Neurology 26:547550, 1976 Mueller S, Sahs AL: Brain stem dysfunction related to cervical manipulation. Report of three cases. Neurology 26:547–550, 1976

    • Search Google Scholar
    • Export Citation
  • 38.

    Nakamura CT, , Lau JM, & Polk NO, et al: Vertebral artery dissection caused by chiropractic manipulation. J Vasc Surg 14:122124, 1991 (Letter) Nakamura CT, Lau JM, Polk NO, et al: Vertebral artery dissection caused by chiropractic manipulation. J Vasc Surg 14:122–124, 1991 (Letter)

    • Search Google Scholar
    • Export Citation
  • 39.

    Phillips SJ, , Maloney WJ, & Gray J: Pure motor stroke due to vertebral artery dissection. Can J Neurol Sci 16:348351, 1989 Phillips SJ, Maloney WJ, Gray J: Pure motor stroke due to vertebral artery dissection. Can J Neurol Sci 16:348–351, 1989

    • Search Google Scholar
    • Export Citation
  • 40.

    Pozzati E, , Padovani R, & Fabrizi A, et al: Benign arterial dissections of the posterior circulation. J Neurosurg 75:6972, 1991 Pozzati E, Padovani R, Fabrizi A, et al: Benign arterial dissections of the posterior circulation. J Neurosurg 75:69–72, 1991

    • Search Google Scholar
    • Export Citation
  • 41.

    Roualdes G, , Lartigue C, & Boudigue MD, et al: Dissection de l'artère vertébrale dans sa portion extra-crânienne après un match de tennis. Presse Med 14:2108, 1985 (Letter) Roualdes G, Lartigue C, Boudigue MD, et al: Dissection de l'artère vertébrale dans sa portion extra-crânienne après un match de tennis. Presse Med 14:2108, 1985 (Letter)

    • Search Google Scholar
    • Export Citation
  • 42.

    Sasaki O, , Ogawa H, & Koike T, et al: A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874882, 1991 Sasaki O, Ogawa H, Koike T, et al: A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:874–882, 1991

    • Search Google Scholar
    • Export Citation
  • 43.

    Senter HJ, & Sarwar M: Nontraumatic dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 56:128130, 1982 Senter HJ, Sarwar M: Nontraumatic dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 56:128–130, 1982

    • Search Google Scholar
    • Export Citation
  • 44.

    Sherman DG, , Hart RG, & Easton JD: Abrupt change in head position and cerebral infarction. Stroke 12:26, 1981 Sherman DG, Hart RG, Easton JD: Abrupt change in head position and cerebral infarction. Stroke 12:2–6, 1981

    • Search Google Scholar
    • Export Citation
  • 45.

    Shimoji T, , Bando K, & Nakajima K, et al: Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61:10381046, 1984 Shimoji T, Bando K, Nakajima K, et al: Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings. J Neurosurg 61:1038–1046, 1984

    • Search Google Scholar
    • Export Citation
  • 46.

    Six EG, , Stringer WL, & Cowley AR, et al: Posttraumatic bilateral vertebral artery occlusion. Case report. J Neurosurg 54:814817, 1981 Six EG, Stringer WL, Cowley AR, et al: Posttraumatic bilateral vertebral artery occlusion. Case report. J Neurosurg 54:814–817, 1981

    • Search Google Scholar
    • Export Citation
  • 47.

    Su CC, , Watanabe T, & Yoshimoto T, et al: Proximal clipping of dissecting intracranial vertebral aneurysm — effect of balloon matas test with neurophysiological monitoring. Case report. Acta Neurochir 104:5963, 1990 Su CC, Watanabe T, Yoshimoto T, et al: Proximal clipping of dissecting intracranial vertebral aneurysm — effect of balloon matas test with neurophysiological monitoring. Case report. Acta Neurochir 104:59–63, 1990

    • Search Google Scholar
    • Export Citation
  • 48.

    Traflet RF, , Babaria AR, & Bell RD, et al: Vertebral artery dissection after rapid head turning. Am J Neuroradiol 10:650651, 1989 Traflet RF, Babaria AR, Bell RD, et al: Vertebral artery dissection after rapid head turning. Am J Neuroradiol 10:650–651, 1989

    • Search Google Scholar
    • Export Citation
  • 49.

    Tramo MJ, , Hianline B, & Petito F, et al: Vertebral artery injury and cerebellar stroke while swimming: case report. Stroke 16:10391042, 1985 Tramo MJ, Hianline B, Petito F, et al: Vertebral artery injury and cerebellar stroke while swimming: case report. Stroke 16:1039–1042, 1985

    • Search Google Scholar
    • Export Citation
  • 50.

    Waga S, , Fujimoto K, & Morooka Y: Dissecting aneurysm of the vertebral artery. Surg Neurol 10:237239, 1978 Waga S, Fujimoto K, Morooka Y: Dissecting aneurysm of the vertebral artery. Surg Neurol 10:237–239, 1978

    • Search Google Scholar
    • Export Citation
  • 51.

    Wilkinson IMS: The vertebral artery. Extracranial and intracranial structure. Arch Neurol 27:392396, 1972 Wilkinson IMS: The vertebral artery. Extracranial and intracranial structure. Arch Neurol 27:392–396, 1972

    • Search Google Scholar
    • Export Citation
  • 52.

    Yamaura A, , Watanabe Y, & Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183188, 1990 Yamaura A, Watanabe Y, Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188, 1990

    • Search Google Scholar
    • Export Citation
  • 53.

    Yonas H, , Agamanolis D, & Takaoka Y, et al: Dissecting intracranial aneurysms. Surg Neurol 8:407415, 1977 Yonas H, Agamanolis D, Takaoka Y, et al: Dissecting intracranial aneurysms. Surg Neurol 8:407–415, 1977

    • Search Google Scholar
    • Export Citation
  • 54.

    Youl BD, , Coutellier A, & Dubois B, et al: Three cases of spontaneous extracranial vertebral artery dissection. Stroke 21:618625, 1990 Youl BD, Coutellier A, Dubois B, et al: Three cases of spontaneous extracranial vertebral artery dissection. Stroke 21:618–625, 1990

    • Search Google Scholar
    • Export Citation

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