Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils

Restricted access

Object. Surgical or endovascular occlusion of the parent artery proximal to an aneurysm has been recommended for treatment of dissecting aneurysms of the intracranial posterior circulation. However, dissecting aneurysms may rupture even after proximal occlusion because distal progression of thrombus is necessary to occlude the dissecting aneurysm completely, and this may be delayed by the presence of retrograde flow. In this article the authors present their experience in treating six patients with ruptured dissecting aneurysms.

Methods. The authors report on six patients with a ruptured dissecting aneurysm in the posterior fossa who were successfully treated by endovascular occlusion of the aneurysm by using Guglielmi detachable coils. The procedure was particularly aimed at occluding the dissected site.

Conclusions. At the present time, endovascular occlusion of the dissected site is a safe, minimally invasive, and reliable treatment for dissecting aneurysms when a test occlusion is tolerated and adequate collateral circulation is present.

Article Information

Address reprint requests to: Ikuya Yamaura, M.D., Department of Neurosurgery, Hyogo College of Medicine, 1–1 Mukogawa-cho, Nishinomiya, Hyogo 663–8501, Japan. email: yama-ns@hyo-med.ac.jp.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Case 1. Anteroposterior (a) and lateral (b) right VA angiograms obtained at admission revealing a dissecting aneurysm (arrow) arising from the right VA distal to the origin of the PICA. Sixteen days later no opacification is observed in the aneurysm or right VA distal to the origin of PICA (arrowhead in c), indicating progression of the dissection. However, both are visualized by the retrograde flow from the left VA (arrow in d). Complete obliteration of the dissecting aneurysm, including the dissected site (arrows), is shown by postembolization right (e) and left (f) VA angiograms.

  • View in gallery

    Case 2. a and b: Right VA angiograms demonstrating a dissecting VA aneurysm distal to the origin of the right PICA (arrows). c and d: No opacification of the dissecting aneurysm, including the dissected site, is seen after embolization (arrows).

  • View in gallery

    Case 3. a and b: Right VA angiograms demonstrating a fusiform dissecting aneurysm of the proximal portion of the PICA (arrows). c and d: Follow-up angiograms obtained 12 months after endovascular treatment revealing complete occlusion of the dissecting aneurysm (arrows) and good filling of the PICA territory through retrograde circulation from the AICA.

References

  • 1.

    Andoh TShirakami SNakashima Tet al: Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:9879931992Andoh T Shirakami S Nakashima T et al: Clinical analysis of a series of vertebral aneurysm cases. Neurosurgery 31:987–993 1992

    • Search Google Scholar
    • Export Citation
  • 2.

    Aoki NSakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:162816311990Aoki N Sakai T: Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631 1990

    • Search Google Scholar
    • Export Citation
  • 3.

    Aymard AGobin YPHodes JEet al: Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms. J Neurosurg 74:3933981991Aymard A Gobin YP Hodes JE et al: Endovascular occlusion of vertebral arteries in the treatment of unclippable vertebrobasilar aneurysms. J Neurosurg 74:393–398 1991

    • Search Google Scholar
    • Export Citation
  • 4.

    Berger MSWilson CB: Intracranial dissecting aneurysms of the posterior circulation. Report of six cases and review of the literature. J Neurosurg 61:8828941984Berger 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
  • 5.

    Ezura MTakahashi AYoshimoto T: [Intravascular neurosurgery for ruptured dissecting vertebral artery aneurysms—angiographical classification and selection of the site of embolization.] Surg Cereb Stroke 21:3553601993 (Jpn)Ezura M Takahashi A Yoshimoto T: [Intravascular neurosurgery for ruptured dissecting vertebral artery aneurysms—angiographical classification and selection of the site of embolization.] Surg Cereb Stroke 21:355–360 1993 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 6.

    Fox AJViñuela FPelz DMet al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40461987Fox AJ Viñuela F Pelz DM et al: Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46 1987

    • Search Google Scholar
    • Export Citation
  • 7.

    Friedman AHDrake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:3253341984Friedman AH Drake CG: Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg 60:325–334 1984

    • Search Google Scholar
    • Export Citation
  • 8.

    Gobin YPViñuela FGurian JHet al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55621996Gobin YP Viñuela F Gurian JH et al: Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 84:55–62 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Guglielmi GViñuela FDion Jet al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8141991Guglielmi G Viñuela F Dion J et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 2: Preliminary clinical experience. J Neurosurg 75:8–14 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Guglielmi GViñuela FSepetka Iet al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis, technique, and experimental results. J Neurosurg 75:171991Guglielmi G Viñuela F Sepetka I et al: Electrothrombosis of saccular aneurysms via endovascular approach. Part 1: Electrochemical basis technique and experimental results. J Neurosurg 75:1–7 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Halbach VVHigashida RTDowd CFet al: Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:1831911993Halbach VV Higashida RT Dowd CF et al: Endovascular treatment of vertebral artery dissections and pseudoaneurysms. J Neurosurg 79:183–191 1993

    • Search Google Scholar
    • Export Citation
  • 12.

    Hodes JEAymard AGobin YPet al: Endovascular occlusion of intracranial vesseles for curative treatment of unclippable aneurysms: report of 16 cases. J Neurosurg 75:6947011991Hodes JE Aymard A Gobin YP et al: Endovascular occlusion of intracranial vesseles for curative treatment of unclippable aneurysms: report of 16 cases. J Neurosurg 75:694–701 1991

    • Search Google Scholar
    • Export Citation
  • 13.

    Hunt WEKosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79891974Hunt WE Kosnik EJ: Timing and perioperative care in intracranial aneurysm surgery. Clin Neurosurg 21:79–89 1974

    • Search Google Scholar
    • Export Citation
  • 14.

    Kitanaka CMorimoto TSasaki Tet al: Rebleeding from vertebral artery dissection after proximal clipping. Case report. J Neurosurg 77: 4664681992Kitanaka C Morimoto T Sasaki T et al: Rebleeding from vertebral artery dissection after proximal clipping. Case report. J Neurosurg 77:466–468 1992

    • Search Google Scholar
    • Export Citation
  • 15.

    Kitanaka TSasaki TEguchi Tet al: Intracranial vertebral artery dissections: clinical, radiological features, and surgical considerations. Neurosurgery 34:6206271994Kitanaka T Sasaki T Eguchi T et al: Intracranial vertebral artery dissections: clinical radiological features and surgical considerations. Neurosurgery 34:620–627 1994

    • Search Google Scholar
    • Export Citation
  • 16.

    Lefkowitz MATeitelbaum GPGiannotta SL: Endovascular treatment of a dissecting posteroinferior cerebellar artery aneurysm: case report. Neurosurgery 39:103610391996Lefkowitz MA Teitelbaum GP Giannotta SL: Endovascular treatment of a dissecting posteroinferior cerebellar artery aneurysm: case report. Neurosurgery 39:1036–1039 1996

    • Search Google Scholar
    • Export Citation
  • 17.

    Levy WJ Jr: Clinical experience with motor and cerebellar evoked potential monitoring. Neurosurgery 20:1691821987Levy WJ Jr: Clinical experience with motor and cerebellar evoked potential monitoring. Neurosurgery 20:169–182 1987

    • Search Google Scholar
    • Export Citation
  • 18.

    Little JRLesser RPLüders H: Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:4214271987Little JR Lesser RP Lüders H: Electrophysiological monitoring during basilar aneurysm operation. Neurosurgery 20:421–427 1987

    • Search Google Scholar
    • Export Citation
  • 19.

    Manz HJLuessenhop AJ: Dissecting aneurysm of intracranial vertebral artery: case report and review of the literature. J Neurol 230:25351983Manz HJ Luessenhop AJ: Dissecting aneurysm of intracranial vertebral artery: case report and review of the literature. J Neurol 230:25–35 1983

    • Search Google Scholar
    • Export Citation
  • 20.

    Mokri BHouser OWSandok BAet al: Spontaneous dissections of the vertebral arteries. Neurology 38:8808851988Mokri B Houser OW Sandok BA et al: Spontaneous dissections of the vertebral arteries. Neurology 38:880–885 1988

    • Search Google Scholar
    • Export Citation
  • 21.

    Nakata MIkeda KTachibana Oet al: [Usefulness of the interlocking detachable coil for the repeatedly ruptured dissecting aneurysm of the vertebral artery in the acute stage.] No Shinkei Geka 25:57601997 (Jpn)Nakata M Ikeda K Tachibana O et al: [Usefulness of the interlocking detachable coil for the repeatedly ruptured dissecting aneurysm of the vertebral artery in the acute stage.] No Shinkei Geka 25:57–60 1997 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 22.

    Nishizawa SNinchoji TRyu Het al: [Angiographic findings of vertebral dissecting aneurysms. Report of two cases and review of literature.] Neurol Med Chir 30:8938981990 (Jpn)Nishizawa S Ninchoji T Ryu H et al: [Angiographic findings of vertebral dissecting aneurysms. Report of two cases and review of literature.] Neurol Med Chir 30:893–898 1990 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 23.

    Sasaki OOgawa HKoike Tet al: A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 75:8748821991Sasaki 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
  • 24.

    Senter HJSarwar M: Nontraumatic dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 56:1281301984Senter HJ Sarwar M: Nontraumatic dissecting aneurysm of the vertebral artery. Case report. J Neurosurg 56:128–130 1984

    • Search Google Scholar
    • Export Citation
  • 25.

    Takahashi ASugawara TSuga Tet al: [Detachable balloon treatment of dissecting vertebral aneurysms in its acute stage of subarachnoid hemorrhage.] Surg Cereb Stroke 17:44481989 (Jpn)Takahashi A Sugawara T Suga T et al: [Detachable balloon treatment of dissecting vertebral aneurysms in its acute stage of subarachnoid hemorrhage.] Surg Cereb Stroke 17:44–48 1989 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 26.

    Takahashi ASuzuki JSugawara Tet al: [Detachable balloon treatment of vertebral fusiform aneurysms.] No Shinkei Geka 16:6396461988 (Jpn)Takahashi A Suzuki J Sugawara T et al: [Detachable balloon treatment of vertebral fusiform aneurysms.] No Shinkei Geka 16:639–646 1988 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 27.

    Tikkakoski TLeinonen SSiniluoto Tet al: Isolated dissecting aneurysm of the left posterior inferior cerebellar artery: endovascular treatment with a Guglielmi detachable coil. AJNR 18:9369381997Tikkakoski T Leinonen S Siniluoto T et al: Isolated dissecting aneurysm of the left posterior inferior cerebellar artery: endovascular treatment with a Guglielmi detachable coil. AJNR 18:936–938 1997

    • Search Google Scholar
    • Export Citation
  • 28.

    Waga SFujimoto KMorooka Y: Dissecting aneurysm of the vertebral artery. Surg Neurol 10:2372391978Waga S Fujimoto K Morooka Y: Dissecting aneurysm of the vertebral artery. Surg Neurol 10:237–239 1978

    • Search Google Scholar
    • Export Citation
  • 29.

    Wilkinson IMS: The vertebral artery. Extracranial and intracranial structure. Arch Neurol 27:3923961972Wilkinson IMS: The vertebral artery. Extracranial and intracranial structure. Arch Neurol 27:392–396 1972

    • Search Google Scholar
    • Export Citation
  • 30.

    Yamaura A: Diagnosis and treatment of vertebral aneurysms. J Neurosurg 69:3453491988Yamaura A: Diagnosis and treatment of vertebral aneurysms. J Neurosurg 69:345–349 1988

    • Search Google Scholar
    • Export Citation
  • 31.

    Yamaura AWatanabe YSaeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:1831881990Yamaura A Watanabe Y Saeki N: Dissecting aneurysms of the intracranial vertebral artery. J Neurosurg 72:183–188 1990

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 113 113 11
Full Text Views 170 131 4
PDF Downloads 97 84 3
EPUB Downloads 0 0 0

PubMed

Google Scholar