Endovascular parent artery coil occlusion for ruptured vertebral artery dissecting aneurysms

Abstract

Background: The outcome of ruptured vertebral artery dissecting aneurysms (VADA) managed with endovascular coil occlusion technique is reviewed. Method: This is a retrospective study of prospectively collected data of 25 cases with ruptured VADA managed by a standardized endovascular parent artery occlusion technique. All cases were treated with coil occlusion of the dilated segment with a short proximal segment of the involved non-dominant or co-dominant vertebral artery within 12 hours of admission. All cases were done under general anesthesia with no anticoagulation. Outcome was assessed clinically with modified Rankin score as well as follow up MRI at 6 months. Results: There were a total of 25 cases, 10 female and 15 males. Age range 18 to 70, mean age 41. Twenty cases (80%) were WFNS grade 1 to 3. Five cases were grade 4 to 5. Treatment complication of cerebellar embolic infarct occurred in one case (4%). There was no hemorrhagic complication post treatment. 16 cases required ventriculoperitoneal shunting. Outcome was good with modified Rankin score of 0 to 2 in 20 cases (80%). There were 5 poor outcomes including one death (4%) due to the primary effect of subarachnoid hemorrhage in a case presenting with WFNS grade 5. All cases with WFNS grade 1 to 3 at presentation obtained good outcome. In all 24 cases who survived, follow up MRI showed that all aneurysms remained occluded at 6 months. Conclusion: Endovascular parent artery coil occlusion is effective and durable for ruptured VADA.