Coil embolization for the treatment of ruptured dissecting vertebral aneurysms

BACKGROUND AND PURPOSE: Proximal occlusion of the parent artery has been wi dely used for treatment of vertebral dissecting ruptured aneurysms, but thi s does not always completely prevent rerupture. We retrospectively studied 24 consecutive patients for clinical characteristics and/or for efficacy of occlusion with detachable coils at the site of dissection. METHODS: During a 45-month period, 24 of 242 patients with aneurysms associ ated with subarachnoid hemorrhage had dissecting vertebral aneurysms identi fied at angiography, Eighteen of the 24 patients were treated with platinum coil occlusion at the affected site as early as possible after diagnosis, two patients were treated conservatively, and four others were not eligible for treatment owing to intractable elevation of intracerebral pressure and severe brain stem dysfunction. RESULTS: The rate of aneurysmal rupture in the posterior fossa was high, at 56 (23%) of the 242 aneurysms, including 24 (10%) vertebral dissecting ane urysms. Subsequent rupture occurred in 14 (58%) of the patients, all within 24 hours after the first attack and three during transportation to the hos pital. In all 18 patients, coil embolization at the affected site was succe ssful, with no complications. Radiologic findings showed complete occlusion of the dissection site and patency of the unaffected artery (mean follow-u p, 9 months). Among the six patients who did not undergo embolization, only one survived with a good outcome, the others died of repeat hemorrhage. CONCLUSION: A high rate of vertebral artery dissecting aneurysms may be exp ected in patients with subarachnoid hemorrhage, especially in those with ea rly repeat hemorrhage. Detachable platinum coil embolization may be more ef fective than proximal occlusion for treatment of ruptured vertebral dissect ing aneurysms because of immediate cessation of blood flow to the dissectio n site; however, in patients with bilateral dissections or hypoplastic cont ralateral vertebral arteries, prior bypass surgery or stent placement to pr eserve the artery will be needed.