We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.
Aneurysm ; Aneurysm, Dissecting ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vertebral Artery Dissection

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.
Aneurysm ; Aneurysm, Dissecting ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vertebral Artery Dissection

The equipment and techniques associated with magnetic resonance imaging (MRI) have rapidly evolved. The development of 3.0 Tesla MRI has enabled high-resolution imaging of the intracranial vessel wall. High-resolution MRI (HRMRI) can yield excellent visualization of both the arterial wall and lumen, thus facilitating the detection of the primary and secondary features of intracranial arterial dissection. In the present report, we describe the manner in which HRMRI affected our endovascular treatment planning strategy in 2 cases with unruptured intracranial vertebral artery dissection aneurysm. HRMRI provides further information about the vessel wall and the lumen of the unruptured intracranial vertebral artery dissecting aneurysm, which was treated by an endovascular approach in the 2 current cases.
Aneurysm ; Aneurysm, Dissecting* ; Magnetic Resonance Imaging* ; Vertebral Artery Dissection ; Vertebral Artery*

The optimal treatment and appropriate follow-up period for an unruptured vertebral artery (VA) and/or posterior inferior cerebellar artery (PICA) dissection have not been established. Decisions regarding treatment of these vascular lesions are usually based on the manifesting symptoms and changes in radiologic findings during the follow-up period. We experienced a patient who had a simultaneous unruptured VA dissection and a contralateral PICA dissecting aneurysm. We did not find such a case in other literature.
Aneurysm, Dissecting ; Arteries ; Follow-Up Studies ; Humans ; Pica ; Vertebral Artery ; Vertebral Artery Dissection

We report two cases of patients with ruptured vertebral artery dissecting aneurysms that were treated using double overlapping stent placement. Angiography performed immediately after the procedure revealed a significant reduction of aneurysmal filling due to the intraaneurysmal thorombosis. In one case, complete disappearance of the lesion was observed after seven days and in the another one, the size of previous aneurysm sac was decreased on 7th post-procedure day. The reduced stent porosity caused by the overlapping stents, which result in significant hemodynamic changes inside aneurysmal sac, may accelerate intraanuerysmal thromobosis and may be helpful in achieving a more rapid complete occlusion of aneurysm. This double stent method may represent a therapeutic alternatives for dissecting vertebral artery aneurysm in which conventional endovascular techniques or stent supported coil embolization is not considered feasible and surgical treatment is contraindicated.
Aneurysm ; Aneurysm, Dissecting* ; Angiography ; Embolization, Therapeutic ; Endovascular Procedures ; Hemodynamics ; Humans ; Porosity ; Stents* ; Vertebral Artery Dissection ; Vertebral Artery*

PURPOSE: This study aimed to find any difference in the clinical or the anatomical findings of vertebral artery dissection (VAD) between the trauma and the non-trauma groups. METHODS: We retrospectively reviewed the clinical data and radiologic images of VAD patients. We compared data on symptoms, neurologic deficit, National institutes of health stroke scale (NIHSS) at admission, Rankin score (RS) at admission and discharge, and radiological findings including anatomical features, between the trauma and the non-trauma groups. RESULTS: From January 1997 to May 2006, 42 patients were enrolled and 13 patients (31%) had a history of earlier trauma. Focal neurologic deficit (trauma group 11/13 vs. non-trauma group 11/29), cerebral stroke (10/13 vs. 9/29), and extradural lesions of dissection (6/13 vs. 3/28) were more common in the trauma group than non-trauma group (p=0.007, p=0.017, p=0.018, respectively) and NIHSS at admission and discharge were significantly higher (p=0.012, p=0.001, respectively). Dissecting aneurysms were less frequent in the trauma group (2/13 vs. 19/29, p=0.006). Subarachnoid hemorrhage and unfavorable prognostic value (Rankin score at discharge> or =2) showed no differences between the groups (p=0.540, p=0.267, respectively). CONCLUSION: In VAD patients after trauma, focal neurologic deficit due to ischemic stroke and a steno-occlusive pattern are more frequent than they are in non-trauma patients. The location of dissection was most frequent at the extradural vertebral artery in the trauma group. NIHSS was higher in the trauma groups but the incidence of an unfavorable prognostic value (RS> or =2) was not significantly different between the groups.
Aneurysm, Dissecting ; Humans ; Incidence ; National Institutes of Health (U.S.) ; Neurologic Manifestations ; Retrospective Studies ; Stroke ; Subarachnoid Hemorrhage ; Vertebral Artery Dissection* ; Vertebral Artery*

OBJECTIVE: The reduced stent porosity caused by a double stent may accelerate the intraaneurysmal thrombosis and be helpful in achieving a more rapid complete occlusion compared with that achieved by single stent placement. This study examined the safety and efficacy of stent angioplasty according to two different stent techniques (single versus double stent placement). METHODS: Twenty two patients who underwent stent angioplasty for vertebral dissections were reviewed retrospectively. RESULTS: In the 22 patients, 23 intracranial vertebral artery dissections were treated using stent placement. Among them, 12 dissections were treated with single stent placement. The immediate and follow-up angiography showed a complete occlusion in only one case(8.3%). Eleven dissections were treated using a double stent method. Although an immediate complete occlusion was performed in only one case, the follow-up angiography revealed a complete occlusion in six cases(54.6%). Complications were encountered in only one case (4.3%, acute thrombosis) in the double stent placement group. On the modified Rankin scale applied in the follow-up, all the patients were assessed as being functionally improved or of a stable clinical status in both groups except for one patient with a severe subarachnoid hemorrhage who underwent a double stent placement. CONCLUSIONS: Intracranial vertebral artery dissections can be treated alternatively using an endovascular method with a stent. Double stent placement is superior to the single stent method. However, there are some limitations and complications associated with stent angioplasty.
Aneurysm, Dissecting ; Angiography ; Angioplasty* ; Follow-Up Studies ; Humans ; Porosity ; Retrospective Studies ; Stents* ; Subarachnoid Hemorrhage ; Thrombosis ; Vertebral Artery ; Vertebral Artery Dissection

No abstract available.
Aneurysm, Dissecting* ; Paraplegia*

OBJECTIVE: Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion for treating intracranial vertebral artery dissections. However, complete aneurysm obliteration after single stent placement is often not accomplished. The aim of the study was to evaluate the safety and efficacy of placing multiple stents in intracranial vertebral dissecting aneurysms. METHODS: We retrospectively reviewed 8 patients who underwent stent angioplasty with placing multiple stents for treating intracranial vertebral dissecting aneurysms. There were 5 male patients and 3 female patients with a mean age of 54 years (age range, 37-71 years). Three patients presented with subarachnoid hemorrhage (SAH), 1 presented with ischemic events and 4 presented with headache. Follow-up angiogram was performed in 8 patients within 6~12 months to determine whether or not the affected segment was occluded. RESULTS: Eight patients with intracranial vertebral artery dissections were treated by placing multiple stents, 6 were treated by double stent placement and the others were treated by triple and quadruple stent placement. Although immediate complete occlusion was not shown in any cases, the follow-up angiogram revealed complete occlusion in 5 cases (62.5%) within 6-12 months. There were 2 complications (25%, temporary vasospasm during the procedure and acute thrombosis). On the modified Rankin scale applied during follow-up, 6 patients were ssessed as functionally improved or of a stable clinical status, 1 patient expired due to cardiopulmonary complications, and 1 was lost to follow-up). CONCLUSION: Intracranial vertebral artery dissections can be treated by the endovascular method with placing multiple stents and the morbidity is acceptable. However, further study is needed since the treatment of patients presenting with SAH using multiple stent placement can be controversial.
Aneurysm ; Aneurysm, Dissecting ; Angioplasty ; Arteries ; Female ; Follow-Up Studies ; Headache ; Humans ; Male ; Parents ; Retrospective Studies ; Stents ; Subarachnoid Hemorrhage ; Vertebral Artery ; Vertebral Artery Dissection

OBJECTIVE: The dissecting aneurysms of vertebral artery with various clinical manifestations have been increasingly reported with recent advent of diagnostic tools such as 3-Dimension computed tomography angiogram, magnetic resonance image and conventional angiogram. The authors analyzed the various treatment modalities according to their clinical presentations of vertebral artery dissecting aneurysms. METHODS: At the author's institution between March 2001 and February 2004, 28 patients were managed under diagnose of vertebral artery dissection. The medical record and neuroimaging studies of patients were reviewed retrospectively. RESULTS: Seven patients were presented with subarchnoid hemorrhage and 2 patients with mass effect. The other 12 patients were presented with ischemic stroke and 7 patients with headache or neck pain. 19 patients were treated with endovascular coils or stent. The other 8 patients were treated conservatively. and one patient was treated with operation. We had no endovascular treatment-related complications. Sixteen patients who underwent endovascular treatment survived with good recovery. but one patient died and 2 patients were in poor neurological status. Among patients with mass effect, one patient was treated with operation. and the other one patient with endovascular coils. We obtained optimal treatment results with improvement of myelopathy in both patients. CONCLUSION: The choice of the treatment of vertebral artery dissecting aneurysm of patients, clinical characteristics, and relation with posterior inferior cererebellar artery. The endovascular treatment using stent with/without coiling could be the treatment of choice if preservation of the vertebral artery is necessory.
Aneurysm, Dissecting* ; Arteries ; Headache ; Hemorrhage ; Humans ; Medical Records ; Neck Pain ; Neuroimaging ; Retrospective Studies ; Spinal Cord Diseases ; Stents ; Stroke ; Vertebral Artery Dissection ; Vertebral Artery*