Endovascular treatment of ruptured vertebral dissecting aneurysms with electrodetachable coils

Ruptured intradural vertebral dissecting aneurysm (VDA) is associated with a high risk of rebleeding and a high incidence of mortality if left untreated because of its natural history. We report our experience of endovascular treatment of ruptured VDAs using electrodetachable coils.

Over 7 years, 10 patients with spontaneously ruptured intradural VDAs were managed by endovascular embolization in our institute. All patients received endovascular trapping of the dissecting aneurysm and proximal occlusion by electrodetachable coils.

There were 5 men and 5 women, with a mean age of 48 years. Of the 10 VDAs, 8 were located in the supra-posterior inferior cerebellar artery (PICA) area, and 2 were in the infra-PICA area. Six affected vertebral arteries were dominant (n = 3) or co-dominant (n = 3) in the vertebrobasilar system. Nine ruptured VDAs and their parent arteries were successfully occluded by a single session of endovascular embolization by electrodetachable coils. In the tenth patient, the dissecting aneurysm showed subtotal occlusion because of involvement of the vertebrobasilar junction. The mean number and coil length were 7 and 58 cm, respectively. There were no significant periprocedural complications or recurrent bleeding. All patients demonstrated good clinical recovery (n = 9) or improvement (n = 1) after embolization over a mean follow-up of 15 months (range, 6-24 months).

Endovascular embolization is a useful and safe method in the treatment of ruptured VDAs even when the affected vertebral arteries are dominant or co-dominant in vertebrobasilar flow. Trapping procedures and direct occlusion of the dissecting segment with preservation of the PICA by detachable coils should be performed as early as possible in the management of VDAs.