The efficacy of coil embolization at the dissection site of ruptured dissecting vertebral aneurysms

Proximal occlusion of the parent artery has been widely used for treatment of vertebral dissecting ruptured aneurysms, but this does not always completely prevent re-rupture. In this series, the efficacy of occlusion at the dissection site using detachable coils was compared with proximal balloon occlusion. Over a five year period, 25 patients suffering from subarachnoid hemorrhage with dissecting vertebral aneurysms were treated by endovascular surgery. The first three of these 25 patients were treated with proximal balloon occlusion of the parent artery. The remainder underwent platinum coil occlusion at the affected site as early as possible after the diagnosis. In two of the three cases treated with proximal balloon occlusion, clipping or coating surgery were added because of progressive dissection. In all 22 cases of coil embolization, the intervention was successfully performed without complication. In one case with a dissection involving bilateral vertebral arteries, minor rebleeding from a contralateral dissection occurred after embolization. In the other 21 cases, rebleeding was not apparent (clinical follow-up: mean 24 months). Radiological findings showed complete occlusion of the dissection site and patency of the non affected artery (follow-up: mean ten months). We conclude that detachable platinum coil embolization at the dissection site is more effective than proximal occlusion for treatment of ruptured vertebral dissecting aneurysms because of immediate cessation of blood flow to the dissection site. However, in cases with bilateral dissections or hypoplastic contralateral vertebral arteries, preceding bypass surgery or stent treatment to preserve the affected vertebral artery may be needed.