Ruptured Vertebral Artery Dissection Treated with Endovascular Intervention

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Vertebral artery dissecting aneurysms (VADA) are a significant cause of subarachnoid hemorrhage (SAH).
• Optimal treatment strategies for VADA remain an area of active research.

Purpose of the Study:

• To evaluate the outcomes of endovascular treatment for VADA with SAH.
• To analyze VADA cases based on anatomical patterns and explore potential rupture factors.

Main Methods:

• Retrospective analysis of 11 VADA cases with SAH treated at Ota Memorial Hospital.
• Classification of VADA based on posterior inferior cerebellar artery (PICA) involvement.
• Inclusion of computational fluid dynamics (CFD) analysis in one bilateral VADA case.

Main Results:

• Endovascular treatment was performed in 8 of 11 VADA patients with SAH.
• No postoperative ischemic complications or rebleeding were observed.
• CFD analysis suggested potential rupture factors including wall shear stress and oscillatory shear index.

Conclusions:

• Tailored treatment strategies based on PICA branching patterns can prevent VADA rupture and ischemic complications.
• Predicting rupture in bilateral VADA is crucial for timely and appropriate intervention.