Spontaneous intradural
vertebral artery dissections may cause
subarachnoid hemorrhage and often result in devastating damage. Increased use of noninvasive imaging studies has allowed larger numbers of patients to be diagnosed. In addition, intracranial
vertebral artery dissection tends to induce multiple lesions affecting both intracranial vertebral arteries recurrently. Although unruptured dissections in this area usually have a benign nature, some authors have reported on the incidence of
rupture from this lesion. Once
hemorrhage from a dissecting vessel wall has occurred, it needs to be treated in the acute phase because of the high risk of rebleeding resulting in high morbidity and mortality. From December 2004 to July 2010, we managed 47 patients with
spontaneous vertebral artery dissection, 31 patients were ruptured and 16 were unruptured. All patients who suffered from
subarachnoid hemorrhage were treated with
endovascular procedures. Most of the patients with unruptured dissection received medical
therapy, but if the aneurysmal dilatation persisted or grew, surgical interventions were performed. Stenting with or without coils was deployed for 13 patients with posterior inferior cerebellar artery involvement at the site of dissection and/or were affected on the dominant side. In some patients, stenting was performed even if they were in the acute phase. For other ruptured patients, internal coil trappings were performed. Six patients died due to severe initial
subarachnoid hemorrhage and one patient, who underwent
stent deployment with coils for the dominant vertebral artery, with bilateral dissection continuing to the basilar artery died due to rerupture while the next additional coiling was planning. There were two cases of complications related to the intervention. During the follow-up period no
bleeding occurred in any of the patients except for the previously mentioned patient. In conclusion, internal coil trapping or
stent placement with or without coils was effective in preventing rebleeding of ruptured
vertebral artery dissection. If the dissection is unruptured, it is necessary to detect the risk of
bleeding with careful watching and when progress appears to be made, patients should be treated promptly.
Stent-assisted
therapy for preserving the patency of the parent artery and major branches is a promising treatment for
vertebral artery dissection, even in the acute stage of
subarachnoid hemorrhage. However, the risk of acute rerupture and recurrence remains even with the porous
stent placement with or without coils.