Zhao Wen-Yuan, Zhao Kai-Jun, Huang Qing-Hai, Xu Yi, Hong Bo, Liu Jian-Min
Changhai Hospital, Second Military Medical University Shanghai, China.
Changhai Hospital, Second Military Medical University Shanghai, China
Interv Neuroradiol. 2016 Apr;22(2):138-42. doi: 10.1177/1591019915617325. Epub 2015 Dec 18.
Treatment of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage remains challenging as bilateral deconstructive procedures may not be feasible. In this case series, we describe our approach to their management and review the pertinent literature.
A retrospective review of our prospectively collected database on aneurysms was performed to identify all patients with acute subarachnoid hemorrhage in the setting of bilateral intradural vertebral artery dissections (VAD) encompassing a period from January 2000 and March 2012.
Four patients (M/F = 2/2; mean age, 51.5 years) were identified. In two cases the site of rupture could be identified by angiographic and cross-sectional features; in these patients deconstructive treatment (proximal obliteration or trapping) of the ruptured site and reconstructive treatment of the unruptured site (using stents and coils) were performed. In the patients in whom the site of hemorrhage could not be determined, bilateral reconstructive treatment was performed. No treatment-related complications were encountered. Modified Rankin scale scores were 0-1 at discharge, and on follow-up (mean 63 months), no recurrence, in-stent thrombosis or new neurological deficits were encountered.
We believe that single-stage treatment in patients with bilateral VAD is indicated: If the site of hemorrhage can be determined, we prefer deconstructive treatment on the affected site and reconstructive treatment on the non-affected site to prevent increased hemodynamic stress on the unruptured but diseased wall. If the site of dissection cannot be determined, we prefer bilateral reconstructive treatment to avoid increasing hemodynamic stress on the potentially untreated acute hemorrhagic dissection.
双侧椎动脉夹层动脉瘤伴蛛网膜下腔出血的治疗仍然具有挑战性，因为双侧解构性手术可能不可行。在本病例系列中，我们描述了我们的治疗方法并回顾了相关文献。
对我们前瞻性收集的动脉瘤数据库进行回顾性分析，以确定2000年1月至2012年3月期间所有患有双侧硬脊膜内椎动脉夹层（VAD）并伴有急性蛛网膜下腔出血的患者。
共确定4例患者（男/女 = 2/2；平均年龄51.5岁）。在2例中，通过血管造影和横断面特征可确定破裂部位；对这些患者，对破裂部位进行解构性治疗（近端闭塞或包裹），对未破裂部位进行重建性治疗（使用支架和弹簧圈）。对于无法确定出血部位的患者，进行双侧重建性治疗。未遇到与治疗相关的并发症。出院时改良Rankin量表评分为0 - 1分，随访（平均63个月）时，未发现复发、支架内血栓形成或新的神经功能缺损。
我们认为双侧VAD患者适合进行一期治疗：如果能确定出血部位，我们倾向于对患侧进行解构性治疗，对未患侧进行重建性治疗，以防止未破裂但病变的血管壁上血流动力学压力增加。如果无法确定夹层部位，我们倾向于进行双侧重建性治疗，以避免增加潜在未治疗的急性出血性夹层的血流动力学压力。
