Han Jinsol, Lim Dong-Jun, Ha Sung-Kon, Choi Jong-Il, Jin Sung-Won, Kim Se-Hoon
Department of Neurosurgery, Korea University Ansan Hospital, Ansan, Korea.
Department of Neurosurgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea.
J Cerebrovasc Endovasc Neurosurg. 2016 Sep;18(3):201-207. doi: 10.7461/jcen.2016.18.3.201. Epub 2016 Sep 30.
Vertebral artery dissecting aneurysms (VADAs) are rare and many debates are present about treatment options. We review types and efficacy of our endovascular treatments and establish a safe endovascular therapeutic strategy regard to the angio-architecture of VADAs.
Between July 2008 and October 2015, we treated 22 patients with symptomatic VADAs. Fifteen patients presented with subarachnoid hemorrhage from the ruptured VADAs, digital subtraction angiography and magnetic resonance image confirmed the diagnosis and endovascular treatments were followed as their angio-architecture.
Clinical results were good in 13 patients (86.7%), and there were no technical problems during endovascular procedures. The other 2 patients with poor prognosis showed severe neurological deficits at the initial evaluation. Among the three different endovascular treatments, there were no radiologic cure in one patient with stent insertion alone, but the patient had no significant clinical symptoms either.
Endovascular treatments are safe and effective treatment option for managing VADAs and can be the first treatment of choice for most patients. To select proper endovascular treatment according to the angio-architecture of VADAs can reduce the risk of the treatment.
椎动脉夹层动脉瘤（VADA）较为罕见，关于其治疗方案存在诸多争议。我们回顾了血管内治疗的类型及疗效，并根据VADA的血管结构制定了安全的血管内治疗策略。
2008年7月至2015年10月期间，我们治疗了22例有症状的VADA患者。15例患者因VADA破裂出现蛛网膜下腔出血，数字减影血管造影和磁共振成像确诊后，根据其血管结构进行了血管内治疗。
13例患者（86.7%）临床结果良好，血管内治疗过程中未出现技术问题。另外2例预后较差的患者在初始评估时即有严重神经功能缺损。在三种不同的血管内治疗方法中，仅接受支架置入的1例患者影像学上未治愈，但该患者也无明显临床症状。
血管内治疗是管理VADA的安全有效治疗选择，对大多数患者而言可作为首选治疗方法。根据VADA的血管结构选择合适的血管内治疗可降低治疗风险。
