Endovascular and surgical management of vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage: medium-term experience.

INTRODUCTION: Dissecting aneurysms of the vertebral artery are associated with a high incidence of rebleeding and mortality if untreated. Current endovascular alternatives to surgery are being evaluated.
MATERIALS AND METHODS: We conducted a retrospective review of our experience with endovascular as well as surgical treatments of dissecting vertebral artery aneurysms in 6 patients. Three patients were treated with a combination of coils in the proximal artery and aneurysm sac; 1 with a combination of coils and balloon; and 2 with aneurysm clipping surgery. All patients were treated with the primary intention of coil deposition within the aneurysm sac and proximal vertebral artery. No proximal flow arrest was used. Anticoagulation was given during and after the procedure.
RESULTS: Technical success was achieved in all patients, and there was no postprocedural neurological deficit. Follow-up for a mean of 40 months (range, 7 to 64) confirmed the clinical stability of symptoms, as well as the cessation of flow to the aneurysm.
CONCLUSIONS: Endovascular treatment of vertebral artery dissections is a viable alternative to surgery in the appropriate setting. It has the benefit of being minimally invasive, allowing concomitant balloon testing as well as retaining the option to convert to surgery.