• Masaaki Korai, Yasuhisa Kanematsu, Izumi Yamaguchi, Tadashi Yamaguchi, Yuki Yamamoto, Nobuaki Yamamoto, Takeshi Miyamoto, Kenji Shimada, Junichiro Satomi, Mami Hanaoka, Kazuhito Matsuzaki, Koichi Satoh, and Yasushi Takagi.
• Department of Neurosurgery, Tokushima University, Tokushima, Japan. Electronic address: komakun@gmail.com.
• World Neurosurg. 2021 Aug 1; 152: e86-e93.

BackgroundMortality rate after subarachnoid hemorrhage due to rupture of vertebral artery dissecting aneurysms (VADAs) is high; endovascular coil trapping is the first-line therapy to prevent rerupture. To select optimal treatments, the positional relationship between the VADA and posterior inferior cerebellar artery (PICA) and the morphology of the contralateral vertebral artery must be considered, and outcome predictors of different treatment methods and their possible complications must be identified.MethodsWe retrospectively studied 44 patients with ruptured VADAs who had undergone endovascular or surgical treatment. VADA morphology was assessed on conventional preoperative angiograms, and VADAs were categorized based on their site in relation to the PICA. VADA site, treatment method, and complications were used to identify prognostic factors.ResultsThe sites of the 44 VADAs were PICA-proximal (n = 3), PICA-distal (n = 22), PICA-absent (n = 7), and PICA-involved (n = 12). Treatments included internal coil trapping (n = 30), proximal coil occlusion (n = 5), and stent placement (n = 3); surgical flow alteration via an occipital artery-PICA bypass and ligation at the proximal vertebral artery and the PICA origin was performed in 6 patients. Periprocedural rebleeding was associated with a poor outcome. Internal coil trapping prevented the rerupture of PICA-proximal and PICA-absent VADAs, and flow alteration prevented rerupture of PICA-involved VADAs; there were no complications directly attributable to these procedures.ConclusionsPeriprocedural rebleeding was a poor prognostic factor. Internal trapping of PICA-proximal and PICA-absent VADAs and flow alteration in PICA-involved VADAs prevented rerupture.Copyright © 2021 Elsevier Inc. All rights reserved.

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