• Yu Otaki, Takuro Nagano, Futoshi Saito, and Hiroyuki Yaoita.
• Department of Neurosurgery, Ota Memorial Hospital, Ota, Gunma, Japan; Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. Electronic address: m12201021@gunma-u.ac.jp.
• World Neurosurg. 2024 Sep 1; 189: e162e167e162-e167.

ObjectiveA retrospective study of cases of endovascular treatment of dissection of the vertebral artery with subarachnoid hemorrhage was conducted.Material And MethodsData were 11 cases of vertebral artery dissecting aneurysm (VADA) among 291 consecutive subarachnoid hemorrhage patients who underwent clipping or endovascular treatment at Ota Memorial Hospital. Classified into 4 patterns based on the location of the dissection and posterior inferior cerebellar artery (PICA): pre-PICA, post-PICA, involved PICA, and non-PICA. And one of the cases had bilateral vertebral artery dissection, and computational fluid dynamics analysis was included in the study.ResultsRuptured VADA occurred in 11 of the 291 patients (3.8%). Endovascular treatment was performed in 8 of these 11 patients. Postoperative diffusion-weighted imaging detected no high-intensity lesions and no postoperative ischemic complications or rebleeding occurred in any patient. In a case of bilateral VADA, computational fluid dynamics analysis of very low or high wall shear stress at the dissection, low aneurysm formation indicator, and high oscillatory shear index may be considered rupture factors.ConclusionsTreatment strategies for each branching pattern of PICA can prevent rupture and avoid ischemic complications. And prediction of the rupture side is important in patients with bilateral dissection to consider the appropriate treatment and timing.Copyright © 2024 Elsevier Inc. All rights reserved.

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