Seminars in Neurosurgery 2000; 11(1): 59-70
DOI: 10.1055/s-2000-11558
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

VESSEL ARTERY DISSECTION AND PSEUDOANEURYSMS: ENDOVASCULAR APPROACHES

Robert A. Willinsky
  • Medical Imaging and Surgery, The University of Toronto, Neuroradiologist, The Toronto Western Hospital, University Health Network, Brain Vascular Malformation Study Group, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
31 December 2000 (online)

 

ABSTRACT

Intracranial dissections are frequently recognized as a cause of stroke and subarachnoid hemorrhage. The posterior circulation is the most common location for these dissections. The purpose of this article is to focus on the presentation and management of vertebral artery and posterior cerebral artery dissections. For patients presenting with stroke anticoagulation is the first line of treatment. For those presenting with a bleed proximal occlusion using endovascular techniques is the treatment of choice. Vertebral artery dissections (VADs) can be treated with either balloons or coils, and early angiographic follow-up is needed to reassess the status of the diseased segment. Trapping by endovascular techniques may be needed in a limited number of these VADs. Posterior cerebral artery dissections presenting with a bleed are best treated using Guglielmi detachable coils to achieve the shortest segment of occlusion.

KEYWORD

Dissecting aneurysm - vertebral artery - posterior cerebral artery - endovascular therapy

REFERENCES

  • 1 Friedman A, Drake C G. Subarachnoid hemorrhage from intracranial dissecting aneurysm.  J Neurosurg . 1984;  60 325-334
    CrossrefPubMedGoogle Scholar
  • 2 Johnson A C, Graves V B, Pfaff Jr P J. Dissecting aneurysm of intracranial arteries.  Surg Neurol . 1977;  7 49-52
    PubMedGoogle Scholar
  • 3 Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T. Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms.  Neurosurgery . 1995;  36 905-911
    CrossrefPubMedGoogle Scholar
  • 4 Nakatomi H, Nagata K, Kawamoto S, Shiokawa Y. Ruptured dissecting aneurysm as a cause of subarachnoid hemorrhage of unverified etiology.  Stroke . 1997;  28 1278-1282
    CrossrefPubMedGoogle Scholar
  • 5 Shimoji T, Bando K, Nakajima K, Ito K. Dissecting aneurysm of the vertebral artery. Report of seven cases and angiographic findings.  J Neurosurg . 1984;  61 1038-1046
    PubMedGoogle Scholar
  • 6 Yamaura A, Watanabe Y, Saeki N. Dissecting aneurysms of the intracranial vertebral artery.  J Neurosurg . 1990;  72 183-188
    CrossrefPubMedGoogle Scholar
  • 7 Yonas H, Agamanolis D, Takaoka Y, White R J. Dissecting intracranial aneurysms.  Surg Neurol . 1977;  8 407-415
    PubMedGoogle Scholar
  • 8 Yoshimoto Y, Wakai S. Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings.  Stroke . 1997;  28 370-374
    PubMedGoogle Scholar
  • 9 Berger M S, Wilson C B. Intracranial dissecting aneurysm of the posterior circulation. Report of six cases and review of the literature.  J Neurosurg . 1984;  61 882-894
    CrossrefPubMedGoogle Scholar
  • 10 Lefkowitz M A, Teitelbaum G P, Giannotta S L. Endovascular treatment of a dissecting posteroinferior cerebelar artery aneurysm: Case report.  Neurosurgery . 1996;  39 1036-1038
    PubMedGoogle Scholar
  • 11 Pozzati E, Andreoli A, Limoni P, Casmiro M. Dissecting aneurysms of the vertebrobasilar system: Study of sixteen cases.  Surg Neurol . 1994;  41 119-124
    CrossrefPubMedGoogle Scholar
  • 12 Shinoda S, Murata H, Waga S, Kojima T. Bilateral spontaneous dissection of the posteroinferior cerebellar arteries: Case report.  Neurosurgery . 1998;  43 357-359
    PubMedGoogle Scholar
  • 13 Pelkonen O, Tikkakoski T, Leinonen S. Intracranial arterial dissection.  Neuroradiology . 1998;  40 442-447
    CrossrefPubMedGoogle Scholar
  • 14 Berthier E, Bourrat C. Dissecting aneurysm of the posterior cerebral artery: Case report and review of the literature.  Cerebrovasc Dis . 1993;  3 56-59
    PubMedGoogle Scholar
  • 15 Lazinski D, Willinsky R A, terBrugge K, Montanera W. Dissecting aneurysms of the posterior cerebral artery: Angioarchitecture and review of the literature.  Neuroradiology. 42 128-133
    PubMedGoogle Scholar
  • 16 Maillo A, Diaz P, Morales F. Dissecting aneurysm of the posterior cerebral artery: Spontaneous resolution.  Neurosurgery . 1991;  29(2) 291-294
    PubMedGoogle Scholar
  • 17 Ishikawa R, Sunagana S, Itoh I, Iwashita K. An experience of dissecting cerebral aneurysm of the anterior cerebral artery.  No Shinkei Geka . 1993;  21 355-359
    PubMedGoogle Scholar
  • 18 Kidooka M, Okada T, Sonobe M, Nakazawa T, Handa J. Dissecting aneurysm of the anterior cerebral artery: Report of two cases.  Surg Neurol . 1993;  39 53-57
    PubMedGoogle Scholar
  • 19 Kunze S, Scheter W. Angiographic demonstration of a dissecting aneurysm of the middle cerebral artery.  Neuroradiology . 1971;  2 201-206
    CrossrefPubMedGoogle Scholar
  • 20 Piepgras D, McGrail K, Tazelaar H. Intracranial dissection of the distal middle cerebral artery as an uncommon cause of distal cerebral artery aneurysm.  J Neurosurg . 1994;  80 909-913
    CrossrefPubMedGoogle Scholar
  • 21 Sasaki O, Koike T, Takeuchi S, Tanaki R. Serial angiography in a spontaneous dissecting anterior cerebral artery aneurysm.  Surg Neurol . 1991;  36 49-53
    PubMedGoogle Scholar
  • 22 Terai S, Matsubara T. A case of dissecting aneurysm involving solely anterior cerebral artery.  Jpn J Stroke . 1991;  13 159-164
    PubMedGoogle Scholar
  • 23 Kitanaka C, Sasaki T, Eguchi T, Teraoka A, Nakane M, Hoya K. Intracranial vertebral artery dissections: Clinical, radiological features, and surgical considerations.  Neurosurgery . 1994;  34 620-626
    PubMedGoogle Scholar
  • 24 Provenzale J M, Morgenlander J C, Gress D. Spontaneous vertebral dissections: Clinical, conventional angiographic, CT and MRI findings.  J Comput Assist Tomogr . 1996;  20 185-193
    CrossrefPubMedGoogle Scholar
  • 25 Schievink W I, Katzmann J A, Piepgras D G. Alpha-1-antitrypsin deficiency in spontaneous intracranial arterial dissections.  Cerebrovasc Dis . 1998;  8 42-44
    PubMedGoogle Scholar
  • 26 Bigelow N H. Intracranial dissecting aneurysms. An analysis of their significance.  Arch Pathol . 1995;  60 271-275
    PubMedGoogle Scholar
  • 27 Endo S, Nishijima M, Nomura H, Takaku A, Okada E. A pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: Report of three autopsied cases and review of the literature.  Neurosurgery . 1993;  33 732-728
    PubMedGoogle Scholar
  • 28 Hart R G, Easton J D. Dissections of cervical and cerebral arteries.  Neurol Clin . 1983;  1 155-182
    PubMedGoogle Scholar
  • 29 Mokri B, Houser O W, Sandok B A, Piepgras D G. Spontaneous dissections of the vertebral arteries.  Neurology . 1988;  38 880-885
    PubMedGoogle Scholar
  • 30 Wilkinson I MS. The vertebral artery: Extracranial and intracranial structure.  Arch Neurol . 1972;  27 392-396
    PubMedGoogle Scholar
  • 31 Schellhas K P, Latchaw R E, Wendling L R, Gold L HA. Vertebrobasilar injuries following cervical manipulation.  JAMA . 1980;  244 1450-1453
    CrossrefPubMedGoogle Scholar
  • 32 Stringer W L, Kelly Jr L D. Traumatic dissection of the extracranial internal carotid artery.  Neurosurgery . 1980;  6 123-130
    CrossrefPubMedGoogle Scholar
  • 33 Manninen H I, Koivisto T, Saari T. Dissecting aneurysms of all four cervicocranial arteries in fibromuscular dysplasia: Treatment with self-expanding endovascular stents, coil embolization, and surgical ligation.  Am J Neuroradiol . 1997;  18 1216-1220
    PubMedGoogle Scholar
  • 34 Halbach V V, Higashida R T, Dowd C F. Endovascular treatment of vertebral artery dissections and pseudoaneurysms.  J Neurosurg . 1993;  79 183-191
    PubMedGoogle Scholar
  • 35 Aoki N, Sakai T. Rebleeding from intracranial dissecting aneurysm in the vertebral artery.  Stroke . 1990;  21 1628-1631
    PubMedGoogle Scholar
  • 36 Sano H, Kato Y, Okuma I. Classification and treatment of vertebral dissecting aneurysm.  Surg Neurol . 1997;  48 598-605
    CrossrefPubMedGoogle Scholar
  • 37 Tsukahara T, Wada H, Satake K. Proximal balloon occlusion for dissecting vertebral aneurysms accompanied by subarachnoid hemorrhage.  Neurosurgery . 1995;  36 914-919
    PubMedGoogle Scholar
  • 38 Yamada K, Hayakawa T, Ushio Y. Therapeutic occlusion of the vertebral artery for unclippable vertebral aneurysm: Relationship between site of occlusion and clinical outcome.  Neurosurgery . 1984;  15 834-838
    PubMedGoogle Scholar
  • 39 Steinberg G, Drake C G, Peerless S J. Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms. Immediate results and long-term outcome in 201 patients.  J Neurosurg . 1993;  79 161-173
    PubMedGoogle Scholar
  • 40 Yamaura I, Tani E, Yokota M. Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Gugliemi detachable coils.  J neurosurg . 1999;  90 853-856
    PubMedGoogle Scholar
  • 41 Yasui T, Sakamoto H, Kishi H, Komiyama M, Iwai Y, Yamanaka K, Nishikawa M. Bilateral dissecting aneurysms of the vertebral arteries resulting in SAH: Case report.  Neurosurgery . 1998;  42 162-164
    PubMedGoogle Scholar
  • 42 Amin-Hanjani S, Ogilvy C S, Buonanno F S. Treatment of dissecting artery aneurysm by flow reversal.  Acta Neurochir . 1997;  139 44-51
    CrossrefPubMedGoogle Scholar
  • 43 Boardman P, Byrne J V. Giant fusiform basilar artery aneurysm: endovascular treatment by flow reversal I the basilar artery.  Br J Radiol . 1998;  71 332-335
    PubMedGoogle Scholar
  • 44 Boulanger T H, Aymand A, Urbain E. Diagnosis and endovascular treatment of midbasilar dissecting aneurysm.  J Belg Radiol . 1996;  79 171-174
    PubMedGoogle Scholar
  • 45 Lylyk P, Cerratto R, Hurvitz D, Basso A. Treatment of a vertebral dissecting aneurysm with stents and coils: Technical case report.  Neurosurgery . 1998;  43 385-3881
    PubMedGoogle Scholar
      >