gms | German Medical Science

Objective: Endovascular internal trapping is an effective procedure for the treatment of acute vertebral artery dissection (VAD). However, the results of reconstructive treatment outcomes have not been well established. To evaluate the long-term clinical and angiographic results of endovascular internal trapping or reconstructive treatment of acute VAD.

Method: Between September, 2005 and August, 2013, 26 patients with acute VAD were treated by internal coil trapping (n=10), stent-assisted coiling (n=14), stent only (n=1) and proximal occlusion (n=1) in our hospital. Stent-assisted coiling include modified stent-assisted semi-jailing technique (n=10), balloon-in-stent technique (n=2), coiling followed by balloon mounted stent (n=2). All hemorrhagic type VADs were treated emergently within 12 hours from hospital arrival. All patients except three expired during acute stage were regularly followed-up by digital subtraction angiography (DSA) and clinical examination.

Results: Fourteen patients had hemorrhagic type VAD, and 12 had non-hemorrhagic type acute VAD. Clinical and angiographic follow-up at least 6 months data were obtained from 23 (88.5%) patients. There were 13 male and 13 female with a mean age of 49.5 years (age range, 34-70 years). The dominancy of relevant artery was dominant in 9, even in 12 and non-dominant in 5. All six dominant side ruptured VADs which were failed balloon test occlusion (BTO) and nine non-hemorrhagic type VADs were treated with reconstructive technique. Clinical outcomes were favorable in 22 (84.6%), 1 had severe disability and 3 (11.5%) patients died due to poor initial clinical grade. Follow-up DSA results of 9 internal tapping and 1 proximal occlusion were all stable occlusion state. Among 15 cases of reconstructive treatment, 10 revealed stable occlusion of aneurismal dilatation and patent parent artery. Two developed regrowth of the coiled arterial wall in ruptured cases and successful retreatment was achieved in one patient. One in-stent parent artery occlusion occurred without symptom. There was no recurrent bleeding or ischemic symptom during the follow-up period.

Conclusions: The result of this study have proven that internal trapping is a stable and effective treatment for acute VAD and reconstructive treatment using stent and coils also could be feasible and safe alternative treatment modality even though it was hemorrhage type VAD. But close serial DSA follow-up is mandatory.