Endovascular Management of Vertebral Artery Aneurysms

Background: The management outcome of a series of ruptured vertebral artery (VA) aneurysms was reviewed. Method: This is a retrospective study of prospectively collected data of 60 cases with ruptured VA aneurysms in the author’s database from the year 2004. All cases were managed with coiling, stent-assisted coiling, flow diversion or endovascular parent artery sacrifice. Nimodipine and hypertensive, hypervolemic therapy was applied as standard. Outcome was assessed at 6 months with modified Rankin score (mRS). Results: There were 26 females and 34 males. Age range is 18 to 70 with a mean age of 42. There were 27 dissecting aneurysms and 33 saccular aneurysms. 50 (83%) cases were World Federation of Neurological Surgeons (WFNS) grade one to three. There were four WFNS grade four and six WFNS grade five. 25 cases of dissecting aneurysms were managed with parent artery coil occlusion. Two dissecting aneurysms affecting the dominant VA were treated with flow diverters. At 6 months follow up 50 (83%) achieved good outcome with mRS one to two. There were eight cases with poor outcome and two deaths. Six-month follow-up MR angiogram documented stable occlusion for the 24 cases with dissecting aneurysms treated with parent artery coil occlusion who survived. The two treated with flow diversion demonstrated good remodelling at 6 months on angiography. Six-month follow-up angiogram for the 32 cases of saccular aneurysm who survived documented stable aneurysm obliteration. Conclusion: Good outcome can be achieved with endovascular treatment for ruptured VA aneurysms. Parent artery occlusion is a safe and effective technique for ruptured VA dissecting aneurysm.