Endovascular treatment of dissections and pseudoaneurysms of the vertebral artery. / Tratamento endovascular das dissecções e pseudoaneurismas da artéria vertebral.

AUTOR(ES)
DATA DE PUBLICAÇÃO

1999

RESUMO

Vertebral artery dissections can cause brain ischemia and hemorrhage. Arterial dissection consist of mural tears with subsequent intramural hematoma formation. They may occur either spontaneously or as a consequence of traumatism, in the extracranial or intracranial vertebral artery. The treatment is usually clinical, but in some instances intervention is indicated. The endovascular approach is an important tool, allowing specific treatment of the lesion in some cases, but sacrificing the vertebral artery in most cases. With the aim of analyze the clinical and technical aspects of the endovascular treatment, we studied prospectively 15 patients treated by endovascular approach. Three presented traumatic dissections (all extracranial) and 12 spontaneous dissections, two of which after minor traumatic events. Five patients had extracranial dissections, eight, intracranial and two, combined. In the extracranial dissection group, the main indication for treatment was the presence of an arteriovenous fistula (three of five patients). In the intracranial group, it was subarachnoid hemorrhage. Four patients presenting with brain isquemia were treated because of pseudoaneurysms that did not resolve in clinical treatment. In this group 2 patients had extracranial dissections, one had intracranial and one had both. One patient did not tolerate occlusion and was treated clinically. Fourteen patients were treated by endovascular means, one with selective lesion occlusion, 12 with proximal vertebral artery occlusion and two with proximal and distal vertebral artery occlusion. The embolic material were detachable balloons in 7 patients, platinum microcoils in 6 patients and electrically detachable platinum microcoils and platinum microcoils in one patient. Two patients presented complications, and one presented recurrence of an arteriovenous fistula, all resolved without sequelae. Angiographic controls disclosed total occlusion of the segment with dissection or of the pseudoaneurysm in 9 patients, retrograde flow in 4 and vertebral artery preservation with selective lesion occlusion in 1. During a mean follow-up period of 8,6 months no recurrence was observed. The treatment was efficient in preventing recurrent hemorrhage and promoting pseudoaneurysms thrombosis, besides it was a safe treatment option.

ASSUNTO(S)

aneurisma dissecante/terapia transtornos cerebrovasculares/terapia seguimentos cerebral angiography/methods embolização terapêutica/métodos dissecting aneurysm/therapy hemorragia subaracnóide/etiologia vertebral artery/pathology artéria vertebral/patologia subarachnoid hemorrhage/etiology angiografia cerebral/métodos cerebrovascular disorders/therapy therapeutic embolization/methods

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