Outcome of internal trapping for preservation of the posterior inferior cerebellar artery for ruptured vertebral artery dissecting aneurysm

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  • 破裂椎骨動脈解離性動脈瘤に対する後下小脳動脈の温存に努めた血管内治療（internal trapping）の成績
  • ハレツ ツイコツ ドウミャク カイリセイ ドウミャクリュウ ニ タイスル アト カ ショウノウ ドウミャク ノ オンゾン ニ ツトメタ ケッカン ナイ チリョウ(internal trapping)ノ セイセキ

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Abstract

<p>  We investigated the treatment outcomes of internal trapping for preservation of the posterior inferior cerebellar artery (PICA) in cases of a ruptured vertebral artery dissecting aneurysm (rVADA) in 19 consecutive patients (11 men, eight women; 43‒82 years; mean age, 54.7 years) who underwent endovascular treatment for an rVADA during the period January 2004 to June 2018. The preoperative Hunt and Kosnik (H&K) grades were grade III in three cases, IV in ten, and V in six. A positional relationship between the dissection site and PICA bifurcation was observed in seven cases in which the dissection site contained the PICA. The dissection site was distal to the PICA in seven cases and proximal to the PICA in two cases; the PICA was unrecognized in three cases. We performed internal trapping to preserve the PICA, and in the cases with hydrocephalus we performed ventricular or spinal drainage. There were no complications or recurrent bleeding associated with the procedure in any patient. Blood flow in the PICA perfusion area was maintained in 16 cases, and PICA flow was maintained in four of the seven PICA‒involved cases. Outcomes were evaluated based on the modified Rankin scale (mRS) scores at 90 days: score 0 (n＝3 cases), 1 (n＝5), 2 (n＝3), 4 (n＝3), and 6 (n＝5). There were 11 cases (58%) with favorable outcomes (mRS0‒2), and in all the cases, the PICA was preserved or the PICA perfusion area was perfused by the anterior inferior cerebellar artery. The five deaths were severe (H&K grade V) cases. Endovascular treatment for rVADA is useful for preventing recurrent bleeding. Blood flow maintenance in the PICA perfusion area is important for achieving a favorable outcome.</p>

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