![]() Additionally, it is uncommon for a dissecting aneurysm to resolve spontaneously or with medical treatment only, as sometimes seen with arterial dissections. ![]() The high rate of re-bleeding among patients treated conservatively argues for treatment in the acute phase. Dissecting aneurysms pose a great challenge to both surgical and endovascular treatments due to their location and anatomic configuration. They are significantly less frequent than saccular lesions but usually more difficult to treat, with a devastating natural history and up to 80% mortality in 5 years if left untreated. ĭissecting aneurysms of the intracranial circulation are uncommon, accounting for 3% of all cerebral aneurysms. MR imaging techniques may sometimes replace the conventional angiography in diagnosis of arterial dissections, due to good resolution nowadays and actual demonstration of the intramural hematoma. Classical findings are pearl-and-string sign, double lumen, or a simple fusiform dilatation, in addition to a delayed clearance of the dilatation or a false lumen. The gold standard in vascular imaging is still represented by the digital subtraction angiography (DSA). A re-bleeding rate of more than 40% within the first 24 h has been reported. The hemorrhagic presentations occur in 20% of internal carotid artery dissections and 50% of vertebral artery dissections. The absence of an external elastic membrane and the presence of thin muscular and adventitial layers make intracranial arteries potentially prone to sub-adventitial dissection and subsequent subarachnoid hemorrhage. Conclusionsīoth endovascular approaches, whether parent artery occlusion or artery preserving technique showed favorable outcome which indicates the safety and efficacy of both approaches if selected properly according to the morphology of the aneurysm.Īrterial dissections are characterized by the sudden disruption of the endothelium, the intima, and the internal elastic lamina with subsequent penetration of circulating blood into the media resulting into arterial narrowing or occlusion with consequent ischemic sequelae or resulting into sub-adventitial aneurysmal formation with possible consequent hemorrhagic event that may occur in children, young and middle-aged adults. ![]() Finally, after six months reassessment with angiography showed that 89.5% of patients had stable aneurysmal occlusion, and 10.5% had recurrence of aneurysm. After three months we found an overall improvement of the clinical outcome, as 57.9% of patients had no disability (mRS = 0), 26.3% had no significant disability (mRS = 1) and 15.8% had mild disability (mRS = 2). One week after the intervention 26.3% of patients had no disability (mRS = 0), 47.4% had no significant disability (mRS = 1), 15.8% had slight disability (mRS = 2) and 10.5% had moderate to severe disability (mRS = 3–4). Among the nineteen patients, 11 cases were treated by parent artery occlusion representing 57.9% of the cases, and 7 cases (36.8%) were treated by artery preserving technique, and only one case (5.3%) was treated by combination of parent artery occlusion and artery preserving technique. Resultsīetween January 2017 and July 2019, 19 patients presenting with intracranial dissecting aneurysms were referred to our department for endovascular treatment. Hence the management of dissecting aneurysms remain challenging. However, the usage of stent with recently ruptured aneurysms is always perplexing due to the necessity of dual antiplatelet administration. In situations in which parent artery preservation is mandatory, the use of stent-assisted techniques may be the most appropriate choice (de Barros Faria et al. Nevertheless, in absence of efficient collateral pathways, the deconstructive technique carries an ischemic risk. Therefore, deconstructive modalities of treatment like trapping or parent vessel occlusion, performed either surgically or endovascularly, have predominated for managing those lesions, usually with good results. On the other hand, recanalization after coiling alone is almost certain. Due to its dissecting nature, wall friability can make surgical clipping difficult and even risky. Deconstructive techniques sacrifice the parent artery, whereas reconstructive techniques aim to maintain a parent artery (Stéphanie et al. All treatment methods aim to reduce the blood flow in the dissected region. Various surgical and endovascular treatment methods have been proposed for intracranial dissecting aneurysms. This is a well-known cause of stroke and subarachnoid hemorrhage in young and middle-aged patients (Santos-Franco et al. The annual incidence of the intracranial dissecting aneurysms is about 1 to 1.5 per 100,000.
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