The mortality rate after subarachnoid hemorrhage (SAH) due to the rupture of vertebral artery dissecting aneurysms (VADAs) is high; endovascular coil trapping is the first-line therapy to prevent rerupture. For the selection of optimal treatments, the positional relationship between the VADA and posterior inferior cerebellar artery (PICA) and the morphology of the contralateral VA must be considered, and outcome predictors of different treatment methods and their possible complications must be identified.
We retrospectively studied 44 patients with ruptured VADAs; they had undergone endovascular or surgical treatment at our institutes. On conventional preoperative angiograms the VADA morphology was assessed and the VADAs were categorized based on their site vis-à-vis the PICA. We used the VADA site, the treatment method, and complications to identify prognostic factors.
The 44 VADA sites were PICA-proximal (PICA-p, n=3) or distal (PICA-d, n=22); in 7 the PICA was absent (PICA-a) and in 12 patients the PICA was involved (PICA-i). The treatments were internal coil trapping (n=30), proximal coil-occlusion (n=5), and stent (n=3); 6 were subjected to surgical flow alteration via an occipital artery (OA)-PICA bypass and ligation at the proximal VA and the PICA origin. Periprocedural rebleeding was associated with a poor outcome. Internal coil trapping prevented the rerupture of PICA-p and PICA-a aneurysms, as did flow alteration in PICA-i VADAs; there were no complications directly attributable to these procedures.
Periprocedural rebleeding was a poor prognostic factor. Internal trapping of PICA-p and PICA-a aneurysms and flow alteration in PICA-i VADAs prevented rerupture.

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