Successful treatment of bilateral vertebral artery dissecting aneurysms with subarachnoid hemorrhage: report of three cases.

Vertebral artery dissecting aneurysm (VADA) is a relatively rare cause of subarachnoid hemorrhage (SAH). Bilateral VADAs are even rare, and management strategies for this type of VADAs are still controversial. Here, we report 3 cases of bilateral VADAs with SAH. All 3 patients were treated conservatively under strict sedation and blood pressure control during the acute stage. During the course, rebleeding was not observed in any case. One patient underwent trapping of the ruptured VADA on day 28, because this lesion was considered to have a high tendency to rebleed, even in the chronic stage. In the other 2 patients, after conservative treatment, the VADAs spontaneously resolved on the both sides. As for the therapeutic strategy for bilateral VADAs presenting with SAH, at the acute stage, considering the difficulty of bypass surgery, we recommend conservative treatment with sedation and strict control of blood pressure. At the chronic stage, however, when the VADA is still large and growing in size, surgical treatment such as proximal occlusion or trapping of the affected VA with or without distal revascularization should be considered to avoid rebleeding.