Fifteen patients of ruptured intracranial vertebrobasilar artery dissection (VBDA) were studied to clarify the clinical problems during treatment. Subsequent rebleeding occurred in 5 of the 15 cases (33.3%) and the mortality rate of patients with rebleeding was 40%. All subsequent rebleeding cases were VBDA of the distal to PICA type. These patients were divided into two groups consisting of a surgical treatment group (chronic stage) with 9 cases and a nonsurgical treatment group with 6 cases. Surgical procedures included proximal occlusion (PO) of the vertebral artery in 7 patients, wrapping in 1 and direct clipping in 1. Postoperative complications occurred in 3 patients by PO. Although proximal occlusion seemed to be a simple and useful method to prevent rebleeding, the occurrence of ischemic complication remains to be solved. Further study is needed to determine the best treatments, including PO for VBDA.
