Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Bilateral Vertebral Artery Dissecting Aneurysms Presenting with Subarachnoid Hemorrhage Treated by Staged Coil Trapping and Covered Stents Graft

  • Yoon, Seok-Mann (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Shim, Jai-Joon (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) ;
  • Kim, Sung-Ho (Department of Neurosurgery, Soonchunhyang University Gumi Hospital) ;
  • Chang, Jae-Chil (Department of Neurosurgery, Soonchunhyang University Hospital)
  • Received : 2011.08.19
  • Accepted : 2012.03.15
  • Published : 2012.03.28
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Abstract

The treatment of bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid hemorrhage (SAH) is still challenging. The authors report a rare case of bilateral VADA treated with coil trapping of ruptured VADA and covered stents implantation after multiple unsuccessful stent assisted coiling of the contralateral unruptured VADA. A 44-year-old woman was admitted to our hospital because of severe headache and sudden stuporous consciousness. Brain CT showed thick SAH and intraventricular hemorrhage. Cerebral angiography demonstrated bilateral VADA. Based on the SAH pattern and aneurysm configurations, the right VADA was considered ruptured. This was trapped with endovascular coils without difficulty. One month later, the contralateral unruptured VADA was protected using a stent-within-a-stent technique, but marked enlargement of the left VADA was detected by 8-months follow-up angiography. Subsequently two times coil packing for pseudosacs resulted in near complete occlusion of left VADA. However, it continued to grow. Covered stents graft below the posterior inferior cerebellar artery (PICA) origin and a coronary stent implantation across the origin of the PICA resulted in near complete obliteration of the VADA. Covered stent graft can be used as a last therapeutic option for the management of VADA, which requires absolute preservation of VA flow.

Keywords

References

  1. Ahn JY, Han IB, Kim TG, Yoon PH, Lee YJ, Lee BH, et al. : Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling. AJNR Am J Neuroradiol 27 : 1514-1520, 2006
  2. Ding H, He M, You C, Deng L : [Application of endovascular covered stent for treating vertebral dissecting aneurysm and carotid-cavernous fistula]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 23 : 215-218, 2009
  3. He M, Zhang H, Lei D, Mao BY, You C, Xie XD, et al. : Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms. J Neurosurg 110 : 418-426, 2009 https://doi.org/10.3171/2008.3.17470
  4. Inoue A, Kohno K, Takechi A, Kohno K, Matsushige T, Takeda T : Bilateral vertebral artery dissecting aneurysm with subarachnoid hemorrhage treated with staged bilateral vertebral artery coil occlusion : a case report. Surg Neurol 70 : 319-322; discussion 322, 2008 https://doi.org/10.1016/j.surneu.2007.04.019
  5. Katsuno M, Mizunari T, Kobayashi S, Takahashi H, Teramoto A : Rupture of a vertebral artery dissecting aneurysm developing immediately after trapping of a dissecting aneurysm on the contralateral vertebral artery : case report. Neurol Med Chir (Tokyo) 49 : 468-470, 2009 https://doi.org/10.2176/nmc.49.468
  6. Koh JS, Ryu CW, Lee SH, Bang JS, Kim GK : Bilateral vertebral-artery-dissecting aneurysm causing subarachnoid hemorrhage cured by staged endovascular reconstruction after occlusion. Cerebrovasc Dis 27 : 202-204, 2009 https://doi.org/10.1159/000193464
  7. Lieber BB, Stancampiano AP, Wakhloo AK : Alteration of hemodynamics in aneurysm models by stenting : influence of stent porosity. Ann Biomed Eng 25 : 460-469, 1997 https://doi.org/10.1007/BF02684187
  8. Lylyk P, Cohen JE, Ceratto R, Ferrario A, Miranda C : Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils. J Neurosurg 94 : 427-432, 2001 https://doi.org/10.3171/jns.2001.94.3.0427
  9. Matsumoto K, Akagi K, Abekura M, Sakaguchi T : Obliteration of bilateral dissecting aneurysms of the vertebral arteries following repeated subarachnoid hemorrhage : a case report. Neurol Res 24 : 837-841, 2002 https://doi.org/10.1179/016164102101200825
  10. Nashimoto T, Komata T, Honma J, Yamashita S, Seki Y, Kurashima A, et al. : Successful treatment of bilateral vertebral artery dissecting aneurysms with subarachnoid hemorrhage : report of three cases. J Stroke Cerebrovasc Dis : 2010 in press
  11. Otawara Y, Ogasawara K, Ogawa A, Kogure T : Dissecting aneurysms of the bilateral vertebral arteries with subarachnoid hemorrhage : report of three cases. Neurosurgery 50 : 1372-1374; discussion 1374-1375, 2002
  12. Park SI, Kim BM, Kim DI, Shin YS, Suh SH, Chung EC, et al. : Clinical and angiographic follow-up of stent-only therapy for acute intracranial vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 30 : 1351-1356, 2009 https://doi.org/10.3174/ajnr.A1561
  13. Redekop G, Marotta T, Weill A : Treatment of traumatic aneurysms and arteriovenous fistulas of the skull base by using endovascular stents. J Neurosurg 95 : 412-419, 2001 https://doi.org/10.3171/jns.2001.95.3.0412
  14. Redekop G, TerBrugge K, Willinsky R : Subarachnoid hemorrhage from vertebrobasilar dissecting aneurysm treated with staged bilateral vertebral artery occlusion : the importance of early follow-up angiography : technical case report. Neurosurgery 45 : 1258-1262; discussion 1262-1263, 1999 https://doi.org/10.1097/00006123-199911000-00056
  15. Sakamoto S, Ohba S, Shibukawa M, Kiura Y, Okazaki T, Arita K, et al. : Staged bilateral vertebral artery occlusion for ruptured dissecting aneurysms of the basilar artery : a report of 2 cases. Surg Neurol 64 : 456-461; discussion 461, 2005 https://doi.org/10.1016/j.surneu.2005.01.021
  16. Somekawa K, Nagata K, Kawamoto S, Furuya H, Tanioka D, Isoo A : [Treatment for the ruptured bilateral vertebral dissecting aneurysms]. No Shinkei Geka 30 : 321-325, 2002
  17. Stone GW, Goldberg S, O'Shaughnessy C, Midei M, Siegel RM, Cristea E, et al. : 5-year follow-up of polytetrafluoroethylene-covered stents compared with bare-metal stents in aortocoronary saphenous vein grafts the randomized BARRICADE (barrier approach to restenosis : restrict intima to curtail adverse events) trial. JACC Cardiovasc Interv 4 : 300-309, 2011 https://doi.org/10.1016/j.jcin.2010.11.013
  18. Suh SH, Kim BM, Park SI, Kim DI, Shin YS, Kim EJ, et al. : Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery. Clinical article. J Neurosurg 111 : 48-52, 2009 https://doi.org/10.3171/2009.2.JNS081418
  19. Yoon WK, Kim YW, Kim SR, Park IS, Kim SD, Jo KW, et al. : Angiographic and clinical outcomes of stent-alone treatment for spontaneous vertebrobasilar dissecting aneurysm. Acta Neurochir (Wien) 152 : 1477-1486; discussion 1486, 2010 https://doi.org/10.1007/s00701-010-0693-7
  20. Zenteno MA, Santos-Franco JA, Freitas-Modenesi JM, Gómez C, Murillo-Bonilla L, Aburto-Murrieta Y, et al. : Use of the sole stenting technique for the management of aneurysms in the posterior circulation in a prospective series of 20 patients. J Neurosurg 108 : 1104-1118, 2008 https://doi.org/10.3171/JNS/2008/108/6/1104

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