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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)
  • 투고 : 2011.08.19
  • 심사 : 2012.03.15
  • 발행 : 2012.03.28

초록

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.

키워드

참고문헌

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피인용 문헌

  1. The Difference of Each Angiographic Finding After Multiple Stent According to Stent Type in Bilateral Vertebral Artery Dissection vol.15, pp.3, 2013, https://doi.org/10.7461/jcen.2013.15.3.229
  2. Are Blood Blister-Like Aneurysms a Specific Type of Dissection? A Comparative Study of Blood Blister-Like Aneurysms and Ruptured Mizutani Type 4 Vertebral Artery Dissections vol.56, pp.5, 2012, https://doi.org/10.3340/jkns.2014.56.5.395
  3. Stent-assisted coil embolisation for bilateral vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage vol.29, pp.6, 2016, https://doi.org/10.1177/1971400916666559
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  5. Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms vol.32, pp.5, 2012, https://doi.org/10.1177/1971400919861406
  6. Treatment of a giant complicated distal posterior inferior cerebellar artery aneurysm: A case report and literature review vol.20, pp.1, 2020, https://doi.org/10.3892/etm.2020.8724
  7. Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience vol.5, pp.3, 2012, https://doi.org/10.1136/svn-2020-000376