Dissection of the distal vertebral artery treated by modified parent artery trapping and a contralateral stent barricade. A case report

Abstract

Endovascular trapping is the preferred treatment method for a vertebral dissecting aneurysm. We describe a case of ruptured dissecting aneurysms located just proximal to the vertebrobasilar junction treated by trapping the dissecting segment and barricading the basilar artery with a stent to protect against coil protrusion. Modified parent artery trapping with a stent barricade allows preservation of the adjoining confluent zone or side branch during endovascular trapping of the vertebral dissection.

Figure 1

A) Transverse CT scan obtained on the day of admission. Blood is present within the prepontine subarachnoid space. B,C) Oblique view of left vertebral arteriography and AP view of simultaneous bilateral vertebral arteriography reveal dissecting aneurysm arising from the left vertebral artery. The dissecting segment is located just proximal to the vertebrobasilar junction. The distance between the left vertebral artery terminus and the PICA origin is significantly short. D) Left vertebral arteriography demonstrates complete occlusion of the aneurysm with a patent left distal VA. The Markings of stent deployed in right vertebral artery and basilar artery are shown (arrows). E) Right vertebral arteriography reveals excellent blood flow within the right vertebral artery and basilar artery. A stent implant in the right vertebrobasilar junction successfully barricades against coil protrusions in the left vertebral artery.

Figure 1

A) Transverse CT scan obtained on the day of admission. Blood is present within the prepontine subarachnoid space. B,C) Oblique view of left vertebral arteriography and AP view of simultaneous bilateral vertebral arteriography reveal dissecting aneurysm arising from the left vertebral artery. The dissecting segment is located just proximal to the vertebrobasilar junction. The distance between the left vertebral artery terminus and the PICA origin is significantly short. D) Left vertebral arteriography demonstrates complete occlusion of the aneurysm with a patent left distal VA. The Markings of stent deployed in right vertebral artery and basilar artery are shown (arrows). E) Right vertebral arteriography reveals excellent blood flow within the right vertebral artery and basilar artery. A stent implant in the right vertebrobasilar junction successfully barricades against coil protrusions in the left vertebral artery.