Antegrade recanalization of parent artery after internal trapping of ruptured vertebral artery dissecting aneurysm

Abstract

We report a patient with a ruptured vertebral artery (VA) dissecting aneurysm that was treated by internal trapping of the aneurysm and parent artery using detachable coils with subsequent antegrade recanalization of occluded vertebral artery during the follow-up period. A 38-year-old man was admitted with a ruptured right VA dissecting aneurysm just distal to origin of right posterior inferior cerebellar artery. The dissected segment of the VA was occluded by coil embolization. The 14 months follow-up angiography showed that dissected aneurysm was completely occluded, but the parent artery was recanalized in an antegrade fashion. Based on this unique case, the authors suggest that careful angiographic follow-up of dissecting aneurysm is required, even in patients successfully treated with endovascular occlusion of the affected artery and aneurysm.

Keywords: Dissecting aneurysm; Recanalization; Vertebral artery.

Fig. 1

A 38-year-old male patient with dissecting aneurysm. A : CT angiography of right vertebral artery reveals fusiform dissecting aneurysm. B : Coronal CT source image shows low density intimal flap (arrow) and pseudoaneurysm. CT : computed tomography.

Fig. 2

Anteroposterior angiogram of the right vertebral artery shows a dissecting aneurysm arising from the right vertebral artery distal to origin of PICA. PICA : posterior inferior cerebellar artery.

Fig. 3

A : The dissecting aneurysm and affected right vertebral artery are completely occluded, whereas the right PICA is preserved. B : Anteroposterior left VA angiogram obtained after embolization, depicting obliteration of the aneurysm. PICA : posterior inferior cerebellar artery, VA : vertebral artery.

Fig. 4

A : Follow-up angiogram after 14 months reveals recanalization of the occluded right vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery. B : The 3-dimensional reconstruction image shows recanalized vertebral artery which is located just inferior and medial to the deployed coil meshes.