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Case Reports
. 2015;55(6):524-7.
doi: 10.2176/nmc.cr.2013-0159. Epub 2014 Jan 10.

De Novo Vertebral Artery Dissection after Endovascular Trapping for Ruptured Dissecting Internal Carotid Artery Aneurysm: Case Report

Nobutaka Horie  1 , Eisaku Sadakata, Tsuyoshi Izumo, Kentaro Hayashi, Minoru Morikawa, Izumi Nagata
Affiliations
Case Reports

De Novo Vertebral Artery Dissection after Endovascular Trapping for Ruptured Dissecting Internal Carotid Artery Aneurysm: Case Report

Nobutaka Horie et al. Neurol Med Chir (Tokyo). 2015.

Abstract

The authors present an extremely rare case of a 54-year-old female patient with subarachnoid hemorrhage due to a rupture of a dissecting internal carotid artery (ICA) aneurysm, who developed de novo vertebral artery dissection in the spasm period after endovascular trapping of the ICA. Interestingly, postoperative cardiopulmonary monitoring showed high global end-diastolic volume index and mean arterial pressure, which could contribute to this de novo dissection via hemodynamic stress in the cerebral circulation. Spontaneous intracranial artery dissection of more than two arteries is rare, and we believe this is the first case of de novo dissection occurring on a circulating vessel different from that of the initial dissection. The clinical implications are discussed in relation to postoperative hemodynamic stress with a review of the literature.

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Conflict of interest statement

Conflicts of Interest Disclosure

The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices in the article. All authors who are members of The Japan Neurosurgical Society (JNS) have registered online Self-reported COI Disclosure Statement Forms through the website for JNS members.

Figures

Fig. 1.
Fig. 1.
Computed tomography angiography showing an intimal flap in the right internal carotid artery (ICA, arrow in A). Digital subtraction angiography showing a dissecting aneurysm with a double lumen (arrow in B) and extravasation of the contrast media at the ophthalmic segment of the right ICA (arrow in C). Postoperative angiography showing complete obliteration of the ICA with detachable coils (D).
Fig. 2.
Fig. 2.
Initial magnetic resonance (MR) angiography showing no abnormal findings on the left vertebral artery before the intervention (A), but segmental stenosis detected 1 week after endovascular trapping of the ICA (arrow in B and C). MR imaging showing an intramural hematoma on T1-weighted image (arrow in D). ICA: internal carotid artery.
Fig. 3.
Fig. 3.
Postoperative hemodynamic monitoring using PiCCO (Pulsion Medical Systems, Munich, Germany). Global end-diastolic volume index (A: GEDI; normal range, 680–800 ml/m2) and mean arterial pressure (B) as indicators of preload are high throughout the postoperative period. N.P: not performed.
See this image and copyright information in PMC

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References

    1. Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi JC, Nagata I: Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97: 259– 267, 2002. - PubMed
    1. Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM: Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24: 1421– 1428, 2003. - PMC - PubMed
    1. Inui Y, Oiwa Y, Terada T, Nakakita K, Kamei I, Hayashi S: De novo vertebral artery dissecting aneurysm after contralateral vertebral artery occlusion—two case reports. Neurol Med Chir (Tokyo) 46: 32– 36, 2006. - PubMed
    1. 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. - PubMed
    1. Kubo Y, Miura K, Suzuki M, Tsuiki K, Kuwata N, Kubo N, Kuroda K, Ogawa A: Development of a dissecting aneurysm on the vertebral artery immediately after occlusion of the contralateral vertebral artery: a case report. Neurosurg Rev 21: 177– 180, 1998. - PubMed

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