Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jan;67(1):115-121.
doi: 10.3340/jkns.2022.0263. Epub 2023 May 4.

De Novo Vertebral Artery Dissecting Aneurysm after Parent Artery Occlusion of the Contralateral Vertebral Artery

Yuichiro Tsuji  1 , Sho Murase  2 , Yuzo Kuroda  1 , Masahiko Wanibuchi  3
Affiliations
Case Reports

De Novo Vertebral Artery Dissecting Aneurysm after Parent Artery Occlusion of the Contralateral Vertebral Artery

Yuichiro Tsuji et al. J Korean Neurosurg Soc. 2024 Jan.

Abstract

After treatment of unilateral vertebral artery dissecting aneurysm (VADA), de novo VADA rarely occurs on the contralateral side. In this article, we report a case of subarachnoid hemorrhage (SAH) due to de novo VADA in the contralateral vertebral artery (VA) 3 years after parent artery occlusion of unilateral VADA, with a review of the literature. A 47-year-old woman was admitted to our hospital complaining of headache and impaired consciousness. Head computed tomography showed SAH, and three-dimensional computed tomography angiography showed a fusiform aneurysm in the left VA. We performed an emergency parent artery occlusion. Three years and 3 months after the initial treatment, the patient presented to our hospital with complaints of headache and neck pain. Magnetic resonance imaging revealed SAH, and magnetic resonance angiography revealed de novo VADA in the right VA. We performed a stent-assisted coil embolization. The patient had a good postoperative course and was discharged with a modified Rankin scale score of 0. Long-term follow-up is necessary in patients with VADA because contralateral de novo VADA can develop even several years after the initial treatment.

Keywords: Dissecting vertebral artery aneurysm; Embolization; Subarachnoid hemorrhage.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
A : Brain computed tomography (CT) scan shows diffuse subarachnoid hemorrhage in the prepontine cistern. B : Three-dimensional CT angiography demonstrates a fusiform aneurysm of the left vertebral artery (VA). C : Left vertebral angiography shows a fusiform dilatation of the left VA. D : Parent artery occlusion for left vertebral artery dissecting aneurysm is performed. E : Right vertebral angiography shows the left posterior inferior cerebellar artery patency after parent artery occlusion. F : Magnetic resonance imaging shows diffusion-weighted imaging high intensity area in bilateral cerebellar hemisphere.
Fig. 2.
Fig. 2.
A : Magnetic resonance angiography 2 months postoperatively shows no dilatation in the right vertebral artery (VA). B : Follow-up digital subtraction angiography performed 16 months postoperatively shows no dilatation of the right VA. C : Magnetic resonance angiography 3 years after the procedure shows no abnormal findings in the right VA.
Fig. 3.
Fig. 3.
A : Fluid attenuated inversion recovery image on admission shows subarachnoid hemorrhage in the prepontine cistern. B : Magnetic resonance angiography reveals dilatation of the right vertebral artery (VA), indicating a VA dissecting aneurysm. C : Right vertebral angiography reveals de novo vertebral artery dissecting aneurysm (VADA). D : After stent-assisted coil embolization of the right VADA, the right vertebral angiography demonstrates occlusion of the aneurysm dilatation. E : Coil embolization with low-profile visualized intraluminal supprt blue stent (MicroVention, Tustin, CA, USA) is performed. F : Diffusion-weighted imaging reveals no high-intensity area.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Cho DY, Choi JH, Kim BS, Shin YS. Comparison of clinical and radiologic outcomes of diverse endovascular treatments in vertebral artery dissecting aneurysm involving the origin of PICA. World Neurosurg. 2019;121:e22–e31. - PubMed
    1. Chung J, Kim BS, Lee D, Kim TH, Shin YS. Vertebral artery occlusion with vertebral artery-to-posterior inferior cerebellar artery stenting for preservation of the PICA in treating ruptured vertebral artery dissection. Acta Neurochir (Wien) 2010;152:1489–1492. - PubMed
    1. Endo H, Matsumoto Y, Kondo R, Sato K, Fujimura M, Inoue T, et al. Medullary infarction as a poor prognostic factor after internal coil trapping of a ruptured vertebral artery dissection. J Neurosurg. 2013;118:131–139. - PubMed
    1. Fukunaga A, Tabuse M, Naritaka H, Nakamura T, Akiyama T. Spontaneous resolution of nontraumatic bilateral intracranial vertebral artery dissections. Neurol Med Chir (Tokyo) 2002;42:491–495. - PubMed
    1. Guan J, Li G, Kong X, He C, Long J, Qin H, et al. Endovascular treatment for ruptured and unruptured vertebral artery dissecting aneurysms: a meta-analysis. J Neurointerv Surg. 2017;9:558–563. - PubMed

Publication types

LinkOut - more resources