Bilateral vertebral artery dissecting aneurysm with subarachnoid hemorrhage treated with staged bilateral vertebral artery coil occlusion: a case report

• Published in: Surgical neurology 2008-09, Vol.70 (3), p.319-322
• Main Authors: Inoue, Akihiro, MD, Kohno, Kanehisa, MD, Takechi, Akihiko, MD, Kohno, Keiji, MD, Matsushige, Toshinori, MD, Takeda, Tetsuji, MD
• Format: Article
• Language: English
• Subjects: Balloon test occlusion; Bilateral vertebral artery dissecting aneurysm; Brain - blood supply; Cerebellopontine Angle - pathology; Cerebellopontine Angle - surgery; Cerebral Angiography; Cerebrovascular Circulation - physiology; Embolization, Therapeutic - instrumentation; Embolization, Therapeutic - methods; Female; Humans; Intracranial Aneurysm - pathology; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - therapy; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Middle Aged; Neurology; Prostheses and Implants - standards; Proximal occlusion; Staged bilateral vertebral artery coil occlusion; Subarachnoid Hemorrhage - pathology; Subarachnoid Hemorrhage - physiopathology; Subarachnoid Hemorrhage - therapy; Surgery; Tomography, X-Ray Computed; Treatment Outcome; Vertebral Artery - diagnostic imaging; Vertebral Artery - pathology; Vertebral Artery Dissection - pathology; Vertebral Artery Dissection - physiopathology; Vertebral Artery Dissection - therapy; Vertebrobasilar Insufficiency - etiology; Vertebrobasilar Insufficiency - physiopathology; Vertebrobasilar Insufficiency - surgery
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2007.04.019

Abstract Background Vertebral artery dissecting aneurysm is now increasingly recognized as a cause of posterior circulation stroke in young adults. Here, we report a case of bilateral VADA with SAH, treated by bilateral coil occlusion using GDCs. Case Description A 64-year-old woman was admitted to our hospital with consciousness disturbance (Hunt and Kosnik: grade 4). Computed tomography showed diffuse SAH with a thick hematoma in the left C-P angle. Magnetic resonance angiography, 3D-CTA, and cerebral angiography revealed bilateral VADAs. First, the ruptured left VADA involving the PICA and a perforating branch was treated by occluding the lower half of the VADA and the proximal VA with GDCs in the acute stage. Thereafter, the residual VADA and contralateral VADA exhibited enlargement on cerebral angiography and MRA for 2 months after the initial surgery; thus, the right VADA was occluded by GDCs just proximal to the right PICA after confirming BTO tolerance. Conclusion Staged bilateral VA coil occlusions combined with BTO may be one of the treatment strategies for bilateral VADA with SAH in cases presenting surgical difficulty due to anatomical factors or severe grade of SAH.