Vertebral Artery Aneurysm: Acute Subarachnoid Hemorrhage Due to a Dissecting V4 Aneurysm, Treatment with a Flow Diverter Stent, and Complete Reconstruction of the Vessel Lumen
We describe the clinical course, radiological findings, and endovascular treatment of a 58-year-old male patient who presented with headache due to a minor subarachnoid hemorrhage (SAH) resulting from a dissecting aneurysm of the intradural segment (V4) of the right vertebral artery. The aneurysm was treated on day seven after the onset of the headache by means of flow diversion with complete obliteration on the angiographic follow-up studies. The affected segment of the vertebral artery was reconstructed, and the posterior inferior cerebellar artery (PICA), which was covered by the flow diverter, remained patent. There was no recurrent hemorrhage, and the patient was asymptomatic apart from headache and neck stiffness during the follow-up period. The use of flow diversion in the setting of acute SAH due to intracranial arterial dissection is the main topic of this case report.
KeywordsDissecting aneurysm SAH Flow diverter Vertebrobasilar aneurysm
- Bhogal P, Pérez MA, Ganslandt O, Bäzner H, Henkes H, Fischer S. Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients. J Neurointerv Surg. 2017a;9(5):471–81. https://doi.org/10.1136/neurintsurg-2016-012781.CrossRefPubMedGoogle Scholar
- Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, Henkes H. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–82. https://doi.org/10.1007/s00234-011-0948-x.CrossRefPubMedGoogle Scholar
- Kung DK, Policeni BA, Capuano AW, Rossen JD, Jabbour PM, Torner JC, Howard MA, Hasan D. Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg. 2011;114(4):1021–7. https://doi.org/10.3171/2010.9.JNS10445.CrossRefPubMedGoogle Scholar