Vertebral Artery Aneurysm: Partially Thrombosed Dissecting Aneurysm, Symptomatic through Brainstem Compression, Treatment with Telescoping Surpass Streamline Flow Diverters
A 57-year-old patient presented with progressive gait ataxia and paresthesia of the upper extremities. CT and MRI revealed a large fusiform aneurysm of the intradural segment of the left vertebral artery (VA), with the right VA only supplying the posterior inferior cerebellar artery (PICA). The aneurysm was partially thrombosed and the aneurysm wall was calcified. A previous dissection was assumed to be the underlying cause of this aneurysm. The aneurysm was treated by the endovascular insertion of two Surpass Streamline (Stryker) flow diverters using a telescoping technique. A DSA carried out three months later confirmed the complete angiographic obliteration of the fusiform vessel dilatation. Significant shrinkage of the thrombosed saccular component did not, however, occur. The calcification of the aneurysm wall and an incomplete hemodynamic isolation of the aneurysm from the parent artery are potential reasons for the aneurysmal mass effect not having reduced. Treating a dissecting aneurysm with flow diversion is often technically easier than stent-assisted coil occlusion. A potential issue after stenting and coil occlusion is a recurrent perfusion of the aneurysm due to the coil compaction, leading to secondary aneurysm growth and coil migration into an intrasaccular thrombus. The use of flow diverters for treating chronic dissecting aneurysms located in the posterior circulation remains controversial. The large number of perforating and branching arteries in the posterior circulation potentially increases the risk involved in flow diversion, exposing patients to thromboembolic complications and a potential brainstem stroke. The main topic of this report is a case in which two flow diverting implants were combined in a large fusiform aneurysm with the expectation of reducing brainstem compression, which has not yet occurred.
KeywordsVertebral artery Fusiform aneurysm Dissection Flow diversion Surpass Streamline
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