Spontaneous resolution of nontraumatic bilateral intracranial vertebral artery dissections

Endovascular Treatment of Intracranial Vertebral Artery Dissecting Aneurysms: Follow up Angiographic and Clinical Results of Endovascular Treatment in Serial Cases

Purpose

To report angiographic and clinical results of endovascular treatment in 45 intracranial vertebral artery dissecting aneurysms (VADAs).

Materials and Methods

From July 2002 to September 2013, a total of 42 patients with 45 VADAs received endovascular treatment. Endovascular treatment consisted of internal trapping with detachable coils, stent-assisted coiling, and stenting only. Immediate and follow-up angiographic findings and clinical outcome were retrospectively reviewed.

Results

There were 17 ruptured VADAs and 28 unruptured VADAs. Overall, 26 VADAs were treated with internal trapping, 14 with stent-assisted coil embolization, and 5 with stenting only. Immediate angiographic results revealed complete occlusion in 31 cases and incomplete occlusion in 14 cases. Follow-up imaging studies were available in 31 cases. On follow-up imaging, antegrade recanalization occurred in 2 of 16 cases treated with internal trapping. Aneurysmal recurrence occurred in one case treated with stent-assisted coiling. Procedural complications occurred in 8 patients. In cases of unruptured VADA, favorable outcome (mRS 0 and 1) was achieved in 26 cases and poor outcome (mRS 2-5) in 2 cases. There was no mortality in patients with unruptured VADAs.

Conclusion

Endovascular treatment of intracranial VADA appears to be safe and effective. Follow-up angiographic study is needed because parent artery recanalization or aneurysmal recurrence can occur.

Subarachnoid haemorrhage with bilateral intracranial vertebral artery dissecting aneurysms treated by staged endovascular stenting

Bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid haemorrhage (SAH) are an exceedingly rare and deadly clinical dilemma. Prompt intervention in the case of unilateral VADAs is advocated to prevent rebleed; however, in the case of bilateral VADAs, the optimal therapeutic intervention is unclear. We describe the case of a patient presenting with SAH with bilateral VADAs treated by staged endovascular stenting. This led to resolution of the aneurysms with patency of both vertebral arteries. Stent-based therapy of the symptomatic aneurysm followed by staged stenting of the asymptomatic, contralateral aneurysm appears to be a viable treatment option. This method allows the ability to preserve flow in both vertebral arteries with minimal changes in flow characteristics that may threaten the contralateral, asymptomatic VADA, and appears to be the ideal treatment in these rare cases.

Basi-parallel anatomical scanning magnetic resonance imaging in patients with bilateral vertebrobasilar artery dissections

A 31-year-old man presented with bilateral unruptured vertebral artery (VA) dissections. The temporal course of the dissected arteries was successively evaluated using brain surface imaging modality basi-parallel anatomical scanning (BPAS) magnetic resonance (MR) imaging in combination with the conventional modalities of MR angiography and three-dimensional computed tomography (3D-CT) angiography. Initially, BPAS-MR imaging clearly demonstrated bilateral fusiform dilatations of the arterial wall, whereas MR angiography and 3D-CT angiography showed irregular, dilated, or interrupted inner contour of the arteries. Finally, BPAS-MR imaging demonstrated resolution of both aneurysms, and MR angiography demonstrated obstruction of the left VA and normal contours of the right VA. Combination of diagnostic tools such as BPAS-MR imaging and MR angiography is useful for evaluating the exact nature of dissected arteries and determining the temporal course.

Spontaneous bilateral carotid and vertebral artery dissections associated with multiple disparate intracranial aneurysms, subarachnoid hemorrhage and spontaneous resolution. Case report and literature review

Spontaneous bilateral carotid and vertebral artery dissections (CADs and VADs) are rare. A 29-year-old female presented with a collapse, 4 weeks after a sudden onset of severe neck and shoulder pain. CT scan revealed diffuse subarachnoid hemorrhage (SAH) and early hydrocephalus. Angiography revealed bilateral CADs and VADs, along with multiple fusiform and saccular aneurysms. Systemic vessels - including the renal arteries - were normal, and no risk factors or underlying vasculopathy were apparent. The presumed source of SAH (a posterior cerebral artery aneurysm) was successfully clipped. Each dissection, by contrast, was managed conservatively with heparin prophylaxis; and spontaneous CAD and VAD resolution occurred within 6 months. We present a unique case of four-vessel dissection associated with multiple disparate saccular and fusiform aneurysms. We suspect that underlying vasculopathy - perhaps novel - may become apparent with time.

Antegrade recanalization of parent artery in internal trapping of vertebral artery dissecting aneurysm: a case report

BACKGROUND

We describe a case involving technical success with internal trapping using controllable detachable coils yet antegrade recanalization of the occluded vertebral artery, in the vertebral artery dissecting aneurysm. Possible explanations for the antegrade recanalization of the occluded vertebral artery and lessons from the case are also discussed.

CASE DESCRIPTION

A 42-year-old woman with a history of stupor (Hunt and Hess grade III) and right vertebral artery dissecting aneurysm, was admitted to our hospital. Endovascular treatment was performed. The dissecting aneurysm and affected right vertebral artery were both completely occluded, whereas the right PICA was preserved. Nine months after the embolization, follow-up angiography was performed, which revealed recanalization of the occluded right vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery. The recanalized vertebral artery was located just superior and lateral to the deployed coil meshes. It was decided that no further intervention was needed. At the last clinical follow-up 15 months after the initial treatment, the patient was fully recovered.

CONCLUSION

Even in the case of technical angiographic success in the endovascular management of a dissecting aneurysm, a prompt follow-up angiography is still crucial. Plus, if the false lumen cannot be separated from the true lumen, treatment with just a stent may not be adequate.