Rapidly evolving large extracranial vertebral artery pseudoaneurysm in Behçet's disease: Case report and review of the literature

Successful Endovascular Trapping for Symptomatic Thrombosed Giant Unruptured Aneurysms of the V1 and V2 Segments of the Vertebral Artery: Case Report and Literature Review

A thrombosed giant aneurysm of the V1 and V2 segments of the vertebral artery (VA) is rare. Therefore, there is controversy regarding its optimal treatment. A case of a symptomatic giant VA aneurysm located in the V1 to V2 segments on the left treated successfully by endovascular trapping of the VA is reported. A 68-year-old woman presented with swelling in the left anterior neck. Computed tomography angiography (CTA) showed a giant aneurysm measuring 47 × 58 × 47 mm³ in the left neck. Ten days after her first visit, she presented with sudden onset of left anterior neck pain. Repeated CTA showed a partial thrombus in the aneurysm. Angiography showed two thrombosed giant aneurysms located in the V1 to V2 segments of the left VA. After endovascular trapping for the aneurysms, the anterior neck pain resolved and the aneurysm gradually shrank. This case demonstrates that endovascular surgery is better than open surgery because it is less invasive. When performing endovascular treatment, trapping will be an alternative strategy for a symptomatic giant thrombotic aneurysm of the V1 and V2 segments of the VA if the patient can tolerate ischemia.

Flow Diverter for the Treatment of Pseudoaneurysms of the Extracraneal Vertebral Artery: Report of Two Cases and Review of the Literature

BACKGROUND

Pseudoaneurysms (PAs) of the extracranial vertebral artery (VA) are rare lesions, representing less than 1% of all aneurysms. Although these lesions may resolve spontaneously, they present a high rupture rate, so early preventive treatment is advised.

CASE DESCRIPTION

Case 1: A 48-year-old woman presented with pain and cervical rigidity. An angiotomography showed a PA of the left VA at the level of the C2 transverse foramen, with mural thrombosis and bone remodeling of the left lateral mass. The PA was treated with the endovascular placement of a flow diverter stent. The patient was discharged 3 days after the procedure without complications. The last vascular imaging follow-up was performed 6 years after the procedure showing a patent left VA, with complete resolution of the aneurysm. Case 2: A 57-year-old woman was admitted referring cervicalgia after a polytraumatism. An angiotomography revealed a fracture of the C1 posterior arch, lateral mass, and left transverse foramen, on top of a left VA thrombosis due to a vascular dissection. Eleven months after the trauma, a left VA V3 segment arteriovenous fistula developed. It was treated with hydrocoils, with no complications. One month after the embolization, a left VA V3 segment PA was observed and treated with a flow diverter stent. An angiographic follow-up 2 years after the procedure showed a patent left VA, with complete resolution of the PA.

CONCLUSION

The use of flow diverters seems to be a safe and effective therapeutic option for the treatment of PAs of the extracranial VAs.

Successful endovascular treatment for thrombosed giant aneurysm of the V1 segment of the vertebral artery: A case report

Thrombosed giant aneurysm of the V1 segment of the vertebral artery is rare, and there is controversy regarding the optimal method of treatment in this portion. Here, we report a thrombosed giant aneurysm of the V1 segment of the vertebral artery with a good clinical course with endovascular proximal artery occlusion of the vertebral artery. A 59-year-old woman presented with a large mass in the left side of the neck. Echographic examination revealed a mass measuring 42 × 38 × 48 mm in the left neck. Angiography showed a thrombosed giant aneurysm of the V1 segment of the left vertebral artery. Endovascular proximal artery occlusion of the vertebral artery was performed, and the aneurysm lessened gradually. Although a number of procedures have been developed to treat extracranial vertebral artery aneurysms, endovascular proximal artery occlusion is a good option to treat aneurysms in this portion.

Spontaneous multisystem deep venous thrombosis as an unusual presentation of Behçet's disease in a young Afro-Caribbean patient

Behçet's disease is an autoimmune mediated multisystem vasculitis. It is most prevalent in Middle Eastern and Mediterranean patients and considered rare in Afro-Caribbean populations. The disease phenotype in Afro-Caribbean patients is more severe with systemic involvement, in particular lesions affecting the vascular system known as angio-Behçet's. The archetypal triad of disease in Behçet's includes oral stomatitis, genital ulceration and ocular lesions, however, the variety of symptoms patients experience is recognised by the revised International Criteria for Behçet's disease and is reflected in the clinical scoring criteria. The authors report an unusual case of Behçet's disease in a young Afro-Caribbean patient presenting with spontaneous bilateral renal, cerebral and pulmonary venous thrombosis as first presentation. Physicians should be aware of the aggressive and atypical manner in which Behçet's can present in Afro-Caribbean patients in order to avoid diagnostic delay and remain vigilant for thromboembolic lesions in this population.