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

Surgical Neurology
Akihiro InoueTetsuji Takeda

Abstract

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. 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. 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.

References

Nov 1, 1990·Stroke; a Journal of Cerebral Circulation·N Aoki, T Sakai
Feb 1, 1990·Journal of Neurosurgery·A YamauraN Saeki
Jun 1, 1988·Neurology·L R CaplanE S Kwan
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Jan 7, 2004·Journal of Neurosurgery·Jun-ichiro HamadaYukitaka Ushio

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Citations

Nov 30, 2010·Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association·Takeo NashimotoTakafumi Saito
Oct 30, 2013·Journal of Cerebrovascular and Endovascular Neurosurgery·Dong Hoon LeeHoon Kim
Sep 23, 2011·Neurosurgery·Ana Paula NarataVitor Mendes Pereira

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