Stent-assisted coil embolisation for bilateral vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage

Abstract

Bilateral dissecting aneurysms presenting with subarachnoid haemorrhage are rare. The treatment strategy for bilateral vertebral artery dissecting aneurysms is controversial because the contralateral vertebral artery is already dissected and can easily undergo enlargement or bleed after non-reconstructive treatment procedures such as trapping or proximal occlusion. Here, we report a case of bilateral vertebral artery dissecting aneurysm presenting with subarachnoid haemorrhage that was treated with stent-assisted coiling for the ruptured side. A 42-year-old man was admitted to our hospital with sudden headache (WFNS grade 1). Computed tomography showed a high-density region in the basal cistern and posterior fossa with more haemorrhage on the right side (Fisher group 3). Three-dimensional computed tomography and three-dimensional rotational angiography demonstrated a bilateral round protrusion on the vertebral arteries with a diameter of 5 mm just distal to the posterior inferior cerebellar artery. Stent-assisted coiling was performed for the ruptured right side and conservative therapy was selected for the contralateral side. The ruptured side was well embolised, and the contralateral side was stable over the 12-month follow-up period after treatment. The treatment strategy for bilateral vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage is different from that for unilateral vertebral artery dissecting aneurysms. Non-reconstructive treatment procedures such as trapping may cause contralateral enlargement or rupture; therefore, reconstructive treatment may be appropriate for the ruptured side.

Clinical Study on Complications of Intracranial Ruptured Aneurysm Embolization by Stent-Assisted Coil

“…A large number of experiments have confirmed that stent-assisted coil embolization is safe, effective, and practical for the treatment of ruptured intracranial aneurysms [ 9 – 11 ]. Although complications are rare, some cases can experience serious adverse consequences [ 11 , 12 ]. Complications should be avoided as much as possible.…”

A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection

“…With recent advances in device technologies, endovascular treatment has become the first-line treatment for vertebral artery dissecting aneurysms. [2,4,17,19] Endovascular treatments of vertebral artery dissecting aneurysms include internal trapping and stent-assisted coil embolization. In the present case, internal trapping was performed for the dissecting aneurysm of the right vertebral artery.…”

“…[7-10,14,16,18] Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. [2,5,11,17,19] In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage (SAH) in the acute stage of cerebral infarction due to unilateral VAD.…”

Endovascular treatment of bilateral intracranial vertebral artery aneurysms: an algorithm based on a 10-year neurointerventional experience

“…This thereby avoids a dramatic increase in flow and haemodynamic stress in the contralateral IVADAs, which would otherwise likely contribute to high mortality. Ishikawa et al 33 reported a bilateral IVADAs case with SAH that the ruptured side was well treated with SAC, and the contralateral side was stable at follow-up after treatment. Such results might also support that reconstructive endovascular treatment has little impact on the haemodynamic stress to the contralateral IVADA.…”