A case of ruptured vertebral artery dissecting aneurysm treated by internal trapping with posterior inferior cerebellar artery preservation

Abstract

  We report a case of ruptured vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) that was treated by short segment internal trapping. A 66‒year‒old woman presented with headache and disturbed consciousness. Her Computed Tomography (CT) scan of the brain revealed a subarachnoid hemorrhage and angiogram revealed left VADA involving the PICA. Endovascular internal trapping of the enlarged distal VADA was performed and the ruptured VADA was treated by short segment occlusion using coil embolization, while the PICA was preserved. After 4 weeks, follow‒up angiography revealed dilatation of the left vertebral artery, located at the proximal end of the dissection. The patient was managed conservatively. Follow‒up angiography at 9 weeks showed complete resolution of the left vertebral artery dilatation. She had an uneventful clinical course. In conclusion, short segment internal trapping can be used to treat ruptured VADA involving the PICA.