2020 Volume 42 Issue 1 Pages 19-23
A 60-year-old woman developed sudden onset of disturbance of consciousness, and was transferred to another hospital where she was diagnosed with subarachnoid hemorrhage, then transferred to our hospital. Cerebral angiography revealed left vertebral artery dissecting aneurysm (VADA) and right vertebral artery dissection with near occlusion. Balloon test occlusion (BTO) of the left vertebral artery (VA) was performed, and the right carotid angiography demonstrated retrograde filling of the right posterior inferior cerebellar artery (PICA) through the posterior communicating artery (Pcom). We performed internal trapping of the left VA to preserve left PICA flow. The postoperative course was favorable, and the final modified Rankin scale score was 0. Internal trapping of a symptomatic VADA may be worth considering even when the contralateral VA is occluded. BTO appears useful for evaluating collateral blood flow.
