Abstract
Few reports have been published on ruptured vertebral artery dissecting aneurysms in which the ipsilateral vertebral arteries distal to the aneurysms are occluded. The proper management of this type of aneurysm is controversial.
We describe 2 patients who presented with subarachnoid hemorrhage and were admitted to our hospital on the day of rupture. CT demonstrated subarachnoid hemorrhage mainly in the posterior fossa. Right vertebral angiography on the day of hemorrhage showed complete occlusion of the right vertebral artery. Left vertebral angiography showed retrograde filling of only the short segment of the distal portion of the right vertebral artery in both patients. Both patients were diagnosed as vertebral artery occlusion after a subarachnoid hemorrhage from a dissecting vertebral artery aneurysm. One patient was treated by trapping. Postoperatively, the patient recovered almost completely with mild hoarseness. The other patient was initially managed conservatively. On the fourth day, however, fulminant rerupture occurred, and 3D-CT angiography showed recanalization of the right vertebral artery. The patient was urgently treated by trapping and recovered well.
The ideal method of treatment for patients with a dissecting vertebral artery with occlusion of the ipsilateral vertebral artery is controversial. Trapping on the day of rupture is one possible treatment option. If conservative management is employed, follow-up neuroimagings such as angiography, 3D-CT angiography and MR angiography within a few days is essential to observe recanalization of the aneurysm.
