抄録
Treatment of ruptured vertebral dissecting aneurysms involving the posterior inferior cerebellar artery (PICA) still poses a challenge because of the necessity of revascularization of the PICA. Below we report the case of a ruptured vertebral dissecting aneurysm involving the PICA treated with endovascular coil embolization and without a revascularization procedure. A 38-year-old man was admitted to our hospital with subarachnoid hemorrhage caused by a right vertebral dissecting aneurysm involving the origin of the PICA.
A right vertebral angiogram clearly revealed that the entry was at the distal part of the dissecting aneurysm medial-inferiorly, and that the PICA had arisen at the proximal part of the dissecting aneurysm lateral-superiorly in the early arterial phase. Furthermore, it was evident that the contrast medium had moved from the middle to the lower section inside the dissection lumen in the late arterial phase. We embolized the dissecting lumen and entry with coils assisted by flow control of the ipsilateral vertebral artery (VA). Thereafter, we preserved the PICA by framing and filling the coils while maintaining blood flow of the VA. We embolized the distal part of the dissecting aneurysm with coils additionally via the contralateral VA, and we selectively obliterated the dissecting aneurysm finally without employing a revascularization procedure. No post-procedural ischemic event occurred in this case. During the follow-up period, there were no occurrences of rebleeding or ischemic events, and no additional surgical procedures were required. The PICA, which maintained its patency during the procedures, was clearly visible for a long time by magnetic resonance angiography (MRA) examination.
When VA dissecting aneurysms involving the PICA with selective coil embolization and without branch revascularization are treated, it is important to identify the entry. In addition, selective and adequate tight embolization of the dissection lumen and VA is useful during the acute stage, and dose not require revascularization.
