Abstract
We report a case of rebleeding after proximal clipping of ruptured vertebral arterydissecting aneurysm.
A 61-year-old-man suffered from severe SAH with coma and dyspnea. VAG showed “pearl & string sign” at the non-dominant right VA distal to the PICA. The left predominant VA demonstrated retrograde filling of the right VA-DA. Through the right suboccipital craniectomy, a Sugita clip was placed across the VA just proximal to the dissection and distal to the PICA.
Just after extubation, 4 hours after surgery, the patient was afflicted with coma and respiratory arrest. Therefore through the left suboccipital approach, the dissecting aneurysm with a small rebleeding point was trapped just distal to the dissection. The patient was discharged under severe disability 1 year after trapping.
We studied 7 cases of rebleeding after proximal clipping of the ruptured VA-DA with our case in a review of the literature.
The following can be concluded:
1) In each case, the evaluation of the preoperative hemodynamics is necessary by balloon occlusion test at cerebral angiography.
2) If a case shows retrograde filling to the VA-DA in the preoperative vertebral angiography, trapping of the VA-DA should be tried.
3) Because rebleeding after proximal clipping of the VA-DA may be encountered not only proximal but also distal to the PICA, the vertebral angiography should be performed within 1 week after surgery.
4) If the angiograms through the contralateral VA demonstrate retrograde filling of the dissecting aneurysm, the patient should be carefully followed up for postoperative rebleeding.
