AneurysmBilateral vertebral artery dissecting aneurysm with subarachnoid hemorrhage treated with staged bilateral vertebral artery coil occlusion: a case report
Introduction
Vertebral artery dissecting aneurysm is now increasingly recognized as the cause of posterior circulation stroke in a number of cases in young adults [2], [4], [6]. Vertebral artery dissecting aneurysm is generally unilateral, but rare cases of bilateral VADA have been reported [3], [4], [11], [13], [18], [19]. Such cases may present problems with preoperative identification of the ruptured side and with treatment of the unruptured dissecting aneurysm in the contralateral VA [12], [14]. Here, we report a case of bilateral VADA with SAH successfully treated by staged bilateral VA coil occlusion.
Section snippets
Case description
A 64-year-old woman experienced a sudden onset of severe headache and consciousness disturbance in August 2005. Computed tomography (Fig. 1A) showed diffuse SAH with thick hematoma in the left C-P angle cistern. Magnetic resonance angiography (Fig. 2A) depicted abnormal dilatation of the bilateral VA. Three-dimensional computed tomographic angiography (Fig. 1B) and cerebral angiography (Fig. 3A) revealed a fusiform dilatation of 16.6 mm maximum in diameter with fenestration, involving the
Discussion
Vertebral artery dissecting aneurysm is generally unilateral, but rare cases of bilateral VADAs have been reported [3], [4], [11], [13], [18], [19]. The strategy for treatment of bilateral VADAs with SAH remains controversial; but to prevent rebleeding, VADAs often require surgical interventions such as proximal occlusion, trapping, wrapping, or, more recently, stent-supported coil embolization [6], [9], [12], [17]. Stent-supported coil embolization has become one of the ideal management
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Ruptured Vertebral Artery Dissecting Aneurysm Concurrent with Spontaneous Cervical Internal Carotid Artery Dissection: A Report of Three Cases and Literature Review
2017, World NeurosurgeryCitation Excerpt :Vertebral artery dissecting aneurysm (VADA) is a well-known cause of subarachnoid hemorrhage (SAH). Multiple spontaneous dissections with VADAs presenting with SAH are rare, and their management is challenging.1-6 Although most of the reported cases involve bilateral VADAs located in the posterior circulation,1-4 cases of multiple-dissection VADA and anterior circulation are even rarer.5,6
Treatment Strategies of Subarachnoid Hemorrhage from Bilateral Vertebral Artery Dissection: A Case Report and Literature Review Focusing on the Availability of Stent Placement
2017, World NeurosurgeryCitation Excerpt :Cases in which the contralateral side was reported as a de novo dissection10,11 also may have been misdiagnosed initially; therefore, they were included in our literature review. The average age of the 39 patients, including our case, was 47.3 years (32–64 years); there were 17 women and 22 men (Table 1).1,2,4-7,10-12,14,15,19,21-23,26-32 SAH grades were described inconsistently; therefore, we used our discretion to apply WFNS grades.
Successful treatment of bilateral vertebral artery dissecting aneurysms with subarachnoid hemorrhage: Report of three cases
2012, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Therefore, proximal occlusion or trapping of the affected VA should be considered.4 Some authors have already reported surgical treatment of the patients with bilateral VADAs presenting with SAH.5-8 However, occlusion of the affected VA may increase the blood flow in the contralateral VA, resulting in increased hemodynamic shear stress on the VA wall.
Flow diverters in the treatment of unruptured vertebral artery dissecting aneurysm: A single-center experience
2023, Frontiers in Neurology