Intravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: technical case report.
OBJECTIVE
An innovative stenting technique to treat a difficult case of a fusiform aneurysm of the intracranial vertebral artery (VA), with restoration of the vessel lumen, is described.


METHODS
A 58-year-old patient experienced sudden pain in the upper cervical spine, followed by a severe headache. He underwent computed tomographic evaluation, which demonstrated subarachnoid hemorrhage in the prepontine cistern. A fusiform aneurysm of the distal right VA and critical stenosis of the left VA were detected in digital subtraction angiograms. The patient experienced a new subarachnoid hemorrhaging episode, and urgent endovascular treatment was planned.


METHODS
The patient underwent angioplastic and stenting procedures in the left VA, with good results. Forty-eight hours later, an endovascular procedure was performed to treat the right VA aneurysm. We decided to use a graft stent (Jostent graft stent; Jomed, Conroe, TX) instead of a balloon to preserve the arterial lumen. The complete procedure was well tolerated by the patient, and he was discharged, without symptoms, 48 hours later.


CONCLUSIONS
The patient was discharged, without neurological deficits, 48 hours after completion of the endovascular procedure, with clopidogrel (75 mg/d) and aspirin (325 mg/d) therapy. This treatment was discontinued after 4 weeks. According to our search of the medical literature, this is the first clinical case in which an intracranial fusiform aneurysm was permanently sealed with a graft stent.
Chiaradio
Juan Carlos
JC
Department of Neurosurgery, Buenos Aires Cardiovascular Institute, Buenos Aires, Argentina.
Guzman
Luis
L
Padilla
Lucio
L
Chiaradio
Maria Paula
MP
D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D000800:Angioplasty, Balloon; D002533:Cerebral Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000628:therapy*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*