The use of CT-angiography for monitoring thrombus formation after balloon occlusion of a dissecting vertebral artery pseudoaneurysm.
We present a 49-year-old man with a subarachnoid haemorrhage from a dissecting vertebral artery (VA) pseudoaneurysm treated with a proximal balloon occlusion. The clinical course was complicated by the sudden appearance of a lateral medullary syndrome (Wallenberg), which completely resolved after anticoagulant therapy. During this course, CT-angiography (CTA) enabled monitoring of both the progression and partial resolution of the thrombus in the occluded VA. An anatomical variant of a perforating artery originating from the VA proximal to the posterior inferior cerebral artery (PICA) was subsequently demonstrated, explaining the ischemic event. The value of CTA in clinical management is discussed. The prophylactic use of anticoagulant therapy especially in the case of a perforating artery to the lateral medulla originating proximally to the PICA, is suggested.
Verstegen
Marco J T
MJ
Department of Neurosurgery H2-225, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
Hulsmans
Frans-Jan H
FJ
Majoie
Charles B L M
CB
Bouma
Gerrit J
GJ
D017541:Aneurysm, False / Q000150:complications* / Q000628:therapy*; D000792:Angiography / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D021721:Balloon Occlusion / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000209:etiology*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000628:therapy*
D000925:Anticoagulants