Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report.
BACKGROUND
The authors present a patient who experienced late (5-year follow-up) morphological progression of a dissecting aneurysm of the distal basilar artery after treatment with a combined microsurgical and neuroendovascular Hunterian strategy. In addition to postulating about the possible reasons underlying the evolution of this lesion, the role of stenting is discussed.


METHODS
The patient was 37 years old when she suffered a subarachnoid hemorrhage from spontaneous basilar artery dissection. At the time of the hemorrhage, minimal aneurysmal enlargement was noted angiographically, and she was therefore treated nonoperatively. On reimaging 5 months later, massive enlargement of the aneurysm was noted. The patient was treated with staged bilateral vertebral artery sacrifice using a combination of microsurgical and neuroendovascular techniques. The dominant vertebral artery was clip-ligated distal to the posteroinferior cerebellar artery, whereas the contralateral vertebral artery was coil-occluded cervically 1 week later.


CONCLUSIONS
Despite the patient remaining asymptomatic, follow-up angiography 5 years after the initial hemorrhage revealed further enlargement of the aneurysm as well as a newly discovered inferiorly projecting daughter sac measuring 5 mm in diameter. Clearly, certain aneurysms exist for which indirect approaches involving hemodynamic attenuation fail to prevent progression. With greater refinements in stent technology, such lesions may be more effectively treated.
O'Shaughnessy
Brian A
BA
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Getch
Christopher C
CC
Bendok
Bernard R
BR
Batjer
H Hunt
HH
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D021721:Balloon Occlusion / Q000379:methods*; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020526:Brain Stem Infarctions / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D002533:Cerebral Angiography; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D015607:Stents / Q000592:standards; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D013525:Surgical Instruments; D013997:Time Factors; D017211:Treatment Failure; D014711:Vertebral Artery / Q000033:anatomy & histology / Q000601:surgery*
D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors