Bilateral vertebral artery dissecting aneurysm with subarachnoid hemorrhage treated with staged bilateral vertebral artery coil occlusion: a case report.
BACKGROUND
Vertebral artery dissecting aneurysm is now increasingly recognized as a cause of posterior circulation stroke in young adults. Here, we report a case of bilateral VADA with SAH, treated by bilateral coil occlusion using GDCs.


METHODS
A 64-year-old woman was admitted to our hospital with consciousness disturbance (Hunt and Kosnik: grade 4). Computed tomography showed diffuse SAH with a thick hematoma in the left C-P angle. Magnetic resonance angiography, 3D-CTA, and cerebral angiography revealed bilateral VADAs. First, the ruptured left VADA involving the PICA and a perforating branch was treated by occluding the lower half of the VADA and the proximal VA with GDCs in the acute stage. Thereafter, the residual VADA and contralateral VADA exhibited enlargement on cerebral angiography and MRA for 2 months after the initial surgery; thus, the right VADA was occluded by GDCs just proximal to the right PICA after confirming BTO tolerance.


CONCLUSIONS
Staged bilateral VA coil occlusions combined with BTO may be one of the treatment strategies for bilateral VADA with SAH in cases presenting surgical difficulty due to anatomical factors or severe grade of SAH.
Inoue
Akihiro
A
Department of Neurosurgery, Ehime Prefectural Central Hospital, Kasuga-machi 83, Matsuyama-shi, Ehime-Prefecture 790-0024, Japan. iakihiro@m.ehime-u.ac.jp
Kohno
Kanehisa
K
Takechi
Akihiko
A
Kohno
Keiji
K
Matsushige
Toshinori
T
Takeda
Tetsuji
T
D001921:Brain / Q000098:blood supply; D002530:Cerebellopontine Angle / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology; D004621:Embolization, Therapeutic / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019736:Prostheses and Implants / Q000592:standards*; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D020217:Vertebral Artery Dissection / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D014715:Vertebrobasilar Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery