title: Stent-assisted coil embolization and computational fluid dynamics simulations of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage:  case report.
abstract: BACKGROUND
  A vertebral artery dissecting aneurysm (VADA) is a relatively rare cause of subarachnoid hemorrhage. Bilateral VADAs are even rarer, and management strategies are controversial. We report a case of bilateral VADAs presenting with subarachnoid hemorrhage. We treated the patient by stent-assisted coil embolization of both aneurysms at a single session on the basis of results of preoperative computational fluid dynamic simulations.
  
  
  METHODS
  A 48-year-old man presented with subarachnoid hemorrhage resulting from bilateral VADAs. We treated the patient by stent-assisted coil embolization of both aneurysms at a single session. Before the treatment, we performed computational fluid dynamics simulations to predict the ruptured side. We also estimated the increase in wall shear stress on an aneurysm in case of trapping of another aneurysm, which might cause enlargement and rupture of the aneurysm. The treatment was performed successfully. The patient remains neurologically intact at 14 months from the onset.
  
  
  CONCLUSIONS
  Stent-assisted coil embolization of subarachnoid hemorrhage with bilateral VADAs for both sides is a reasonable treatment because it prevents rebleeding and preserves bilateral vertebral arteries without increasing hemodynamic stress. To the best of our knowledge, this is the first report to describe this type of treatment for bilateral VADAs with subarachnoid hemorrhage. Computational fluid dynamics simulations may be useful for developing treatment strategies for aneurysms.
authors.affiliation: Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama, Japan. vyr01450@gmail.com
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kono
authors.forename: Aki
authors.initials: A
authors.lastname: Shintani
authors.forename: Takeshi
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Terada
mesh_terms: D000784:Aortic Dissection / Q000150:complications / Q000628:therapy*; D002533:Cerebral Angiography; D003198:Computer Simulation; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging