title: Subarachnoid haemorrhage with bilateral intracranial vertebral artery dissecting aneurysms treated by staged endovascular stenting.
abstract: Bilateral vertebral artery dissecting aneurysms (VADAs) presenting with subarachnoid haemorrhage (SAH) are an exceedingly rare and deadly clinical dilemma. Prompt intervention in the case of unilateral VADAs is advocated to prevent rebleed; however, in the case of bilateral VADAs, the optimal therapeutic intervention is unclear. We describe the case of a patient presenting with SAH with bilateral VADAs treated by staged endovascular stenting. This led to resolution of the aneurysms with patency of both vertebral arteries. Stent-based therapy of the symptomatic aneurysm followed by staged stenting of the asymptomatic, contralateral aneurysm appears to be a viable treatment option. This method allows the ability to preserve flow in both vertebral arteries with minimal changes in flow characteristics that may threaten the contralateral, asymptomatic VADA, and appears to be the ideal treatment in these rare cases.
authors: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors: David Andrew
authors: DA
authors: Wilkinson
authors: Thomas J
authors: TJ
authors: Wilson
authors: William R
authors: WR
authors: Stetler
authors: Aditya S
authors: AS
authors: Pandey
mesh_terms: D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D012039:Regional Blood Flow; D015607:Stents; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D020217:Vertebral Artery Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*