title: Treatment of a dissecting vertebral artery aneurysm with angioplasty and the pipeline embolisation device.
abstract: A 49-year-old woman was admitted with Hunt and Hess grade 1 subarachnoid haemorrhage. A cerebral aneurysm of the intracranial left vertebral artery (VA) distal to the left posterior inferior cerebellar artery (PICA) was found and treated using parent vessel occlusion with coils. The PICA was preserved. Angiography at three time points during her hospitalisation showed a normal right VA. Eight months later, angiography demonstrated a new 14 mm right VA dissecting aneurysm with 90% outflow stenosis and recurrence of the left VA aneurysm distal to the coils. A Marksman microcatheter would not traverse the stenosis despite the use of two intraluminal wires. Following Gateway balloon (1.5 mm × 9 mm) angioplasty, the Marksman passed easily. The pipeline embolisation device (PED) was successfully deployed across the aneurysm and 11 coils placed through a trapped microcatheter. The patient was discharged home 2 days later. Eighteen-month follow-up has revealed complete resolution of both aneurysms.
authors.affiliation: Marion Bloch Neuroscience Institute, St Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Veer A
authors.initials: VA
authors.lastname: Shah
authors.affiliation: Marion Bloch Neuroscience Institute, St Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Patrik
authors.initials: P
authors.lastname: Leonard
authors.affiliation: Marion Bloch Neuroscience Institute, St Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Sessions
authors.affiliation: Marion Bloch Neuroscience Institute, St Luke's Plaza, Kansas City, Missouri, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Holloway
mesh_terms: D017130:Angioplasty / Q000295:instrumentation* / Q000379:methods*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D008875:Middle Aged; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014711:Vertebral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D020217:Vertebral Artery Dissection / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*