Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes.
Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur.Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1) came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed.Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Davide
0000-0003-4429-2714
D
Strambo
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Luca
L
Peruzzotti-Jametti
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Aurora
0000-0003-1882-0747
A
Semerano
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Giovanna
G
Fanelli
Neuroradiology Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Franco
F
Simionato
Vascular Surgery Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Roberto
R
Chiesa
Vascular Surgery Department, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Enrico
E
Rinaldi
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Vittorio
0000-0002-5987-5739
V
Martinelli
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Giancarlo
G
Comi
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy; Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Marco
0000-0002-0213-2328
M
Bacigaluppi
Stroke Unit, Department of Neurology and Neurophysiology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
Maria
M
Sessa