A case of ruptured vertebral artery dissecting aneurysm treated with stent-assisted coil embolization in the acute phase and OA-PICA anastomosis and trapping in the chronic phase.

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  • 急性期にステント支援下コイル塞栓術を行い，慢性期にOA‒PICA bypass併用trapping術を施行した破裂解離性椎骨動脈瘤の１例
  • 症例 急性期にステント支援下コイル塞栓術を行い,慢性期にOA-PICA bypass併用trapping術を施行した破裂解離性椎骨動脈瘤の1例
  • ショウレイ キュウセイキ ニ ステント シエン カ コイル ソクセンジュツ オ オコナイ,マンセイキ ニ OA-PICA bypass ヘイヨウ trappingジュツ オ シコウ シタ ハレツ カイリセイ ツイコツ ドウミャクリュウ ノ 1レイ

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Abstract

<p>  A 59‒year‒old man who presented with severe subarachnoid hemorrhage was found to have a dissecting aneurysm on the right vertebral artery (vertebral artery dissecting aneurysm, VADA) at the junction of the posterior inferior cerebellar artery (PICA). As an initial treatment to prevent re‒rupture of the aneurysm, a stent‒assisted coil embolization (SAC) was performed. The rupture point was successfully embolized and the patency of the parent vessels was preserved. The patient made steady recovery in the acute phase and was discharged with a modified Rankin Scale score of 1. Three months later, however, a recurrence of the aneurysm was found. This time it was treated radically by occipital artery (OA)‒PICA anastomosis and trapping without any trouble. Ruptured VADA should be treated immediately because of the high risk of rebleeding. SAC to prevent rebleeding is thought to be a reasonable technique in the acute phase in patients with this serious condition because it can preserve the patency of the parent vessels. Although long‒term results and the curative role of SAC remain to be investigated, we believe that it is a useful treatment in the acute phase until radical trapping and revascularization can be carried out in the chronic phase.</p>

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