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AJNR - American Journal of Neuroradiology

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Endovascular Management of Spontaneous Bilateral Symptomatic Vertebral Artery Dissections

José E. Cohen^a,b, John Moshe Gomori^b and Felix Umansky^a

^a Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
^b Department of Endovascular Neurosurgery and Interventional Neuroradiology, Hadassah University Hospital, Jerusalem, Israel

View larger version (156K): [in a new window]   FIG 1. Angiography of the cervical left VA reveals a multiple and irregular subintimal dissection with associated pseudoaneurysms extending through the cervical segment (A, left). Magnified radiographic view of the implanted stents (B, center). Angiography of the reconstructed artery (C, right).

View larger version (129K): [in a new window]   FIG 2. Angiography of the cervical right VA reveals a severe hemodynamically significant arterial dissection with multiple intraluminal thrombi. Magnified angiographic view shows migration of the intraluminal thrombi (A–C, left to right). Rapid occlusion of the artery was performed by using detachable coils (D).

View larger version (178K): [in a new window]   FIG 3. Digital angiography follow-up after 2 months. The left VA is patent and shows no signs of in-stent de novo stenosis (A). The plain unsubtracted image shows the unchanged continuous string of stents (B).