Endovascular Management of Vertebrobasilar Dissecting Aneurysms
James D. Rabinova,
Frank R. Hellingerc,
Pearse P. Morrisd,
Christopher S. Ogilvyb and
Christopher M. Putmane
a Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston
b Department of Neurosurgery, Massachusetts General Hospital, Boston
c Department of Radiology, Florida Medical Center Hospital, Orlando
d Department of Radiology, Wake Forest Medical Center, Winston-Salem, NC
e Department of Radiology, Fairfax Hopsital, Fairfax, VA
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FIG 1. Patient 25.
A, Anteroposterior and B, lateral diagnostic angiograms demonstrate a dissecting aneurysm of the dominant left vertebral artery involving the supra-PICA segment and proximal basilar artery (arrow). Arrowhead indicates the pseudoaneurysm.
C, Lateral view of the left internal carotid artery injection shows good collateral circulation to the basilar artery (arrow) through the posterior communicating artery after proximal occlusion of the left vertebral artery. Arrowhead indicates the tip of the distal balloon.
D, Two-year follow-up left internal carotid artery angiogram in the lateral projection shows interval thrombosis of the pseudoaneurysm and dissected segment of the left vertebral artery. The basilar artery (arrow) appears less irregular.
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FIG 2. Patient 27.
A, Anteroposterior angiogram of the left vertebral artery shows irregular narrowing of the supra-PICA segment (arrow) and a pseudoaneurysm at the vertebrobasilar junction (arrowhead). The anterior spinal artery and left PICA are not included in the abnormal segment.
B, Anteroposterior angiogram of the right vertebral artery shows a codominant vessel with full delineation of the vertebrobasilar junction pseudoaneurysm (arrowhead). The dissection extends in the basilar artery to include the AICA origins (arrow).
C, Posttreatment angiogram of the right vertebral artery shows coil occlusion of the vertebrobasilar junction pseudoaneurysm (arrowhead).
D, Posttreatment angiogram of the left vertebral artery shows proximal occlusion of the supra-PICA segment of the vessel with preservation of flow in the anterior spinal artery (arrow) and PICA.
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FIG 3. Patient 11.
A, Anteroposterior angiogram of the left vertebral artery demonstrates irregularity of the lumen (arrow) and a 4–5-mm pseudoaneurysm (arrowhead) near the PICA origin.
B, Lateral angiogram of the left vertebral artery shows the small pseudoaneurysm (arrow).
C, Lateral angiogram of the right vertebral artery at the time of rehemorrhage 2 weeks after proximal occlusion of the left vertebral artery shows that the pseudoaneurysm (arrow) has not enlarged and the left PICA remains patent.
D, Anteroposterior angiogram of the right vertebral artery after delivery of coils across the vertebrobasilar junction into the pseudoaneurysm shows the lesion is occluded (arrow), with the PICA filling antegrade
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FIG 4. Patient 22.
A, Anteroposterior angiogram of the right vertebral artery shows a dissection of this codominant vertebral artery (black arrow) and psuedoaneurysm (arrowhead). Note the fenestration in the basilar artery (white arrow).
B and C, Follow-up angiograms of the right (B) and left (C) vertebral arteries, respectively, show no residual aneurysm.
D, Follow-up angiogram 1 year later shows recurrence of the dissecting aneurysm (arrow) proximally in the left vertebral artery to involve the PICA. The coil mass has compacted (arrowhead).
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