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Stent-within-a-Stent Technique for the Treatment of Dissecting Vertebral Artery Aneurysms

Bharat Mehtaa, Tom Burkea, Max Koleb, Ali Bydonb, Donald Seyfriedb and Ghaus Malikb

a Department of Radiology, Henry Ford Hospital, Detroit, MI
b Department of Neurosurgery, Henry Ford Hospital, Detroit, MI



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  		FIG 1. Case 1. Angiograms in a 46-year-old right-handed woman with an SAH of Hunt-Hess grade II.

A, Left VA injection image obtained at an outside institution. The right VA aneurysm (arrow) was missed because of the failure to perform an ipsilateral injection.

B, Right VA ejection image (anteroposterior [AP] projection) shows dissection and pseudoaneurysm at the origin of the right PICA (bottom arrow). Top arrow indicates vasospasm in the distal VA.

C, Right VA injection image (lateral oblique projection) shows a residual fusiform aneurysm. The area is protected by a stent, and the PICA is patent.

D and E, Right VA injection images (lateral [D and E] projections) obtained 6 months after the stent-within-stent procedure shows complete healing of the aneurysm, with patency of the PICA and restoration of the normal caliber of the vessel.



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  		FIG 2. Angiograms in a 54-year-old man with a history of hypertension and a sudden, severe occipital headache. He had SAH tracking into the ventricles (Hunt-Hess grade II, Fisher grade IV).

A, Left VA injection image (oblique projection) demonstrates a fusiform irregular dissecting aneurysm at the origin of the left PICA.

B, Left VA injection image obtained 6 months after the stent-within-a-stent procedure demonstrates partial resolution of the aneurysm with patency of the PICA.

C (lateral) and D (oblique), Left VA injections images obtained 18 months after the stent-within-a-stent procedure demonstrate complete healing of the aneurysm with restoration of the normal lumen. The stent is across from the origin of the patent PICA.



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  		FIG 3. Angiograms in a 52-year-old woman who was referred for evaluation of a left VA aneurysm. She was experiencing episodes of occipital headaches and neck pain associated with vertigo and dizziness.

A, Left VA injection image (AP view) demonstrates a left VA intracranial aneurysm distal to the PICA origin.

B, Left VA injection image demonstrates the stent-within-a-stent construct created with two Velocity stents in the left VA.

C (AP view) and D (lateral view), Left VA injection images (AP and lateral views) demonstrate patency of the PICA and complete healing of the aneurysm, with restoration of the normal lumen of the left VA.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X