Abstract
A 55-year-old female patient was referred for the treatment of a giant, partially thrombosed aneurysm originating from the proximal course of the left vertebral artery (VA). This aneurysm had been found incidentally 8 years before during work-up for chronic headaches. Follow-up contrast enhanced MRA revealed a significant growth in the thrombosed part of said aneurysm. DSA showed the hypoplastic right vertebral artery mainly supplying the right posterior inferior cerebellar artery (PICA). The left vertebral artery was stenotic distal to the origin of the aneurysm. The further vessel course (the V2 and V3 segments) showed sequelae of a chronic dissection. The patient denied there having been any significant trauma or chiropractic maneuver. Other manifestations of a connective tissue disease were missing. The aneurysm was considered to be a potential source of emboli into the dependent vasculature. A rupture of this aneurysm could have caused a hemothorax. In a single endovascular treatment session, the aneurysm was loosely packed with detachable coils. The VA stenosis was dilated with a drug-eluting coronary stent. The entire V1 and the proximal V2 segments, including the origin of the aneurysm, were reconstructed using telescoping flow diverter stents. Short-term follow-up DSA confirmed the separation of the aneurysm from the blood circulation. Indications for and management of the treatment of proximal VA aneurysms are the main topics of this chapter.
This is a preview of subscription content, log in via an institution to check access.
References
Abdulrazeq HF, Goldstein IM, Elsamna ST, Pletcher BA. Vertebral artery aneurysm rupture and hemothorax in a patient with neurofibromatosis Type-1: a case report and review of the literature. Heliyon. 2019;5(8):e02201. https://doi.org/10.1016/j.heliyon.2019.e02201.
Albuquerque FC, Hu YC, Dashti SR, Abla AA, Clark JC, Alkire B, Theodore N, McDougall CG. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 2011;115(6):1197–205. https://doi.org/10.3171/2011.8.JNS111212.
Ali MS, Amenta PS, Starke RM, Jabbour PM, Gonzalez LF, Tjoumakaris SI, Flanders AE, Rosenwasser RH, Dumont AS. Intracranial vertebral artery dissections: evolving perspectives. Interv Neuroradiol. 2012;18(4):469–83. https://doi.org/10.1177/159101991201800414.
Berenstein A, Ransohoff J, Kupersmith M, Flamm E, Graeb D. Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization. Surg Neurol. 1984;21(1):3–12. https://doi.org/10.1016/0090-3019(84)90392-6.
Do KH, Leggit JC, Galifianakis A. Extracranial vertebral artery dissecting aneurysm with snowboarding: a case report. Curr Sports Med Rep. 2018;17(1):16–9. https://doi.org/10.1249/JSR.0000000000000441.
Dragon R, Saranchak H, Lakin P, Strauch G. Blunt injuries to the carotid and vertebral arteries. Am J Surg. 1981;141(4):497–500. https://doi.org/10.1016/0002-9610(81)90147-1.
Egnor MR, Page LK, David C. Vertebral artery aneurysm – a unique hazard of head banging by heavy metal rockers. Case report. Pediatr Neurosurg 1991–1992;17(3):135-138. https://doi.org/10.1159/000120583.
Gallo P, Dalacorte A, Raupp E, Santos AJ, Frank MR, Saraiva GA. Giant pseudoaneurysm of the extracranial vertebral artery: case report. Arq Neuropsiquiatr. 1996;54(2):297–303. https://doi.org/10.1590/s0004-282x1996000200.
Hilton-Jones D, Warlow CP. Non-penetrating arterial trauma and cerebral infarction in the young. Lancet. 1985;1(8443):1435–8. https://doi.org/10.1016/s0140-6736(85)91856-2.
Johnson-Mann C, Schonholz C, Vandergrift W 3rd, Elliott BM, Brothers T. Bypass and embolization for a vertebral artery aneurysm in a patient with Marfan syndrome. J Vasc Surg Cases. 2015;1(2):77–80. https://doi.org/10.1016/j.jvsc.2015.02.002.
Kim ST, Brinjikji W, Lanzino G, Kallmes DF. Neurovascular manifestations of connective-tissue diseases: a review. Interv Neuroradiol. 2016;22(6):624–37. https://doi.org/10.1177/1591019916659262.
Lim SH, Shin HS, Lee SH, Koh JS. Endovascular treatment of vertebral artery dissecting aneurysms that cause subarachnoid hemorrhage: consideration of therapeutic approaches relevant to the angioarchitecture. J Korean Neurosurg Soc. 2015;58(3):175–83. https://doi.org/10.3340/jkns.2015.58.3.175.
McLean JM, Wright RM, Henderson JP, Lister JR. Vertebral artery rupture associated with closed head injury. Report of two cases. J Neurosurg. 1985;62(1):135–8. https://doi.org/10.3171/jns.1985.62.1.0135.
Negoro M, Nakaya T, Terashima K, Sugita K. Extracranial vertebral artery aneurysm with neurofibromatosis. Endovascular treatment by detachable balloon. Neuroradiology. 1990;31(6):533–6. https://doi.org/10.1007/BF00340136.
Nenadic D, Balevic M, Milojevic M, Tanskovic S. Extracranial vertebral artery aneurysm rupture complicated by extrapleural haematoma. EJVES Short Rep. 2018;38:12–4. https://doi.org/10.1016/j.ejvssr.2018.01.001.
Oderich GS, Sullivan TM, Bower TC, Gloviczki P, Miller DV, Babovic-Vuksanovic D, Macedo TA, Stanson A. Vascular abnormalities in patients with neurofibromatosis syndrome type I: clinical spectrum, management, and results. J Vasc Surg. 2007;46(3):475–84. https://doi.org/10.1016/j.jvs.2007.03.055.
Rahimizadeh A, Sabouri-Daylami M, Amir-Moezi N, Haddadian K. Traumatic aneurysm of the extracranial vertebral artery. Neurosurgery. 1986;19(4):628–30. https://doi.org/10.1227/00006123-198610000-00021.
Rao S, Rao S, Dhindsa-Castanedo L, Benndorf G. Rapidly evolving large extracranial vertebral artery pseudoaneurysm in Behçet’s disease: case report and review of the literature. Mod Rheumatol. 2015;25(3):476–9. https://doi.org/10.3109/14397595.2013.843751.
Strambo D, Peruzzotti-Jametti L, Semerano A, Fanelli G, Simionato F, Chiesa R, Rinaldi E, Martinelli V, Comi G, Bacigaluppi M, Sessa M. Treatment challenges of a primary vertebral artery aneurysm causing recurrent ischemic strokes. Case Rep Neurol Med. 2017;2017:2571630. https://doi.org/10.1155/2017/2571630.
Wiener I, Flye MW. Traumatic false aneurysm of the vertebral artery. J Trauma. 1984;24(4):346–9. https://doi.org/10.1097/00005373-198404000-00012.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Khanafer, A., Dukiewicz, M., Bernhard, A., Jost, D., Bäzner, H., Henkes, H. (2020). Extracranial Vertebral Artery Aneurysm: Incidentally Diagnosed Dissecting Giant Proximal Vertebral Artery (V1) Aneurysm, Treated with Drug Eluting Stent Deployment, Coil Occlusion, and Flow Diversion. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_177-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-70267-4_177-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-70267-4
Online ISBN: 978-3-319-70267-4
eBook Packages: Springer Reference MedicineReference Module Medicine