Vertebral artery occlusion with vertebral artery-to-posterior inferior cerebellar artery stenting for preservation of the PICA in treating ruptured vertebral artery dissection

Abstract

We report a patient with a right vertebral artery (VA) dissecting aneurysm who was treated by placing an Enterprise stent (Cordis Neurovascular, Miami Lakes, FL) from the proximal VA to the posterior inferior cerebellar artery (PICA) in order to save the patency of the PICA. A 47-year-old man was admitted with a ruptured right VA dissecting aneurysm that involved the origin of the PICA. A 4.5 × 37-mm Enterprise stent was then placed through the proximal VA to the PICA. The dissected segment of the VA was completely occluded by coil embolization. The 1-year follow-up angiography showed that the dissected segment was completely occluded and the diameter of the PICA was slightly increased, and the PICA’s patency was good.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    Aoki N, Sakai T (1990) Rebleeding from intracranial dissecting aneurysm in the vertebral artery. Stroke 21:1628–1631

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Hara M, Yamamoto I (2000) Introduction to symposium: intracranial dissecting aneurysms. Neuropathology 20:83–84

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi JC, Nagata I (2002) Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg 97:259–267

    PubMed  Article  Google Scholar 

  4. 4.

    Mercier PH, Brassier G, Fournier H-D, Picquet J, Papon X, Lasjaunias P (2008) Vascular microanatomy of the pontomedullary junction, posterior inferior cerebellar arteries, and the lateral spinal arteries. Interv Neuroradiol 14:49–58

    PubMed  CAS  Google Scholar 

  5. 5.

    Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T (1995) Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery 36:905–913

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Naito I, Iwai T, Sasaki T (2002) Management of intracranial cerebral artery dissection initially presenting without subarachnoid hemorrhage. Neurosurgery 51:930–938

    PubMed  Google Scholar 

  7. 7.

    Ogasawara K, Kubo Y, Tomitsuka N, Sasoh M, Otawara Y, Arai H, Ogawa A (2006) Treatment of vertebral artery aneurysms with transposition of the posterior inferior cerebellar artery to the vertebral artery combined with parent artery occlusion: Technical note. J Neurosurg 105:781–784

    PubMed  Article  Google Scholar 

  8. 8.

    Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM (2003) Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol 24:1421–1428

    PubMed  Google Scholar 

  9. 9.

    Sakata N, Takebayashi S, Kojima M, Masawa N, Suzuki K, Takatama M (2000) Pathology of a dissecting intracranial aneurysm. Neuropathology 20:104–108

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Shin YS, Kim HS, Kim SY (2007) Stenting for vertebrobasilar dissection: a possible treatment option for nonhemorrhagic vertebrobasilar dissection. Neuroradiology 49:149–156

    PubMed  Article  Google Scholar 

  11. 11.

    Siddiqui MA, Bhattacharya JJ, Lindsay KW, Jenkins S (2009) Horizontal stent-assisted coil embolization of wide-necked intracranial aneurysms with the Enterprise stent – a case series with early angiographic follow-up. Neuroradiology 51:411–418

    PubMed  Article  Google Scholar 

  12. 12.

    Takikawa S, Kamiyama H, Nomura M, Abe H, Saitoh H (1991) Vertebral dissecting aneurysm treated with trapping and bilateral PICA side-to-side anastomosis: a case report. No Shinkei Geka 19:571–576

    PubMed  CAS  Google Scholar 

  13. 13.

    Turk AS, Niemann DB, Ahmed A, Aagaard-Kienitz B (2007) Use of self-expanding stents in distal small cerebral vessels. AJNR Am J Neuroradiol 28:533–536

    PubMed  Article  CAS  Google Scholar 

Download references

Acknowledgements

We declare that we have no conflict of interest in relation to this article.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Yong Sam Shin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chung, J., Kim, Bs., Lee, D. et al. Vertebral artery occlusion with vertebral artery-to-posterior inferior cerebellar artery stenting for preservation of the PICA in treating ruptured vertebral artery dissection. Acta Neurochir 152, 1489–1492 (2010). https://doi.org/10.1007/s00701-010-0725-3

Download citation

Keywords

  • Vertebral artery dissection
  • PICA stenting
  • Enterprise
  • Stent