Vertebral Artery Aneurysm: Acute Subarachnoid Hemorrhage Due to a Dissecting V4 Aneurysm, Treatment with a Flow Diverter Stent, and Complete Reconstruction of the Vessel Lumen

  • Muhammad AlMatterEmail author
  • Marta Aguilar Pérez
  • Hans Henkes
Living reference work entry


We describe the clinical course, radiological findings, and endovascular treatment of a 58-year-old male patient who presented with headache due to a minor subarachnoid hemorrhage (SAH) resulting from a dissecting aneurysm of the intradural segment (V4) of the right vertebral artery. The aneurysm was treated on day seven after the onset of the headache by means of flow diversion with complete obliteration on the angiographic follow-up studies. The affected segment of the vertebral artery was reconstructed, and the posterior inferior cerebellar artery (PICA), which was covered by the flow diverter, remained patent. There was no recurrent hemorrhage, and the patient was asymptomatic apart from headache and neck stiffness during the follow-up period. The use of flow diversion in the setting of acute SAH due to intracranial arterial dissection is the main topic of this case report.


Dissecting aneurysm SAH Flow diverter Vertebrobasilar aneurysm 


  1. Bhogal P, Pérez MA, Ganslandt O, Bäzner H, Henkes H, Fischer S. Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients. J Neurointerv Surg. 2017a;9(5):471–81. Scholar
  2. Bhogal P, Ganslandt O, Bäzner H, Henkes H, Pérez MA. The fate of side branches covered by flow diverters – results from 140 patients. World Neurosurg. 2017b;103:789–98. Scholar
  3. Endo S, Nishijima M, Nomura H, Takaku A, Okada EA. Pathological study of intracranial posterior circulation dissecting aneurysms with subarachnoid hemorrhage: report of three autopsied cases and review of the literature. Neurosurgery. 1993;33(4):732–8.PubMedGoogle Scholar
  4. Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bäzner H, Henkes H. Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2012;54(4):369–82. Scholar
  5. Friedman AH, Drake CG. Subarachnoid hemorrhage from intracranial dissecting aneurysm. J Neurosurg. 1984;60(2):325–34.CrossRefPubMedGoogle Scholar
  6. Iihara K, Sakai N, Murao K, Sakai H, Higashi T, Kogure S, Takahashi JC, Nagata I. Dissecting aneurysms of the vertebral artery: a management strategy. J Neurosurg. 2002;97(2):259–67.CrossRefPubMedGoogle Scholar
  7. Kung DK, Policeni BA, Capuano AW, Rossen JD, Jabbour PM, Torner JC, Howard MA, Hasan D. Risk of ventriculostomy-related hemorrhage in patients with acutely ruptured aneurysms treated using stent-assisted coiling. J Neurosurg. 2011;114(4):1021–7. Scholar
  8. Mizutani T, Aruga T, Kirino T, Miki Y, Saito I, Tsuchida T. Recurrent subarachnoid hemorrhage from untreated ruptured vertebrobasilar dissecting aneurysms. Neurosurgery. 1995;36(5):905–11; discussion 912–3.CrossRefPubMedGoogle Scholar
  9. Rabinov JD, Hellinger FR, Morris PP, Ogilvy CS, Putman CM. Endovascular management of vertebrobasilar dissecting aneurysms. AJNR Am J Neuroradiol. 2003;24(7):1421–8.PubMedGoogle Scholar
  10. Ramgren B, Cronqvist M, Romner B, Brandt L, Holtås S, Larsson EM. Vertebrobasilar dissection with subarachnoid hemorrhage: a retrospective study of 29 patients. Neuroradiology. 2005;47(2):97–104.CrossRefPubMedGoogle Scholar
  11. Rinkel GJ, van Gijn J, Wijdicks EF. Subarachnoid hemorrhage without detectable aneurysm. A review of the causes. Stroke. 1993;24(9):1403–9.CrossRefPubMedGoogle Scholar
  12. Yamada M, Kitahara T, Kurata A, Fujii K, Miyasaka Y. Intracranial vertebral artery dissection with subarachnoid hemorrhage: clinical characteristics and outcomes in conservatively treated patients. J Neurosurg. 2004;101(1):25–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Muhammad AlMatter
    • 1
    Email author
  • Marta Aguilar Pérez
    • 1
  • Hans Henkes
    • 1
  1. 1.Neuroradiologische Klinik, NeurozentrumKlinikum StuttgartStuttgartGermany

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