Endovascular treatment for ruptured PICA-involved vertebral artery dissecting aneurysm: Partial trapping preserving the PICA: A case report

Abstract

Objective: There is an ongoing debate as to the proper management of a ruptured vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA). This article describes a case of ruptured VADA successfully treated in the acute stage with endovascular intervention. Clinical Presentation: A 50-year-old male presented with subarachnoid hemorrhage and was admitted to our institution. Preoperative right vertebral angiogram showed a VADA in which the PICA arose from the wall of the aneurysm and a sufficient interval between the rupture point and the origin of PICA. The aneurysm was treated on the day of rupture while preserving the origin of PICA with limited internal trapping of the vertebral artery at the rupture point and entry into the pseudolumen (partial trapping). Postoperative MR angiography demonstrated rapid shrinkage and almost complete disappearance of the residual aneurysm within 2 months while maintaining the patency of PICA. The patient recovered completely without any episodes of recurrent hemorrhage. Conclusion: Partial trapping preserving the origin of PICA offers potential as a treatment for this complex lesion in a select group of patients. © 2008, The Japanese Society for Neuroendovascular Therapy. All rights reserved.