J Cerebrovasc Endovasc Neurosurg.  2013 Sep;15(3):229-234. 10.7461/jcen.2013.15.3.229.

The Difference of Each Angiographic Finding After Multiple Stent According to Stent Type in Bilateral Vertebral Artery Dissection

• Lee DH
• Yoon WK
• Baik MW
• Kim H

• KMID: 1491444
• DOI: http://doi.org/10.7461/jcen.2013.15.3.229

Abstract

We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.

Keyword

Aneurysm; Dissection; Stent angioplasty; Vertebral artery

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Stents
Subarachnoid Hemorrhage
Vertebral Artery
Vertebral Artery Dissection

Figure

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  Fig. 1 (A, B) Brain computed tomography (CT) shows diffuse subarachnoid hemorrhage and early hydrocephalus.

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  Fig. 2 (A, B) Initial angiograms show bilateral intracranial vertebral artery (VA) dissection. The risk of rupture was higher for the left VA because the size of the aneurysm was larger on the left side. Nevertheless, we were not certain about which side had experienced rupture (A: right, B: left). (C): Native image after bilateral VA treatment shows that 2 self-expanding nitinol stents (SESs) on the left VA and 2 balloon-mounted coronary stents (BMSs) on the right VA were deployed across the dissecting lesion. (D, E) Two-month follow-up angiograms show decreased but notable contrast filling to the aneurysm sac through the stent and increased aneurysm sac filling (D:right, E:left).

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  Fig. 3 Left VA native image shows the stent-within-a-stent construct created with three balloon expanding stents (FlexMaster F1 stent, Abbott, Abbott Park, IL, USA) in the left VA.

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  Fig. 4 Serial angiogram of the left VA. (A) Initial angiogram showing a left V4 segment dissecting aneurysm. (B) Follow-up angiogram obtained 2 months after the first treatment showing increased aneurysm sac filling. (C) Follow-up angiogram obtained 5 months after the second treatment, no in-stent stenosis and complete healing of the aneurysm and restoration of the normal caliber of the vessel is observed.

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