Neurointervention.  2020 Jul;15(2):84-88. 10.5469/neuroint.2019.00276.

Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery

• Terakado T
• Nakai Y
• Ikeda G
• Tsukada K
• Hanai S
• Akutagawa K
• Igarashi H
• Konishi T
• Shiigai M
• Uemura K

• KMID: 2503394
• DOI: http://doi.org/10.5469/neuroint.2019.00276

Abstract

We herein report a case of a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery that was treated using the stent-jack technique. After parent artery occlusion of the distal vertebral artery, stenting of the posterior inferior cerebellar artery was performed. Further coiling was needed because distal vertebral artery recanalization occurred due to transformation of the coil mass. The stent-jack technique for a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery is effective; however, careful attention to recanalization after stenting is needed due to transformation of the coil mass.

Keyword

Dissecting aneurysm; Vertebral artery; Subarachnoid hemorrhage

Figure

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  Fig. 1. Treatment course. (A) Posterior inferior cerebellar artery (PICA) (arrow) branches from the middle of the vertebral artery dissecting aneurysm (VADA). The entire length of the dissection (asterisk) needs to be embolized. (B) The distal vertebral artery (VA) from the PICA was densely embolized, while the proximal VA involving the PICA was sparsely embolized. (C) Antegrade VA blood flow disappeared after coiling. (D) The coil shape was changed (arrowheads) by the deployment of Enterprise VRD 4×30 mm. (E) Recanalization of antegrade VA blood flow just after stenting. (F) The coil shape after treatment. The distal VA was densely embolized, while the proximal VA was sparsely embolized and the stent was deployed from the PICA to VA. (G) VADA disappeared, and PICA flow was preserved as shown by digital subtraction angiography just after the treatment. (H) VADA disappeared 1 week after treatment.

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  Fig. 2. Schema of the vertebral artery dissecting aneurysm (VADA) treatment. a: vertebral artery (VA) occlusion and occipital artery (OA)–posterior inferior cerebellar artery (PICA) bypass; b: proximal VA trapping to decrease flow to VADA; c: distal VA occlusion and PICA stenting; d: stenting to the VA (and coiling to VADA). ASA, anterior spinal artery.

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