J Cerebrovasc Endovasc Neurosurg.  2021 Jun;23(2):130-135. 10.7461/jcen.2021.E2020.08.003.

Flow diversion via telescoping stent with Low-profile Visualized Intraluminal Support Junior for treatment of ruptured dissecting aneurysm located at proximal posterior inferior cerebellar artery

• Shin HK
• Koo HW
• Sohn MJ
• Park YK

• KMID: 2517026
• DOI: http://doi.org/10.7461/jcen.2021.E2020.08.003

Abstract

Dissecting aneurysm involving the posterior inferior cerebellar artery (PICA) are challenging because of its nature and anatomic relationship to medulla and lower cranial nerve. We introduce a case of ruptured dissecting aneurysm located at the proximal PICA treated with telescoping stents for flow diversion and dissection healing. A 49 years old female visited to the emergency room for ruptured dissecting aneurysm at right proximal PICA. Telescoping stent was deployed along the right vertebral artery to PICA covering the dissecting aneurysm bleb using two Low-profile Visualized Intraluminal Support Jr (LVIS Jr) stents. Three months follow up angiography revealed a disappearance of aneurysm bleb and healing of dissection by parent artery remodeling. Telescoping stent with LVIS Jr may be an effective treatment for dissecting aneurysm with small diameter (<2 mm) parent artery. Convenient navigation and targeted telescoping stent for minimizing metal coverage at perforating arteries are an advantage for this method.

Keyword

Dissecting aneurysm; Subarachnoid hemorrhage; Intracranial aneurysm

Figure

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  Fig. 1. Noncontrast brain computed tomography at the day of symptom onset. Subarachnoid hemorrhage was noted and dominant at right cerebello-medullary cistern. Intraventricle hemorrhage was also appeared at the fourth ventricle.

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  Fig. 2. Change of digital subtraction angiography between the day of subarachnoid hemorrhage (A, B, C) and follow up image which was taken four days later (D, E, F). Small dissection aneurysm bleb (black arrow) was noticed on the follow up image located at the anterior medullary segment of right posterior inferior cerebellar artery.

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  Fig. 3. (A, B) Right vertebral arteriography after the deployment of telescoping stent with LVIS Jr along the right VA and posterior inferior cerebellar artery. (C, D) Three months follow up cerebral angiography after the telescoping stent insertion. (E, F) Three months follow up digital subtraction and MIP image showing disappearance of dissection aneurysm bleb and healing of dissection (black arrow: proximal and distal tip of LVIS Jr 2.5×23 mm, white arrow: proximal and distal tip of LVIS Jr 2.5×17 mm). LVIS Jr, Low-profile Visualized Intraluminal Support Jr; VA, vertebral artery; MIP, maximum intensity projection.

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