J Cerebrovasc Endovasc Neurosurg.  2024 Jun;26(2):204-209. 10.7461/jcen.2023.E2023.10.002.

Delayed fatal rupture of vertebral artery after treated with flow-diverter in fibromuscular dysplasia patient: A case report and review of the literature

• Kim MW
• Park ES
• Park ES
• Kim DW

• KMID: 2556983
• DOI: http://doi.org/10.7461/jcen.2023.E2023.10.002

Abstract

Fibromuscular dysplasia (FMD) is a noninflammatory arterial diseases that affects predominantly women. Multiple studies have demonstrated an increased prevalence of FMD in patients who experience carotid or vertebral artery dissection (VAD). This case report presents a 57-year-old female who presented with a headache and was diagnosed with partially thrombosed giant aneurysm of vertebral artery. This aneurysm was successfully treated with flow-diverter and coil, but new onset rupture of vertebral artery was detected two weeks later, leading to internal trapping. This case report underscores the need for awareness and understanding of treatment of dissection and aneurysm in patient who is suspected FMD

Keyword

Fibromuscular dysplasia; Vertebral artery dissection; Endovascular procedure; Flow-diverter; Recurrence

Figure

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  Fig. 1. (A) CT shows 25 mm sized hyperdense lesion at posterior fossa. (B) CTA showed 16 mm aneurysm at left vertebral artery. CT, computed tomography; CTA, CT angiography

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  Fig. 2. Vessel wall MRI shows 25 mm giant thrombosed aneurysm and enhanced aneurysm wall. (A) Vessel wall MRI, axial view. (B) Vessel wall MRI, sagittal view.

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  Fig. 3. (A) DSA shows aneurysm at left VA. (B) DSA shows the string of beads appearance that represented FMD (white arrow) (C) Fluoroscopy shows flow-diverter (white arrow) with coil embolization (white arrowhead). (D) DSA shows contrast stagnation after flow-diverter insertion and coil embolization. DSA, digital subtraction angiography; VA, vertebral artery; FMD, fibromuscular dysplasia

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  Fig. 4. (A) CT shows SAH, IVH at posterior fossa and temporal horn widening, indicating hydrocephalus. (B) DSA shows the contrast leakage (white arrow). (C) 3D DSA shows contrast leakage at the site of VA dissection (double white arrows). (D) 3D DSA shows new onset artery dissection at the C3 level that was not previously observed (white arrow). (E) Fluoroscopy shows endovascular internal trapping of left VA. (F) DSA shows totally occluded dissected VA segment. CT, computed tomography; SAH, subarachnoid hemorrhage; IVH, intraventricular hemorrhage; DSA, digital subtraction angiography; VA, vertebral artery

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