Intravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: technical case report

Neurosurgery. 2002 Jan;50(1):213-6; discussion 216-7. doi: 10.1097/00006123-200201000-00034.


Objective and importance: An innovative stenting technique to treat a difficult case of a fusiform aneurysm of the intracranial vertebral artery (VA), with restoration of the vessel lumen, is described.

Clinical presentation: A 58-year-old patient experienced sudden pain in the upper cervical spine, followed by a severe headache. He underwent computed tomographic evaluation, which demonstrated subarachnoid hemorrhage in the prepontine cistern. A fusiform aneurysm of the distal right VA and critical stenosis of the left VA were detected in digital subtraction angiograms. The patient experienced a new subarachnoid hemorrhaging episode, and urgent endovascular treatment was planned.

Intervention: The patient underwent angioplastic and stenting procedures in the left VA, with good results. Forty-eight hours later, an endovascular procedure was performed to treat the right VA aneurysm. We decided to use a graft stent (Jostent graft stent; Jomed, Conroe, TX) instead of a balloon to preserve the arterial lumen. The complete procedure was well tolerated by the patient, and he was discharged, without symptoms, 48 hours later.

Conclusion: The patient was discharged, without neurological deficits, 48 hours after completion of the endovascular procedure, with clopidogrel (75 mg/d) and aspirin (325 mg/d) therapy. This treatment was discontinued after 4 weeks. According to our search of the medical literature, this is the first clinical case in which an intracranial fusiform aneurysm was permanently sealed with a graft stent.

Publication types

  • Case Reports

MeSH terms

  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / therapy*
  • Angioplasty, Balloon
  • Cerebral Angiography
  • Humans
  • Male
  • Middle Aged
  • Retreatment
  • Stents*
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / therapy
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vertebral Artery Dissection / diagnostic imaging
  • Vertebral Artery Dissection / therapy*
  • Vertebrobasilar Insufficiency / diagnostic imaging
  • Vertebrobasilar Insufficiency / therapy*