Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: case report

Surg Neurol. 2005 Mar;63(3):236-43; discussion 243. doi: 10.1016/j.surneu.2004.05.037.


Background: The authors present a patient who experienced late (5-year follow-up) morphological progression of a dissecting aneurysm of the distal basilar artery after treatment with a combined microsurgical and neuroendovascular Hunterian strategy. In addition to postulating about the possible reasons underlying the evolution of this lesion, the role of stenting is discussed.

Case description: The patient was 37 years old when she suffered a subarachnoid hemorrhage from spontaneous basilar artery dissection. At the time of the hemorrhage, minimal aneurysmal enlargement was noted angiographically, and she was therefore treated nonoperatively. On reimaging 5 months later, massive enlargement of the aneurysm was noted. The patient was treated with staged bilateral vertebral artery sacrifice using a combination of microsurgical and neuroendovascular techniques. The dominant vertebral artery was clip-ligated distal to the posteroinferior cerebellar artery, whereas the contralateral vertebral artery was coil-occluded cervically 1 week later.

Conclusions: Despite the patient remaining asymptomatic, follow-up angiography 5 years after the initial hemorrhage revealed further enlargement of the aneurysm as well as a newly discovered inferiorly projecting daughter sac measuring 5 mm in diameter. Clearly, certain aneurysms exist for which indirect approaches involving hemodynamic attenuation fail to prevent progression. With greater refinements in stent technology, such lesions may be more effectively treated.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antihypertensive Agents / therapeutic use
  • Balloon Occlusion / methods*
  • Basilar Artery / diagnostic imaging
  • Basilar Artery / physiopathology*
  • Brain Stem Infarctions / diagnostic imaging
  • Brain Stem Infarctions / etiology
  • Brain Stem Infarctions / physiopathology
  • Cerebral Angiography
  • Disease Progression
  • Female
  • Functional Laterality / physiology
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / physiopathology*
  • Intracranial Aneurysm / surgery*
  • Ligation / instrumentation
  • Ligation / methods
  • Platelet Aggregation Inhibitors / therapeutic use
  • Recurrence
  • Stents / standards
  • Subarachnoid Hemorrhage / diagnostic imaging
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / physiopathology
  • Surgical Instruments
  • Time Factors
  • Treatment Failure
  • Vertebral Artery / anatomy & histology
  • Vertebral Artery / surgery*


  • Antihypertensive Agents
  • Platelet Aggregation Inhibitors