Combined microsurgical PICA-PICA bypass and endovascular parent artery occlusion for a ruptured dissecting vertebral artery aneurysm

Neurosurg Focus. 2015 Jan;38(VideoSuppl1):Video3. doi: 10.3171/2015.V1.FOCUS14526.

Abstract

Dissecting vertebral artery (VA) aneurysms are difficult to obliterate when the parent artery cannot be safely occluded. In this video, we demonstrate a combined microsurgical and endovascular treatment technique for a ruptured, dissecting VA aneurysm incorporating the origin of the posterior inferior cerebellar artery (PICA). We first performed a PICA-PICA side-to-side bypass to preserve flow through the right PICA. An endovascular approach was then utilized to embolize the proximal portion of the aneurysm from the right VA and the distal portion of the aneurysm from the left VA. The video can be found here: http://youtu.be/dkkKsX2BiJI .

Keywords: bypass; endovascular procedures; intracranial aneurysm; parent artery occlusion; stroke; subarachnoid hemorrhage.

Publication types

  • Case Reports
  • Validation Study

MeSH terms

  • Cerebellum / blood supply*
  • Cerebral Angiography
  • Cerebral Revascularization / methods*
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / surgery*
  • Middle Aged
  • Vertebral Artery Dissection / complications
  • Vertebral Artery Dissection / surgery*
  • Vertebral Artery* / surgery