Treatment of a vertebral dissecting aneurysm with stents and coils: technical case report

Neurosurgery. 1998 Aug;43(2):385-8. doi: 10.1097/00006123-199808000-00132.

Abstract

Objective and importance: A clinical case of a dissecting aneurysm of the intracranial vertebral artery successfully treated with a combination of stents and coils is presented. The importance of long-term follow-up and the development of suitable materials and devices are emphasized.

Clinical presentation: This 48-year-old man with a history of progressive bilateral loss of vision caused by glaucoma developed sudden headache, nausea, and vomiting. At admission, he presented with psychomotor agitation and neck pain. A neurological examination showed bilateral IInd and VIth cranial nerve palsy and neck stiffness. Computed tomography demonstrated a diffuse subarachnoid hemorrhage. Digital subtraction angiography showed a fusiform dilation of Segment IV of the left vertebral artery, with a double lumen sign.

Technique: A bifemoral intra-arterial approach was used. A FasTracker 18 (Target Therapeutics, Fremont, CA) microcatheter was advanced through the true arterial lumen and was then replaced by a self-expandable metallic wall stent. Because of reduced radiopacity, a balloon-expandable metallic stent was then placed as well. Next, with a FasTracker 10 advanced through the stent mesh, the aneurysm was embolized using Guglielmi detachable coils.

Conclusion: We applied a new technique to treat a dissecting aneurysm of the intracranial portion of the vertebral artery with a combination of stents and coils. Further work is required on the tracking, flexibility, and thrombogenic properties of diverse materials and devices. This evolving technology may play a role in the near future as the alternative of choice in some cases of aneurysm treatment via the endovascular route.

Publication types

  • Case Reports

MeSH terms

  • Aneurysm, Dissecting / diagnostic imaging
  • Aneurysm, Dissecting / therapy*
  • Angiography, Digital Subtraction
  • Cerebral Angiography
  • Combined Modality Therapy
  • Embolization, Therapeutic / instrumentation*
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Neurologic Examination
  • Stents*
  • Tomography, X-Ray Computed
  • Vertebral Artery* / diagnostic imaging