Antegrade recanalization of parent artery in internal trapping of vertebral artery dissecting aneurysm: a case report

Background: We describe a case involving technical success with internal trapping using controllable detachable coils yet antegrade recanalization of the occluded vertebral artery, in the vertebral artery dissecting aneurysm. Possible explanations for the antegrade recanalization of the occluded vertebral artery and lessons from the case are also discussed. Case Description: A 42-year-old woman with a history of stupor (Hunt and Hess grade 111) and right vertebral artery dissecting aneurysm, was admitted to our hospital. Endovascular treatment was performed. The dissecting aneurysm and affected right vertebral artery were both completely occluded, whereas the right PICA was preserved. Nine months after the embolization, follow-up angiography was performed, which revealed recanalization of the occluded right vertebral artery with a normal arterial configuration and antegrade flow into the basilar artery. The recanalized vertebral artery was located just superior and lateral to the deployed coil meshes. It was decided that no further intervention was needed. At the last clinical follow-up 15 months after the initial treatment, the patient was fully recovered. Conclusion: Even in the case of technical angiographic success in the endovascular management of a dissecting aneurysm, a prompt follow-up angiography is still crucial. Plus, if the false lumen cannot be separated from the true lumen, treatment with just a stent may not be adequate. (c) 2007 Elsevier Inc. All rights reserved.