Sugiu Kenji, Takahashi Kenji, Muneta Koji, Ohmoto Takashi
Department of Neurological Surgery, Okayama University Medical School, Okayama, Japan.
Surg Neurol. 2004 Apr;61(4):365-70; discussion 370. doi: 10.1016/S0090-3019(03)00515-9.
A stent-assisted coil embolization has been applied as a novel choice of treatment for vertebral artery dissecting aneurysms (VADAs).
A 45-year-old man suffered from subarachnoid hemorrhage three times within 2 hours. The left vertebral angiogram showed a VADA at the distal origin of the posterior inferior cerebellar artery. The right vertebral artery was hypoplastic, and collateral circulation to the posterior fossa was poor.
Stent-assisted coil embolization was performed under general anesthesia. The aneurysm was excluded from the circulation with good patency of the vertebral artery, although the fourth coil caused rebleeding from the aneurysmal dome during the procedure.
This is the first case report that demonstrates rebleeding from VADA during stent-assisted coil embolization in the acute stage of its rupture. We have to be aware of the risks and be ready to prevent fatal complications with this novel technique.
支架辅助弹簧圈栓塞术已成为椎动脉夹层动脉瘤（VADA）治疗的一种新选择。
一名45岁男性在2小时内发生3次蛛网膜下腔出血。左椎动脉血管造影显示小脑后下动脉远端起始处有一个VADA。右椎动脉发育不全，后颅窝侧支循环不良。
在全身麻醉下进行支架辅助弹簧圈栓塞术。动脉瘤被排除在血液循环之外，椎动脉通畅良好，尽管在手术过程中第4个弹簧圈导致动脉瘤穹窿再次出血。
这是首例关于VADA在破裂急性期支架辅助弹簧圈栓塞术中发生再次出血的病例报告。我们必须意识到这种新技术的风险，并随时准备预防致命并发症。
