Mahajan Anshu, Goel Gaurav, Das Biplab, Narang Karanjit Singh
Department of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana, India.
Asian J Neurosurg. 2018 Jul-Sep;13(3):910-913. doi: 10.4103/ajns.AJNS_59_18.
Ruptured vertebral artery (VA) dissecting aneurysm carries high risk of rerupture and mortality if not treated immediately. Dissecting aneurysm of the VA involving the posteroinferior cerebellar artery (PICA) origin is difficult to treat by surgical and endovascular route. With the availability of flow diversion device for reconstructive procedure, endovascular treatment has now become easy to treat difficult aneurysm while maintaining the patency of the PICA. However, instead of using flow diverter (FD) in our case, we successfully treated dissecting VA aneurysm involving the PICA origin with retrograde stent placement from distal right VA to the left PICA to maintain the patency of PICA and occlusion of dissecting aneurysm of VA with detachable coils instead of performing surgical bypass and FD placement.
椎动脉（VA）夹层动脉瘤破裂如果不立即治疗，再破裂和死亡风险很高。累及小脑后下动脉（PICA）起源的VA夹层动脉瘤通过手术和血管内途径治疗都很困难。随着用于重建手术的血流导向装置的出现，血管内治疗现已变得易于治疗困难的动脉瘤，同时保持PICA的通畅。然而，在我们的病例中，我们没有使用血流导向装置（FD），而是通过从右侧椎动脉远端向左侧PICA逆行置入支架，成功治疗了累及PICA起源的VA夹层动脉瘤，以保持PICA的通畅，并使用可脱卸弹簧圈栓塞VA夹层动脉瘤，而不是进行外科搭桥和FD置入。
