Endovascular Management of Symptomatic Intracranial Pseudoaneurysm and Intimal Flow-Limiting Dissection with a Single Device.

The natural history of unruptured dissections of the intracranial vertebral artery (VA) is not well delineated. The dissected VA may heal spontaneously or may be associated with ischemic events. The literature on medical management for intracranial VA dissections is also limited. Some patients may develop pseudoaneurysms that can rupture and cause subarachnoid hemorrhage, which is associated with high morbidity and mortality rates. The authors present a challenging case of bilateral VA dissections associated with left VA pseudoaneurysm that was initially managed medically. Imaging follow-up demonstrated rapid progression with flow-limiting dissection and increase in pseudoaneurysm size. The decision making of the case and procedural nuances are discussed in this video case report (Video 1).