Rapid Formation of a Large Aneurysm in a Patient with Fibromuscular Dysplasia.

OBJECTIVE

The authors report the first case of intracranial fibromuscular dysplasia (FMD) presenting with rapid formation of an unruptured large vertebral artery (VA) fusiform aneurysm.

CASE PRESENTATION

A 41-year-old man presented with left hemiparesis. He had a giant thrombosed aneurysm at the basilar artery-superior cerebellar artery (BA-SCA) junction and a left extracranial VA aneurysm. A VA fusiform aneurysm developed during a 1-month interval following the first session of intravascular coil embolization for the BA-SCA aneurysm. Stress on the fragile artery due to FMD during micro-catheterization may have caused the aneurysm. An anomalous aortic origin of the left VA may also have played a role in the formation of the large aneurysm and extracranial VA aneurysm. We performed overlapping stent-assisted coil embolization for the VA fusiform aneurysm using an Enterprise VRDs, and coil embolization for the BA-SCA thrombosed aneurysm using the stent-assisted technique with an Enterprise stent. Both aneurysms remained occluded for 7 years.

CONCLUSION

We concluded micro-catheterization to be the cause of the large aneurysm. This case emphasizes the importance of carefully performing intravascular interventional procedures for patients with FMD.