Yanai Kei, Koizumi Satoshi, Fujii Genta, Otsuka Nozomi, Shojima Masaaki, Yoshikawa Gakushi
Department of Neurosurgery, Showa General Hospital, 8-1-1 Hanakoganei, Kodaira, Tokyo 187-8510, Japan.
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Radiol Case Rep. 2025 Sep 8;20(12):5876-5880. doi: 10.1016/j.radcr.2025.08.027. eCollection 2025 Dec.
Branch involvement can serve as a predicting factor of incomplete occlusion after flow diverter (FD) treatment, including pipeline embolization device. This study reports a case of subarachnoid hemorrhage owing to bilateral vertebral artery dissection with parent artery occlusion to the left side and stent-assisted coiling to the right side. However, a marked enlargement of the dissected lesion was observed at the right dissecting aneurysm at 6 months. Considering that the posterior inferior cerebellar artery (PICA) originating from the aneurysm could prevent aneurysm occlusion after the FD, we first conducted open surgery to perform a bypass from the occipital artery to the PICA and occluded the PICA origin to eliminate blood flow from the dissection site. Subsequently, we placed a pipeline embolization device at the same location. Complete occlusion of the aneurysm was confirmed after 6 months. Thus far, only one case report of a recurrent middle cerebral artery aneurysm treated with an FD following bypass has been reported. This is the first report of a similar procedure applied to the posterior circulation and dissecting aneurysm. This report highlights the potential for successful outcomes when branches arising from an aneurysm are occluded via bypass prior to the placement of an FD.
分支受累可作为血流导向装置（FD）治疗后不完全闭塞的预测因素，包括Pipeline栓塞装置。本研究报告了一例因双侧椎动脉夹层伴左侧供血动脉闭塞及右侧支架辅助弹簧圈栓塞导致的蛛网膜下腔出血病例。然而，6个月时右侧夹层动脉瘤处观察到夹层病变明显增大。考虑到起源于动脉瘤的小脑后下动脉（PICA）可能会妨碍FD术后动脉瘤闭塞，我们首先进行了开放手术，从枕动脉到PICA进行搭桥，并闭塞PICA起始部以消除来自夹层部位的血流。随后，我们在同一位置放置了Pipeline栓塞装置。6个月后证实动脉瘤完全闭塞。到目前为止，仅有一篇关于搭桥术后用FD治疗复发性大脑中动脉瘤的病例报告。这是首次将类似手术应用于后循环夹层动脉瘤的报告。本报告强调了在放置FD之前通过搭桥闭塞动脉瘤分支从而取得成功结果的可能性。
