Successful endovascular reconstruction of acutely ruptured pseudoaneurysm of the vertebral artery, complicated by isolated vertebrobasilar circulation and symptomatic vasospasm

Khan, Shah-Naz Hayat; Abruzzo, Todd A.; Ringer, Andrew J.

doi:10.1016/j.clineuro.2009.07.008

« Previous Next »Clinical Neurology and Neurosurgery
Volume 111, Issue 10 , Pages 868-873, December 2009

Successful endovascular reconstruction of acutely ruptured pseudoaneurysm of the vertebral artery, complicated by isolated vertebrobasilar circulation and symptomatic vasospasm

Shah-Naz Hayat Khan
- Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine, Cincinnati, OH, USA
- Department of Neurosurgery, Marshfield Clinic, Marshfield, WI, USA
- Cerebrovascular and Skull Base Surgery Program, Department of Surgery, Division of Neurosurgery, St. Louis University, School of Medicine, 3635 Vista Avenue at Grand Boulevard, St. Louis, MO 63110-0250, USA
- Corresponding author at: St. Louis University, School of Medicine, Cerebrovascular and Skull Base Surgery Program, Department of Surgery, Division of Neurosurgery, 3635 Vista Avenue at Grand Boulevard, St. Louis, Mo 63110-0250, USA. Tel.: +1 314 577 8715; fax: +1 314 268 5061.
Todd A. Abruzzo
- Department of Neuroradiology, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine and Mayfield Clinic, Cincinnati, OH, USA
Andrew J. Ringer
- Department of Neuroradiology, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine and Mayfield Clinic, Cincinnati, OH, USA
- Department of Neurosurgery, University of Cincinnati (UC) Neuroscience Institute, UC College of Medicine and Mayfield Clinic, Cincinnati, OH, USA

Received 23 December 2008; received in revised form 2 July 2009; accepted 4 July 2009.

Abstract

The management of a ruptured pseudoaneurysm of intracranial vertebral artery (VA), which is the sole supplier to an isolated vertebrobasilar system, is challenging. The authors report on such a case in a 49-year-old man who suffered a grade III subarachnoid hemorrhage (SAH) caused by a dissecting fusiform pseudoaneurysm of the left VA. The right VA terminated in the posterior inferior cerebellar artery and posterior communicating arteries were absent. The patient developed symptoms consistent with vasospasm on day 9 after SAH, which was treated by intra-arterial vasolytic therapy, followed by stent placement and “in-stent” balloon angioplasty. Angiography 2 weeks later showed near-complete resolution of the pseudoaneurysm. At discharge, the patient's modified Rankin score was one. In this complicated case in which an isolated vertebrobasilar circulation precluded parent vessel sacrifice, we detail the successful management using a combination of intra-arterial vasolytic therapy, stent reconstruction, and balloon angioplasty.

Keywords: Endovascular reconstruction, Isolated vertebrobasilar system, Pseudoaneurysm, Sole stenting, Vertebral artery