PMC4228500_01
Anteroposterior (left) and lateral (right) left VA angiograms demonstrate a dissecting aneurysm arising from the left VA distal to the origin of the PICA
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F1
Endovascular treatment under general anesthesia was performed immediately after diagnostic angiography [Figure 1].
Anteroposterior (upper left) and lateral (upper right) left VA angiograms after coil embolization demonstrate complete obliteration of the dissecting aneurysm and affected left VA. Anteroposterior right VA angiography (lower) depicts obliteration of the aneurysm
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F2
The opposite right VA adequately supplied the posterior circulation and left VA perforators arising from the left VA distal to the aneurysm with retrograde flow [Figure 2].
Follow-up MRA performed 16 days after the first operation (right) shows suspected recanalization of the aneurysm, because of newly apparent flow in the left VA distal to the aneurysm (arrows) in comparison with the examination on day 1 after the first operation (left)
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F3
However, 16 days after embolization, routine follow-up magnetic resonance angiography (MRA) performed to ascertain improvement of cerebral vasospasm showed suspected recanalization of the aneurysm because of newly apparent flow in the left VA distal to the aneurysm in comparison with the examination on day 1 after the first operation [Figure 3].
Anteroposterior (upper left) and lateral (upper right) left VA angiograms, and the 3-dimensional reconstruction image (lower) obtained 16 days after first operation, revealing recanalization of the treated left VA with blood supplying the dilated segment of the aneurysm showing morphological change and antegrade flow into the BA through the part where the morphology had changed, not through the dilated segment of aneurysm
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F4
Antegrade blood flow into the basilar artery (BA) was seen through the region of morphological change, not through the dilated segment of aneurysm [Figure 4].
Skull radiography performed 16 days after the first operation (lower) shows no compaction of the framing coil in comparison with the examination on day 1 after the first operation (upper)
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F5
Additionally, skull radiography did not show coil compaction of framing coil in comparison with the examination at first day after first operation [Figure 5].
Anteroposterior (left) and lateral (right) left VA angiograms after additional coil embolization demonstrate complete obliteration of the aneurysm and affected left VA with preservation of the left PICA. The pseudolumen was mainly occluded after a microcatheter was navigated into the pseudolumen via the entrance in additional endovascular treatment
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F6
Further endovascular treatment was performed under local anesthesia, occluding the dilated segment of aneurysm, which showed morphological changes and the segment of the left VA proximal to the dilated segment [Figure 6].
At 1 month (left) and 7 months (right) after initial treatment, follow-up MRA shows no sign of recanalization of the aneurysm
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F7
At both 1 and 7 months after initial treatment, follow-up MRA showed no sign of recanalization of the aneurysm [Figure 7].