PMC8102744_01
MR image detected a partially thrombosed aneurysm adjacent to the left part of medulla (A). 3D DSA image demonstrated a VADA in the fourth segment of the left VA (B). Angiography at 5 months follow-up revealed that the stent were patent with partial aneurysm residues (C). Partial residual aneurysm of the left VADA was observed on 14 months (D) and 2 years (F) follow-up angiography, and complete occlusion on 3 years (G). The volume of the aneurysm was not significantly changed from 14 months (E) and 2 years follow-up MR images (H).
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F1
A 42-years old male patient was referred to a local hospital with a sudden onset of dizziness, nausea, as well as vomiting, and MRI revealed a partially thrombosed aneurysm adjacent to the left portion of the medulla (Figure 1A). An initial DSA image demonstrated dilatation at the fourth segment of the left VA, thus indicating a VADA without the involvement of the posterior inferior cerebellar artery (PICA) (Figure 1B). Angiography conducted at 5 months after initial treatment revealed the patency of the VA and partial aneurysm residues (Figure 1C). This residual of the left VADA persisted on 14 months (Figure 1D) and 2 years (Figure 1F), and completely occluded at 3 years angiography follow-up (Figure 1G). The volume of the aneurysm did not significantly alter from 14 months (Figure 1E) and as noted in 2 years of follow-up MR images (Figure 1H), and the patient did not display any adverse symptoms after the surgery.
No abnormalities were found in the right VA at the time of 5 months after initial treatment (A). Follow-up imaging 14 months postoperatively showed a segmental dilatation and narrowing of the right VA, which suggested that a de novo VADA occurred (B). Stent-assisted coil embolization therapy was performed to occlude this de novo VADA (C). Angiography at 20 months follow-up after surgery revealed a complete occlusion of the aneurysm (D).
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F2
In addition, no major abnormalities were found in the right VA at 5 months after initial treatment (Figure 2A). Surprisingly, follow-up imaging 14 months postoperatively showed a segmental dilatation and narrowing of the right VA (Figure 2B), which suggested the formation of a de novo VADA. Under general anesthesia, Guglielmi detachable coils were positioned in the dissecting aneurysms after placing an LVIS stent in the true lumen of the VA (Figure 2C). Moreover, a 20 months angiography follow-up revealed complete occlusion of the aneurysm (Figure 2D).