PMC3928346_01
Three dimensional computed tomography angiography shows left vertebral artery mild stenosis on admission day and magnetic resonance angiography shows no interval change of left vertebral artery stenosis on 5th hospital days.
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F1
On day 5, the patient underwent magnetic resonance angiography at a follow-up, showing no interval change of left vertebral artery stenosis (Fig. 1).
On day 10, complex vertebral dissecting aneurysm of long segment includs posterior inferior cerebellar artery origin by transfemoral cerebral angiography (AP, Lateral, Oblique view).
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F2
On day 10, the patient underwent transfemoral cerebral angiography (TFCA) showing complex vertebral dissecting aneurysm of long segment arising from the PICA (Fig. 2).
Tonsilomedullary and telovelotonsilar segments of the right posterior inferior cerebellar artery (PICA) shows parallel course compared with contralateral same segments of PICA.
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F3
In this patient, we decided on the segmental occlusion using a coil with stent insertion of contralateral vertebral artery after PICA-to-PICA bypass surgery because of the proximity and parallel course of the distal segments of the PICA (Fig. 3).
Posterior inferior cerebellar artery (PICA) to PICA side anastomosis was done and the patency looks well by intraoperative indocyanine green angiography.
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F4
After removal of temporary clips, a good patency was also seen on intraoperative indocyanine green angiography (Fig. 4).
Post-revascularization transfemoral cerebral angiography after posterior inferior cerebellar artery (PICA) to PICA anastomosis shows the good patency of both PICA from right vertebral artery (VA) and still shows Lt. VA-PICA dissecting aneurysm.
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F5
TFCA, a PICA to PICA anastomosis achieved a good patency of both PICA from the right vertebral artery (VA) (Fig. 5).
Post endovascular segmental occlusion using coil with stent shows total occlusion of vertebral artery dissecting aneurysm and both posterior inferior cerebellar artery was patent.
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F6
Then, the patient underwent segmental occlusion using a coil with stent insertion of contralateral vertebral artery. The patient finally, achieved a total occlusion of the dissecting aneurysms and a good patency of both PICA territories (Fig. 6).