[Serial angiographical changes of a ruptured dissecting vertebral aneurysm]

Area of Science:

• Vascular Neurology
• Interventional Neuroradiology
• Cerebrovascular Diseases

Background:

• Dissecting aneurysms of the vertebral artery are a rare cause of subarachnoid hemorrhage.
• Management strategies for these aneurysms are not well-established, particularly regarding the natural history of the aneurysm after rupture.

Observation:

• A 54-year-old woman presented with subarachnoid hemorrhage due to a ruptured right vertebral artery dissecting aneurysm.
• Initial angiography showed fusiform dilatation and a pseudo lumen, treated conservatively.
• Serial angiograms demonstrated significant, spontaneous fluctuations in aneurysm caliber over 204 days, including periods of normalization and reappearance of dilatation.

Findings:

• The dissecting aneurysm exhibited dynamic changes, including regression and recurrence of fusiform dilatation, potentially due to intramural hematoma organization.
• These rapid, serial angiographical changes in a dissecting aneurysm are unprecedented in medical literature.
• Conservative management led to gradual clinical improvement despite the fluctuating angiographic findings.

Implications:

• Repeated angiographic follow-up is crucial for monitoring the evolution of dissecting aneurysms after rupture.
• Spontaneous regression and recurrence of aneurysmal dilatation can occur, potentially altering treatment decisions.
• Clinicians must be aware of these dynamic changes to avoid overlooking significant aneurysmal evolution and to guide appropriate management.