Endovascular Treatment for Ruptured VA Dissecting Aneurysm Involving the Origin of PICA

Area of Science:

• Vascular Surgery
• Neurosurgery
• Interventional Radiology

Background:

• Ruptured vertebral artery dissecting aneurysms (VADA) have a poor prognosis due to frequent re-bleeding, particularly within 24 hours.
• Current endovascular trapping methods using coils are risky for VADA involving the posterior inferior cerebellar artery (PICA) due to potential ischemic complications.

Purpose of the Study:

• To present a simple and effective endovascular therapeutic method for ruptured VADA involving the PICA.
• To demonstrate the safety and efficacy of preserving PICA blood flow while treating VADA.

Main Methods:

• Occlusion of the affected vertebral artery (VA) near its root to promote collateral flow from the deep cervical artery.
• Utilizing controlled antegrade VA flow and retrograde flow from the contralateral VA to create a watershed at the dissecting aneurysm.
• Inducing thrombosis of the pseudolumen while maintaining antegrade blood flow to the PICA.

Main Results:

• Successful treatment of two cases of ruptured VADA involving the PICA.
• Complete thrombosis of the dissecting aneurysm was achieved in both cases.
• No ischemic complications in the PICA territory were observed.

Conclusions:

• The proposed endovascular technique is a safe and effective treatment for ruptured VADA involving the PICA.
• This method offers a viable alternative to standard trapping techniques, minimizing the risk of ischemic events.
• This approach may be considered the treatment of choice for VADA involving the PICA.