Deploying 5 Overlapping Enterprise Stents and Coiling for Treating Hemorrhagic Vertebral Artery Dissecting Aneurysm

Reconstructive endovascular treatment is a method that can ameliorate vertebral artery dissecting aneurysm (VADA) and preserve the parent artery. Recently, 2 or 3 overlapping stents have been used to treat VADAs through the flow-diversion effect. However, little is known about the use of >3 overlapping stents for acute treatment of hemorrhagic VADA.

A 69-year-old woman was admitted to our institute with the sudden onset of a headache. Brain computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography revealed a VADA in the right intracranial vertebral artery. The contralateral vertebral artery was hypoplastic; thus we performed a reconstructive endovascular procedure using multiple overlapping stents combined with coiling. We used 5 overlapping stents with the aim of preventing coil herniation, fixing the jailed microcatheter, and reinforcing flow diversion and achieved immediate occlusion of the aneurysmal component. Postoperative imaging showed no apparent infarction in the brainstem. Six months after the treatment, angiography revealed complete occlusion of the aneurysm. Therefore in this case, hemorrhagic VADA was successfully treated in the acute setting by 5 overlapping Enterprise stents and coiling, which also preserved the parent artery.

Reconstructive endovascular treatment using multiple overlapping stents and coiling may be a beneficial therapy for hemorrhagic VADA, especially when the contralateral vertebral artery is aplastic or hypoplastic. Using >3 overlapping stents may represent a promising, feasible technique for achieving immediate occlusion by increasing flow diversion.