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Flow diverter implantation for CTA-negative giant vertebral artery dissection aneurysm: a case report
Jun-Ting Li1, Jian-Min Liu2, Kai-Jun Zhao1
1Department of Neurosurgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Objective:
To evaluate the efficacy of flow diverter implantation for treating CTA-negative giant vertebral artery dissection aneurysm (VADA) and to address the challenges in lesion characterization using MRI.
Methods:
A 66-year-old male patient presented with a 3-month history of left facial numbness and dysarthria. Initial MRI-T1 revealed a mixed signal intensity lesion in the CPA region. However, both CTA and digital subtraction angiography (DSA) failed to identify any significant vascular abnormalities. Subsequently, CT-perfusion and dynamic contrast-enhanced computed tomography (DCE-CT) were performed to further characterize the lesion.
Results:
DCE-CT revealed a giant VADA, which was significantly larger than the lesion initially detected by MRI and was identified as the cause of hypoperfusion in the posterior circulation. Based on these findings, a flow diverter implantation procedure was performed successfully without complications. Angiographic follow-up at 8 months demonstrated no recurrence of the lesion. At the 14-month clinical follow-up, the patient exhibited complete resolution of symptoms, with a mRS score of 0, indicating an excellent functional outcome.
Conclusion:
Flow diverter implantation may be an effective treatment for CTA-negative giant VADAs. The limitations of MRI in accurately characterizing lesion size underscore the necessity of advanced imaging techniques, such as DCE-CT, for precise device selection and deployment.
