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Published on: November 8, 2024
Temporary frame coil technique for ruptured vertebral artery dissection involving major branch presentation:
Koki Nakazato1,2, Takayuki Imai1,2, Takahiro Kawashima1,2
1Department of Neurosurgery, Tatebayashi Kosei General Hospital, Tatebayashi, Gunma.
Background:
Endovascular internal trapping is the first-line treatment for ruptured vertebral artery dissection (VAD). However, when critical branches such as the posterior inferior cerebellar artery (PICA) or the anterior spinal artery (ASA) are involved with the dissected segment, the risk of surgery-related ischemia is high.
Observations:
Two patients with ruptured VAD involving critical branches were treated using the temporary frame coil technique. In the first case, a distal temporary frame coil protected the PICA origin during proximal coil embolization and was subsequently retrieved. In the second case, the temporary frame coil protected the distal ASA origin during coil embolization of the dissected segment and was subsequently retrieved. In both cases, antegrade flow into the dissected segment was eliminated, while perfusion of the distal PICA or the ASA was maintained via the contralateral vertebral artery. No cerebral infarction or permanent neurological deficits occurred, and follow-up angiography confirmed durable occlusion without recurrence.
Lessons:
The temporary frame coil technique allows parent artery occlusion while preserving critical branch vessels using coils alone. This approach may treat ruptured VAD in the acute hemorrhagic phase without additional intravascular devices or dual antiplatelet therapy. https://thejns.org/doi/10.3171/CASE2660.
