Aneurisma dissecante de artéria vertebral intracraniana fenestrada submetido ao tratamento endovascular: relato de caso

Abstract

RESUMO -Aneurismas dissecantes da artéria vertebral em seu segmento intracraniano são lesões pouco comuns, principalmente quando associadas a hemorragia subaracnóidea, sendo também raras as fenestrações da artéria vertebral. Apresentam elevada morbidade e mortalidade, com elevado índice de ressangramento e dificuldade de abordagem cirúrgica. Apresentamos o caso de um homem de 19 anos, o qual foi vitima de agressão física em região occipto-cervical, apresentando hemorragia subaracnóidea e aneurisma dissecante na artéria vertebral direita, a qual era fenestrada, sendo submetido ao tratamento endovascular. Realizamos revisão da literatura sobre o assunto, sendo colocado o tratamento endovascular como uma opção terapêutica para estes casos.PALAVRAS-CHAVE: aneurisma dissecante, hemorragia subaracnóidea, artéria vertebral. Dissecting: aneurysm of the intracranial fenestrated vertebral artery submited to endovascular treatment case reportABSTRACT -Dissecting aneurysms of the vertebral artery at its intracranial segment are uncommon lesions, mainly when associated to subarachnoid hemorrhage, being also rare fenestrations of the vertebral artery. They present high morbidity and mortality, with high rebleeding rate and difficulty of surgical approach. We present a 19 years old man who was victim of physical aggression in the occipto-cervical region, presenting subarachnoid hemorrhage and a dissecting aneurysm of the right vertebral artery, which had a fenestration, being submitted to endovascular treatment. We accomplished a literature review about this subject, proposing endovascular treatment as a therapeutic option for these cases.

Dissecting Aneurysm of the Vertebral Artery and Behçet’s Disease

“…Surgical treatment has been considered the first choice for ruptured cerebral aneurysms associated with BD, especially saccular aneurysms of the middle cerebral artery 9 . However, endovascular treatment is a reasonable alternative to surgery in ruptured, peripherally located, fusiform-shaped, dissecting pseudo-aneurysms, and posterior circulation aneurysms, not only in BD 8 , but also in other settings 6,12 .…”

Unusual Finding of Vertebral Artery Fenestration in Spontaneous Deep Nuclear Hemorrhage

“…Several theories have been implicated for the development of the fenestration in the intracranial vasculature. Arterial dissection and a thromboembolic event could have been the causes for the basal ganglia bleed that has been majorly supplied by middle cerebral artery perforators [ 14 ]. Since the hemodynamic effect in the majority of the developmental vascular anomalies gives rise to the growth of an aneurysm, there is no such clarification to explain the basal ganglia bleed and the fenestrated vertebral artery.…”

Endovascular treatment of a basilar artery dissecting aneurysm

“…Finally, a stent also provides a matrix for endothelial growth. The luminal surface of the stent is covered by a layer of neointima and the segment from which the aneurysm arises is thereby remodeled 1,[17][18][19][20] . The approach to posterior circulation arteries by endovascular devices is quite direct and now there are available new, autoexpansible stents designed for intracranial use.…”