Development of a dissecting aneurysm on the vertebral artery immediately after occlusion of the contralateral vertebral artery: A case report

Abstract

A 49 year old female presented with subarachnoid hemorrhage due to a ruptured dissecting aneurysm on the left vertebral artery (VA). Following an occlusion test, we performed proximal occlusion of the left VA with detachable balloons. However, a dissecting aneurysm on the right VA developed three weeks later. After an occlusion test had showed no change in cerebral blood flow, auditory brain stem response, or neurological status, proximal occlusion of the right VA was performed. The patient has returned to normal life without neurological deficits. Bilateral dissecting aneurysms of the VA are quite common, but de novo VA dissecting aneurysms or enlargement of such aneurysms after occlusion of contralateral VA are rare. This case suggests that hemodynamics stress may be a causal factor in the development of VA dissecting aneurysms. Careful pre- and post-operative neuroradiological examination of the contralateral VA are required in patients undergoing VA occlusion for dissecting aneurysms.

Rupture of a Vertebral Artery Dissecting Aneurysm Developing Immediately After Trapping of a Dissecting Aneurysm on the Contralateral Vertebral Artery -Case Report-

“…Hemodynamic stress may lead to the development of VA dissecting aneurysms. 4) Although the cause of the development of the right VA dissecting aneurysm in our patient remains unclear, we can think of three possible mechanisms. First, the normal right VA and BA developed a dissecting aneurysm due to hemodynamic stress after complete trapping of the left VA. Second, preexisting right VA and BA dissecting aneurysms were angiographically occult and enlarged due to hemodynamic changes after trapping of the left VA. Third, incomplete trapping, in which not all segments of the dissection were included, led to hemodynamic changes that contributed to the development of the right VA and BA dissecting aneurysms after trapping of the left VA.…”

“…Hemodynamic changes after occlusion of the VA may lead to enlargement and rupture of the contralateral dissecting aneurysm, 4) and these dissecting changes occurred a few months after the initial operation. 2,3,10) We report a patient with subarachnoid hemorrhage (SAH) due to the rupture of a VA dissecting aneurysm, who died of rupture of a contralateral VA dissecting aneurysm 8 hours after VA trapping and left occipital artery (OA) to posterior inferior cerebellar artery (PICA) anastomosis.…”

Treatment of a dissecting vertebral artery aneurysm with angioplasty and the pipeline embolisation device

“…However, the incidence of a de novo dissecting aneurysm after prior coil sacrifice of contralateral VA is low, with only a few case reports describing this outcome 1 11. The pathophysiology of such aneurysm formation remains unclear.…”

Hemifacial Spasm Developed after Contralateral Vertebral Artery Ligation

“…Increased hemodynamic stress of the VA after contralateral VA occlusion has been suggested in several cases3,12,14). There have been two reported cases of de novo dissecting aneurysm of the VA that occurred 3 weeks and 5 months after balloon occlusion of the contralateral VA. Mizutani and Aruga14) reported a case of enlargement of a pre-existing VA dissecting aneurysm after contralateral VA occlusion which presented as facial spasm 6 years after VA occlusion.…”