Vertebral artery dissecting aneurysm rupture under severe COVID-19

Response to the Letter regarding article, “Vertebral artery dissecting aneurysm rupture under severe COVID-19”

“…The relationships between SARS-CoV-2 and the dissecting aneurysm that we described in our paper are only hypothetical [2] , as Dr. Finsterer pointed out [1] . There is a report that the number of hospitalizations for acute stroke patients, especially for ischemic stroke ones, declined, resulting in that the number of hospitalizations for aneurysmal SAH patients increased relatively under the COVID-19 pandemic compared with the pre-pandemic period, although the exact reasons are unknown [3] .…”

“…We agree with the statement that the causality between SARS-CoV-2 and the dissecting aneurysm remains unclear [1] . However, we still consider that it is worth reporting the case [2] .…”

“…3) The patient had not received any medication until she was infected with COVID-19. 4) The treatment for COVID-19 was as shown in the paper [2] , and the other treatments included expectorant s (ambroxol hydrochloride and L-carbocisteine), an antibiotic (ceftriaxone sodium hydrate), a benzodiazepine receptor antagonist (flumazenil), a proton pump inhibitor (lansoprazole), infusions such as Ringer's solution and enteral nutrition. We do not consider that any of the newly presented information contributed to the development of the dissecting aneurysm.…”

Before blaming SARS-CoV-2 for intra-cerebral aneurysm formation and rupture, alternative mechanisms need to be ruled out

“…We eagerly read the article by Sato et al about an 58 years-old female with severe COVID-19 requiring mechanical ventilation from day 10 after onset of the infection, who experienced subarachnoid bleeding (SAB) 21 days after onset of COVID-19 after an episode of arterial hypertension [1] . Computed tomography angiography (CTA) of the intracerebral arteries revealed an aneurysm of the right vertebral artery (VA) distal to the posterior inferior cerebellar artery (PICA) [1] . The patient profited significantly from ventricular drainage and endovascular coiling of the aneurysm and reached a modified Rankin scale score of 2 at the four months follow-up [1] .…”

“…Computed tomography angiography (CTA) of the intracerebral arteries revealed an aneurysm of the right vertebral artery (VA) distal to the posterior inferior cerebellar artery (PICA) [1] . The patient profited significantly from ventricular drainage and endovascular coiling of the aneurysm and reached a modified Rankin scale score of 2 at the four months follow-up [1] . The study is appealing but raises concerns which require discussion.…”