Late morphological progression of a dissecting basilar artery aneurysm after staged bilateral vertebral artery occlusion: Case report

Brian A. O'Shaughnessy, Christopher C. Getch, Bernard R. Bendok, H. Hunt Batjer

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: The authors present a patient who experienced late (5-year follow-up) morphological progression of a dissecting aneurysm of the distal basilar artery after treatment with a combined microsurgical and neuroendovascular Hunterian strategy. In addition to postulating about the possible reasons underlying the evolution of this lesion, the role of stenting is discussed. Case Description: The patient was 37 years old when she suffered a subarachnoid hemorrhage from spontaneous basilar artery dissection. At the time of the hemorrhage, minimal aneurysmal enlargement was noted angiographically, and she was therefore treated nonoperatively. On reimaging 5 months later, massive enlargement of the aneurysm was noted. The patient was treated with staged bilateral vertebral artery sacrifice using a combination of microsurgical and neuroendovascular techniques. The dominant vertebral artery was clip-ligated distal to the posteroinferior cerebellar artery, whereas the contralateral vertebral artery was coil-occluded cervically 1 week later. Conclusions: Despite the patient remaining asymptomatic, follow-up angiography 5 years after the initial hemorrhage revealed further enlargement of the aneurysm as well as a newly discovered inferiorly projecting daughter sac measuring 5 mm in diameter. Clearly, certain aneurysms exist for which indirect approaches involving hemodynamic attenuation fail to prevent progression. With greater refinements in stent technology, such lesions may be more effectively treated.

Original languageEnglish (US)
Pages (from-to)236-243
Number of pages8
JournalSurgical neurology
Volume63
Issue number3
DOIs
StatePublished - Mar 2005

Keywords

  • Basilar artery
  • Bilateral vertebral occlusion
  • Dissecting aneurysm
  • Endovascular coiling
  • Hunterian
  • Pseudoaneurysm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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