Abstract
A 55-year-old female patient was referred for the treatment of a giant, partially thrombosed aneurysm originating from the proximal course of the left vertebral artery (VA). This aneurysm had been found incidentally 8 years before during work-up for chronic headaches. Follow-up contrast enhanced MRA revealed a significant growth in the thrombosed part of said aneurysm. DSA showed the hypoplastic right vertebral artery mainly supplying the right posterior inferior cerebellar artery (PICA). The left vertebral artery was stenotic distal to the origin of the aneurysm. The further vessel course (the V2 and V3 segments) showed sequelae of a chronic dissection. The patient denied there having been any significant trauma or chiropractic maneuver. Other manifestations of a connective tissue disease were missing. The aneurysm was considered to be a potential source of emboli into the dependent vasculature. A rupture of this aneurysm could have caused a hemothorax. In a single endovascular treatment session, the aneurysm was loosely packed with detachable coils. The VA stenosis was dilated with a drug-eluting coronary stent. The entire V1 and the proximal V2 segments, including the origin of the aneurysm, were reconstructed using telescoping flow diverter stents. Short-term follow-up DSA confirmed the separation of the aneurysm from the blood circulation. Indications for and management of the treatment of proximal VA aneurysms are the main topics of this chapter.
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Khanafer, A., Dukiewicz, M., Bernhard, A., Jost, D., Bäzner, H., Henkes, H. (2020). Extracranial Vertebral Artery Aneurysm: Incidentally Diagnosed Dissecting Giant Proximal Vertebral Artery (V1) Aneurysm, Treated with Drug Eluting Stent Deployment, Coil Occlusion, and Flow Diversion. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_177-1
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