Successful endovascular coil embolisation of a ruptured V1-segment vertebral artery dissecting aneurysm making a fistula with the adjacent vein

Sudden supraclavicular pain is often associated with myocardial infarction but seldom due to a rupture of V1-segment vertebral artery aneurysm. A ruptured V1 segment of vertebral artery dissecting aneurysm making a fistula with the adjacent vein has rarely been described in literature. Here we present a case of a 29-year-old healthy woman with sudden supraclavicular pain and palpable mass that developed after pain. Initial ultrasound showed suspicion of large haematoma. CT angiogram showed a left-sided dissecting V1-segment vertebral artery ruptured aneurysm. Angiography showed an additional fistula between the aneurysm and the adjacent vein. The patient was treated successfully with coil embolisation. The vertebral artery occlusion was well tolerated without any complications. Endovascular coiling is a fast and effective treatment modality. However, a parent vessel occlusion can be sometimes dangerous if the contralateral vertebral artery supply is not sufficient. Surgical possibilities to reconstruct the parent vessel should also be considered in complex cases.

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Case 26 Extracranial Left Vertebral Artery Dissecting Aneurysm Following Basilar Artery Stenting

Neurosonology and Neuroimaging of Stroke ◽

10.1055/b-0036-141803 ◽

2017 ◽

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Dissecting Aneurysm ◽

Left Vertebral Artery ◽

Vertebral Artery Dissecting Aneurysm

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Vertebral Artery Dissecting Aneurysm With Cushing's Syndrome

Neurologia medico-chirurgica ◽

10.2176/nmc.50.313 ◽

2010 ◽

Vol 50 (4) ◽

pp. 313-315 ◽

Cited By ~ 4

Author(s):

Masayasu KATO ◽

Yoshitaka TANAKA ◽

Tatsuya KURODA ◽

Toshihiko NAKASHIMA ◽

Tatsuaki HATTORI

Keyword(s):

Vertebral Artery ◽

Cushing’S Syndrome ◽

Cushing's Syndrome ◽

Dissecting Aneurysm ◽

Vertebral Artery Dissecting Aneurysm

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Clinical and radiological risk factors for rupture of vertebral artery dissecting aneurysm: significance of the stagnation sign

Journal of Neurosurgery ◽

10.3171/2021.9.jns211848 ◽

2021 ◽

pp. 1-6

Keyword(s):

Risk Factors ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Significant Risk ◽

Multivariate Logistic Regression Analysis ◽

Significant Risk Factor ◽

Tertiary Hospital ◽

Dissecting Aneurysm ◽

Irregular Surface ◽

Vertebral Artery Dissecting Aneurysm

OBJECTIVE The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA. METHODS Clinical and radiological variables of 117 VADAs treated in a tertiary hospital from September 2008 to December 2020 were retrospectively reviewed. The stagnation sign is defined as the finding of contrast agent remaining in the lesion until the venous phase of angiography. Univariate and multivariate analyses were executed to reveal the associations between rupture status and VADA characteristics. RESULTS The rate of ruptured VADAs was 29.1% (34 of 117) and the stagnation sign was observed in 39.3% (46 of 117). Fusiform shape (OR 5.105, 95% CI 1.591–16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412–12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288–11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131–9.732, p = 0.029) were significantly related to rupture of VADA in multivariate logistic regression analysis. CONCLUSIONS This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.

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