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British Journal of Radiology (2006) 79, e166-e170
© 2006 British Institute of Radiology
doi: 10.1259/bjr/89133751
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Mechanically-induced proximal arterial occlusion and stent-within-a-stent technique for the treatment of bilateral vertebral artery dissecting aneurysms

T-K Kim, MD 1 S I Seo, MD 1 H Y Seol, MD 1 B J Kwon, MD 2 and M H Han, MD 2

1 Department of Diagnostic Radiology, Korea University, College of Medicine, Seoul, 2 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea


Figure 1
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  		Figure 1. Initial angiography.(a) Right vertebral artery (VA) injection angiography shows the eccentric location of the aneurysm relative to the V4 segment of the VA. Tapered proximal and distal narrowing suggests dissection. (b) Left VA injection angiography reveals a fusiform aneurysm in the infra-PICA location.

 

Figure 2
Figure 2
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  		Figure 2. Intervention.(a) Lateral left vertebral artery (VA) angiography after the implantation of one coronary stent reveals a partial contrast stasis in the aneurysmal sac in the venous phase. (b) Lateral left VA angiography after three coronary stents implanted with a "stent-within-a-stent" technique reveals further stasis in the aneurysmal sac in the venous phase. Stents are barely visible due to their poor radiopacity. (c) Right VA test injection before the positioning of the guiding catheter reveals an unusually winding course at C5 level. (d) Right VA test injection immediately after the positioning of the 6 F guiding catheter at the origin of the right VA reveals complete occlusion at the C5 level. (e) Fluorography of the neck 30 min after the right VA occlusion reveals contrast stasis without any movement, although a bolus of verapamil was administered and the guiding catheter had been withdrawn. (f) Left VA angiography after the right VA occlusion reveals the retrograde filling of the right PICA and infra-PICA dissecting aneurysm.

 

Figure 3
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  		Figure 3. 8 months after.(a) Right innominate artery angiography revealed complete occlusion of the right vertebral artery (VA) with a minute stump filling. (b) Lateral left VA angiography revealed absent flow below the right PICA, with a preservation of flow to the right PICA and a decreased fusiform aneurysm of the left infra-PICA location, with patency of the stents.

 




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