Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

Figure 1

(a) (Top) sagittal T1-weighted contrast enhanced brain magnetic resonance imaging (MRI) scan showing a subacute ischemic lesion of the inferior left cerebellar hemisphere in the left posterior-inferior cerebellar artery (PICA) territory and chronic cerebellar and occipital ischemic lesions; (bottom) axial T1-weighted contrast enhanced MRI image of the neck showing a giant fusiform aneurysm (arrow), containing an eccentric thrombotic formation, originating from the left vertebral artery. (b) Left subclavian angiograms showing (left) the displasic and tortuous aspect of the giant aneurysm and (right) aneurysm exclusion after the endovascular treatment by deposition of GDC vortex spirals in the proximal segment of left vertebral artery (VA) (arrow). (c) Late sequences of right vertebral angiogram performed six years after the endovascular procedure showing full revascularization of the rostral part of the aneurysm by retrograde blood flow from the patent vertebrobasilar axis. (d) Diffusion-weighted imaging (DWI) brain MRI showing new acute ischemic lesions of the cerebellum and the brainstem (arrows). (e) Sonography and Color Doppler Ultrasound of neck vessels showing the aneurysm (3.5 cm) and the biphasic flow in the left vertebral artery supportive of the embolic etiology of the new ischemic stroke. (f) Surgery of the giant aneurism by aneurysmorraphy with thrombectomy: aneurysm exposure and isolation from the surrounding tissue.

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