Ruptured Vertebral Artery Dissecting Aneurysm Concurrent with Spontaneous Cervical Internal Carotid Artery Dissection: A Report of Three Cases and Literature Review.

Abstract

Multiple dissections rarely occur with ruptured vertebral artery dissecting aneurysms (VADAs). Here we report 3 cases of ruptured VADA concurrent with spontaneous cervical internal carotid artery (ICA) dissection. None of the 3 patients had a history of vasculopathy or trauma. All ruptured VADAs were treated with internal coil trapping in the acute stage of subarachnoid hemorrhage (SAH). Rebleeding was not observed in any patients after the treatment. In 1 patient, carotid artery stenting (CAS) was performed 3 days after VADA obliteration to improve hemodynamic compromise. In another patient, CAS was performed 3 weeks after treatment because the dissecting lesion was gradually enlarging. In the third patient, the dissecting lesion resolved with conservative management. The clinical management of patients with SAH and cervical ICA dissection is complicated. Given that rebleeding of VADA is fatal, achieving hemostasis is the priority. Subsequently, ICA revascularization should be considered to manage ischemic stroke or aneurysmal changes, depending on the SAH stage. In contrast to the typically benign course of sporadic cervical ICA dissection, hemodynamic changes related to SAH and internal trapping of a VADA may exacerbate the cervical ICA dissection. Careful follow-up may be required for cervical dissecting aneurysms in this specific pathological setting.