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Asian J Neurosurg. 2019 Apr-Jun;14(2):561-564. doi: 10.4103/ajns.AJNS_251_18.

Staged Endovascular Treatment of Ruptured Vertebral Artery Dissection Involving the Posterior Inferior Cerebellar Artery.

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Department of Neurosurgery, Koseikai Takeda Hospital, Kyoto, Japan.
Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Neurosurgery, Uji Tokushukai Medical Center, Kyoto, Japan.
Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.


In the treatment of vertebral artery (VA) dissection involving the origin of the posterior inferior cerebellar artery (PICA), the prevention of rebleeding and the preservation of VA and PICA patency are challenging. We report a case with ruptured VA dissection involving the origin of the PICA. In the acute stage, the fusiform dilatation of the dissection was first treated by means of stent-assisted coil embolization. Dual-antiplatelet therapy was administered just before stent placement. Seven days after the first treatment, two additional stents without coils were added. Rebleeding did not occur, and the lesion was thrombosed successfully 4 days after the second treatment, with the preservation of VA and PICA patency. This staged therapy appears to be beneficial in preventing rebleeding and in preserving VA and PICA patency.


Antiplatelet therapy; endovascular treatment; stent-assisted coil embolization; vertebral artery dissection

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