A Case of a Ruptured Vertebral Artery Dissecting Aneurysm Involving the Anterior Spinal Artery

A 53-year-old man presented to our hospital with a chief complaint of headache with no neurological deficit. Computed tomography (CT) showed subarachnoid hemorrhage in the left ambient cistern. Cerebral angiography revealed a fusiform-shaped aneurysm at the origin of the left vertebral artery (VA). We performed endovascular treatment using stent with coiling. Left VA angiography showed the anterior spinal artery arising from the middle part of the true lumen and revealed contrast material retrograde inflow into the pseudo-lumen from the distal potion of the dissection. Therefore, we introduced a microcatheter to the left VA across the right VA and the entry at the distal side of the aneurysm, embolized the pseudo-lumen, and concomitantly deployed the stent from the left VA to the true lumen of the dissection to preserve the anterior spinal artery. After coil embolization of the aneurysm, the anterior spinal artery was preserved, and the parent artery was well reconstructed. Despite persistent truncal ataxia, the patient has been subjected to follow-up as an outpatient (modified Rankin Scale score: mRS 2) and remains recurrence-free three months postoperatively.