A patient with a large unruptured vertebral arterial aneurysm had been treated by endovascular proximal occlusion of the parent vertebral artery (VA). The aneurysm regrew however 6 months after the treatment. The 64-year- old male suffered from truncal ataxia in the pulses, came from seventh and eighth cranial nerves on the right side. Neuroradiological evidence revealed a very large, partially thrombosed VA aneurysm on the right side. Endovascular proximal occlusion of the VA was performed using an interlocking detachable coil (IDC) and a vortex proximally to the exit of the posterior inferior cerebellar artery (PICA). He recovered from the operation most successfully, with no sign of the aneurysm in the angiogram. Six months after the occlusion, however, the cerebellar symptoms reappeared. CT and three- dimensional CT angiography clearly demonstrated the aneurysmal enlargement. The patient then died abruptly of respiratory distress, probably due to compression of to the medulla. The authors discussed the hemodynamic mechanism of aneurysmal enlargement. The PICA flow and the distance between the aneurysm and the vertebral union are important factors to consider for successful VA occlusion therapy.
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