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case_images: (A, B) MRI diffusion weighted images showed multiple high-intensity areas at left posterior lobe(yellow arrow), right cerebellum(blue arrow) and left thalamus(red arrow) of the left posterior cerebral artery (PCA) and the right superior cerebellar artery (SCA) territory (C) Magnetic resonance angiography (MRA) showing no significant stenosis of the intracranial main artery.
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case_images: TX Quasar, Philips) revealed multiple high-intensity areas at left posterior lobe, cerebellum, and left thalamus of the left posterior cerebral artery (PCA) and the right superior cerebellar artery (SCA) territory (Figure 1A,B). Magnetic resonance angiography (MRA) showed no significant severe stenosis or occlusion of the intracranial arteries (Figure 1C).
case_images: (A) Three-dimensional computed tomography angiography showed a 40 mm diameter fusiformic aneurysm from the proximal right vertebral artery(yellow arrows). (B) Antero-posterior view on right vertebral artery angiography showed a gourd-shaped aneurysm at theV1 segment of vertebral artery (yellow arrows). (C) Antero-posterior view on left vertebral artery angiography showing elongation of intracranial vertebral and basilar artery.
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case_images: Three-dimensional computed tomography angiography (3D-CTA, Aquilion PRIME, Canon Medical Systems Corporation) and digital subtraction angiography (DSA) demonstrated right subclavian artery fusiformic aneurysm with thrombosis, which diameter was 40 mm involving the right extracranial vertebral artery (VA) at V1 segment (Figure 2A,B). The right intracranial VA was elongated, but there was no severe stenosis or occlusion. There was no difference in the development of both vertebral arteries (Figure 2C).
case_images: MRI T1 (A) and T2-weighted coronal images (B) showed a low intensity into the aneurysm suggested thrombotic change. (C) Ultrasound sonography also showed thrombotic change as low echo signal at the ventral side of aneurysm (yellow arrow heads).
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case_images: MRI T1- and T2-weighted image showed low intensity area within the aneurysm (Figure 3A,B). And the ultrasonography also showed a low-echo signal on the ventral side of the aneurysm (Figure 3C), which was thought to be a thrombus.
case_images: (A) Intraoperative findings: Antero-posterior view on right vertebral angiography: Coiling was filled from the right vertebral artery distal to the aneurysm. (B) Anteroposterior view on postoperative right subclavian angiography confirming complete obliteration of the aneurysm and occlude right vertebral artery (yellow arrows). (C) Anteroposterior view on postoperative left vertebral angiography showed retrograde flow of the right distal vertebral artery.
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case_images: Then the coil packing was applied from this region to occlude the distal side of the right vertebral artery (Figure 4A). After the procedure, no aneurysm was visualized by postoperative right subclavian artery angiography (Figure 4B), and left subclavian artery angiography showed the right distal VA was filled retrogradely (Figure 4C).