Coil Embolization for Ruptured Dissection on the Vertebral Artery Distal to the Origin of Posterior Inferior Cerebellar Artery

Although many surgical or endovascular treatments for ruptured vertebral dissection have been reported, the best treatment remains controversial. Recently endovascular vertebral occlusion using coils has been reported, the appropriate occlusion site has not yet been fully discussed.

Five cases of ruptured vertebral dissection located distally to the origin of posterior inferior cerebellar artery were occluded by platinum coil packing in the angiographical “pearl” portion or “fusiform dilatation” together with its proximal vertebral artery. All dissections were occluded completely together with occlusion of distal portion of vertebral artery to PICA's origin. No complications related to procedure were seen in this series.

Occlusion of rupture point with preserving tiny perforators arising from vertebral artery would be an ideal method for this lesion. The present cases suggest that the short segment occlusion by coil packing in the angiographical “pearl” portion or “fusiform dilatation” together with its proximal vertebral artery would be near to the ideal.