Endovascular treatment for ruptured cervical anterior spinal artery aneurysm caused by occlusive disease of bilateral vertebral arteries: A case report and literature review.

A cervical anterior spinal artery (ASA) aneurysm not concomitant with vascular malformations is extremely rare, and is treated by conservative management or direct surgery in most cases. The endovascular treatment approach for these lesions is not well-documented. We present a case of a ruptured flow-related cervical ASA aneurysm due to the occlusive disease of the bilateral vertebral arteries (VA) treated by endovascular therapy. A 77-year-old woman with acute onset of headache and right hemiparesis was transferred to our hospital. Computed tomography revealed subarachnoid hemorrhage thick in the posterior fossa. A cerebral angiogram showed tandem stenosis of the left VA and the occlusion of the right VA at the V4 segment, with an enlarged C4 radiculomedullary artery and a subsequent aneurysm on the ASA. VA angiography revealed retrograde flow through the lesion and ASA axis to posterior circulation, suggesting a flow-related etiology of the aneurysm. We embolized the aneurysm using a flow-directed microcatheter and coils, preserving the ASA axis. Then, we dilated the VA stenosis using stents to prevent aneurysm recurrence by reducing hemodynamic stress on the ASA.