[Stent-assisted embolization for ruptured vertebral artery dissection involving the origin of the posterior inferior cerebellar artery:a case report of staged strategy].

We report a ruptured vertebral artery dissection (VAD) involving the origin of the posterior inferior cerebellar artery(PICA)treated by a staged strategy with stent-assisted coil embolization. A 52-year-old woman was admitted with a ruptured right VAD involving the origin of the developed PICA. Endovascular internal trapping of the enlarged distal VAD was performed (Stage 1). After 1 month, following confirmation of platelet inhabitation (Stage 2) an Enterprise stent (Cordis Neurovascular, Miami Lakes, FL) placement from the PICA to the proximal VA with coil embolization for proximal VAD was performed under dual antiplatelet therapy. The dissected VA segment was occluded by coil embolization and the PICA was preserved. Advantages of this staged treatment are the avoidance of ischemic/hemorrhagic complications due to antithrombotic therapy when stent placement to the PICA is planned during the acute stage of SAH and confirmation of platelet inhabitation before stent placement in second treatment. VAD can be occluded, and this challenging endovascular treatment can be a therapeutic option for a ruptured VAD.