Basilar Artery Trunk Aneurysm: Concomitant Retroperitoneal and Subarachnoid Hemorrhage, Segmental Arterial Mediolysis (SAM), Dissecting Aneurysm, Treatment by Partial Coil Occlusion and Flow Diversion
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“Segmental mediolytic arteriopathy” or “segmental arterial mediolysis” (SAM) is an idiopathic disorder of visceral and intracranial arteries and known as a cause of major abdominal, retroperitoneal, and subarachnoid hemorrhage (SAH). The affected arteries show a non-inflammatory and non-atherosclerotic vacuolization and lysis of the tunica media, smooth muscle degeneration, and serration of the lamina elastica interna, undermining the vessel wall stability. Spontaneous dissection and aneurysm formation followed by aneurysm rupture may occur. SAM is the most likely diagnosis in the case of simultaneous abdominal or retroperitoneal and subarachnoid hemorrhage. This is the case of a patient with simultaneously ruptured dissecting aneurysms of abdominal and intracranial arteries. The evolution and treatment of the dissecting basilar artery aneurysm by endovascular coil-assisted flow diversion is the main topic of this report.
KeywordsBasilar artery trunk aneurysm Segmental arterial mediolysis SAH Dissecting aneurysm Partial coil occlusion Flow diversion
This case report has been previously published with open access (Hellstern et al. 2017).
- Cooke DL, Meisel KM, Kim WT, Stout CE, Halbach VV, Dowd CF, Higashida RT. Serial angiographic appearance of segmental arterial mediolysis manifesting as vertebral, internal mammary and intra-abdominal visceral artery aneurysms in a patient presenting with subarachnoid hemorrhage and review of the literature. J Neurointerv Surg. 2013;5(5):478–82. https://doi.org/10.1136/neurintsurg-2012-010323.CrossRefPubMedGoogle Scholar
- Hellstern V, Aguilar Perez M, Kohlhof-Meinecke P, Bazner H, Ganslandt O, Henkes H. Concomitant retroperitoneal and subarachnoid hemorrhange due to segmental arterial mediolysis: case report and review of the literature. Clin Neuroradiol; 2017. https://doi.org/10.1007/s00062-017-0641-5.
- Loeys BL, Schwarze U, Holm T, Callewaert BL, Thomas GH, Pannu H, De Backer JF, Oswald GL, Symoens S, Manouvrier S, Roberts AE, Faravelli F, Greco MA, Pyeritz RE, Milewicz DM, Coucke PJ, Cameron DE, Braverman AC, Byers PH, De Paepe AM, Dietz HC. Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med. 2006;355:788–98.CrossRefPubMedGoogle Scholar
- Shinoda N, Hirai O, Mikami K, Bando T, Shimo D, Kuroyama T, Matsumoto M, Itoh T, Kuramoto Y, Ueno Y. Segmental arterial mediolysis involving both vertebral and middle colic arteries leading to subarachnoid and intraperitoneal hemorrhage. World Neurosurg. 2016;88:694.e5–10. https://doi.org/10.1016/j.wneu.2015.12.058.CrossRefGoogle Scholar
- Welch BT, Brinjikji W, Stockland AH, Lanzino G. Subarachnoid and intraperitoneal hemorrhage secondary to segmental arterial mediolysis: a case report and review of the literature. Interv Neuroradiol. 2017;23(4):378–81. https://doi.org/10.1177/1591019917703074.CrossRefPubMedPubMedCentralGoogle Scholar