Internal trapping for ruptured vertebral artery dissection involving the anterior spinal artery: A case report

Endovascular treatment of ruptured vertebral artery dissections in the acute phase often requires consideration of the posterior inferior cerebellar artery; however, the anterior spinal artery has seldom been discussed. We report a case of ruptured vertebral artery dissection involving the origin of the anterior spinal artery that was successfully treated with internal trapping while preserving the anterior spinal artery. A 49-year-old woman in semi-comatose state was transferred to our hospital. Computed tomography revealed a diffuse subarachnoid hemorrhage. The dissected segment was located distal to the posterior inferior cerebellar artery origin, and the anterior spinal artery originated from the distal portion of the aneurysmal dilatation. The anterior spinal artery was primarily supplied by the affected side. Internal trapping of the aneurysmal segment was performed, with meticulous preservation of the anterior spinal artery origin. The patient recovered without any neurological deficits and was discharged on postoperative day 30. This case highlights the importance of careful angiographic evaluation of the anterior spinal artery when planning endovascular treatment for ruptured vertebral artery dissection. Preservation of the anterior spinal artery is critical for achieving favorable clinical outcomes.