{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T07:15:53Z","timestamp":1771571753496,"version":"3.50.1"},"reference-count":12,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Subarachnoid hemorrhage (SAH) due to intracranial dissecting aneurysm is uncommon and may be challenging to secure when conventional clipping, coiling, or parent artery occlusion are not feasible. Flow-diverter stents have recently emerged as a rescue option in ruptured aneurysms, but their use in the acute phase remains controversial. We report a complex vertebrobasilar dissection presenting with aneurysmal SAH that was successfully treated with emergency flow diversion and adjunctive coiling.<\/jats:p>\n <\/jats:sec>\n \n Case description:<\/jats:title>\n A 54-year-old man with untreated hypertension presented comatose with diffuse SAH. CT angiography and digital subtraction angiography demonstrated a dominant right vertebral artery with a long-segment vertebrobasilar dissection, a large ruptured pseudoaneurysm at the vertebrobasilar junction, and a small aneurysm at the ipsilateral PICA origin, with hypoplastic contralateral vertebral artery. The anatomy precluded clipping, coiling alone, or parent vessel sacrifice. After loading doses of aspirin and clopidogrel, a Derivo2 flow-diverter stent was deployed from the proximal basilar artery to the V4 segment of the right vertebral artery, and the ruptured pseudoaneurysm was selectively coiled. Acute distal in-stent thrombosis was managed with balloon angioplasty and intravenous heparin. The patient awoke promptly and was extubated 6 hours later. Follow-up MRI at 12 hours showed a patent stent, complete exclusion of the pseudoaneurysm, and no SAH progression.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n This case illustrates that emergency flow diversion with adjunctive coiling can be a feasible strategy for ruptured vertebrobasilar dissecting pseudoaneurysms in carefully selected patients when conventional surgical or endovascular strategies are not feasible.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_1330_2025","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T06:53:04Z","timestamp":1771570384000},"page":"107","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endovascular management of subarachnoid hemorrhage due to vertebrobasilar artery dissection using emergency flow-diverter stent placement combined with pseudoaneurysm coiling"],"prefix":"10.25259","volume":"17","author":[{"given":"Phuong Viet","family":"Dao","sequence":"first","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ton Mai","family":"Duy","sequence":"additional","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anh Nguyen","family":"Quang","sequence":"additional","affiliation":[{"name":"Radiology Center, Bach Mai Hospital, Ha Noi, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dung Nguyen","family":"Tien","sequence":"additional","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tho Pham","family":"Quang","sequence":"additional","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Trung Xuan","family":"Vuong","sequence":"additional","affiliation":[{"name":"Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"10.25259\/SNI_1330_2025\/ref-1","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.3174\/ajnr.A2478","article-title":"Stent-assisted coiling in acutely ruptured intracranial aneurysms: A qualitative, systematic review of the literature","volume":"32","author":"Bodily","year":"2011","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_1330_2025\/ref-2","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1177\/1591019920945059","article-title":"Safety of stent-assisted coiling for the treatment of wide-necked ruptured aneurysm: A systematic literature review and meta-analysis of prevalence","volume":"26","author":"Bsat","year":"2020","journal-title":"Interv Neuroradiol"},{"key":"10.25259\/SNI_1330_2025\/ref-3","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s10143-018-0999-0","article-title":"Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. 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