Abstract
Background: Fusiform ruptured aneurysms of the vertebral artery involving PICA or the PICA origin are challenging aneurysms to treat. Many surgical approaches including wrapping techniques as well as various bypass procedures with aneurysm trapping have been described. Endovascular techniques currently do not offer acceptable solutions for these aneurysms, particularly in the ruptured state. Deconstructive procedures (occlusion of the fusiform segment) will result in PICA stroke and may involve the brain stem. Flow diversion is controversial in ruptured cases because of the need for dual antiplatelet agents and the lack of immediate aneurysm obliteration.
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