Successful Surgical Management of Vertebral Artery Aneurysm in a Patient With Takayasu Disease With a Single Vessel Intracranial Circulation

Abstract

Cerebrovascular complications are seen in <10% of the patients with Takayasu arteritis (TA). Subarachnoid hemorrhage and cerebral aneurysms in TA are exceedingly rare, and have been documented as case reports in the literature. We present the case of a 38-year-old lady who presented with subarachnoid hemorrhage to the emergency room. Clinical and radiologic evaluation documented that she had TA. Her digital subtraction angiogram revealed complete occlusion of the bilateral common carotid arteries and left subclavian artery at their origins. The right subclavian artery was completely occluded after the origin of the right vertebral artery. The right vertebral artery was dilated, and was the only vessel supplying the entire intracranial circulation. She harbored an aneurysm at the right vertebral artery-posterior inferior cerebrally artery (VA-PICA) junction, measuring 9.5×11.7 mm in size, with neck measuring 8.6 mm. She underwent retromastoid craniectomy and microsurgical clipping of the aneurysm, with no major complications. To the best of our knowledge, only 1 case had been reported earlier in the literature so far, with a single vessel supplying the whole intracranial circulation, who was conservatively managed. We report the first case of successful surgical management of a rare case of vertebral artery aneurysm in the only patent vessel supplying the whole intracranial circulation and both upper limbs.