Growing Thrombosed Dissecting Aneurysm of the Vertebral Artery after Endovascular Proximal Artery Occlusion: the Role of the Vasa Vasorum

traditional methods of treatment for ruptured dissecting aneurysm of vertebral artery (rVADA). Proximal artery occlusion may be effective in the acute period, but is not enough to eradicate the risk of rebleeding (1). Mass effect usually is not a concern for a case of well occluded rVADA. However, we experienced a growing thrombosed aneurysm after rVADA occlusion, and conventional angiography did not reveal antegrade and retrograde luminal flow into the rVADA but faint contrast staining of the aneurismal periphery, which corresponded to a histological finding, proliferative vasa vasorum. We suggest that the vasa vasorum plays a crucial role in the growth of excluded rVADAs from the VA after endovascular trapping or proximal artery occlusion.