Figure 3. Retreatment with endovascular occlusion with aneurysm trapping was performed for recurrent huge intracranial VADA after multiple stents assisted coiling.

A 54-year old male presented with headache and dysphagia. MR imaging showed huge onion skin-like thrombus (black arrowhead), intramural hematoma and compression to brain stem (A). Right vertebral angiograms of frontal (B) and lateral (C) view showed a dissecting aneurysm. Multiple stents assisted coiling (D) were performed with complete occlusion (E, F). Follow up angiography (G) after three months revealed regrowth of original dissecting aneurysm (black arrow). Retreatment by endovascular occlusion with aneurysm trapping (white arrow) (H) was performed. Collateral blood flow could be seen from contralateral VA (I) and left posterior communicating artery (J).