We present a rare case of dissection of both limbs of a vertebral artery fenestration, with a ruptured dissecting aneurysm in one limb. A 54-year-old man was diagnosed subarachnoid hemorrhage. An emergency digital subtraction angiography revealed a fenestration in the intracranial region of the left vertebral artery. The limb of the ventral side showed a fusiform dilation in the proximal and the limb of the dorsal side showed irregular stenosis. These were characteristic of arterial dissection. We diagnosed dissection of both limbs of the vertebral artery fenestration, and a ruptured dissecting aneurysm of the ventral limb. Endovascular trapping of the ventral limb was performed. A follow-up image showed that the stenosis of the dorsal limb had completely resolved to normal, suggesting spontaneous remodeling of the dissection. The vascular fragility inherent in the fenestration may have contributed to the dissection, suggesting dissections occurring simultaneously in both limbs of the fenestration.
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