Basilar Trunk Aneurysm: Blunt Head Trauma, Dissecting Aneurysm of the Proximal Basilar Trunk Causing a Subarachnoid Hemorrhage, Reconstruction of the Basilar Artery with Three Telescoping Flow Diverters Anchored in the Left Vertebral Artery, Followed by Coil Occlusion of the Right V4 Segment

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

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Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

BMJ Case Reports ◽

10.1136/bcr-2019-231335 ◽

2019 ◽

Vol 12 (8) ◽

pp. e231335 ◽

Cited By ~ 1

Author(s):

Sean Thomas O’Reilly ◽

Ian Rennie ◽

Jim McIlmoyle ◽

Graham Smyth

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Posterior Inferior Cerebellar Artery ◽

Left Vertebral Artery ◽

Basilar Artery Thrombosis ◽

Direct Puncture ◽

Alternative Approach ◽

Cerebellar Artery ◽

First Pass ◽

The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

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A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

Case Reports in Emergency Medicine ◽

10.1155/2014/706147 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Katleen Devue ◽

Annemie Van Ingelgem ◽

Katrien De Keukeleire ◽

Marc De Leeuw

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Vertebral Artery Dissection ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Minor Trauma ◽

Systemic Thrombolysis ◽

The Right

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

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Combined reconstructive and deconstructive endovascular approach for bilateral vertebral artery dissection with subarachnoid hemorrhage

Neurosurgical FOCUS ◽

10.3171/2019.1.focusvid.18483 ◽

2019 ◽

Vol 46 (Suppl_1) ◽

pp. V13

Author(s):

Jacob Cherian ◽

Thomas P. Madaelil ◽

Frank Tong ◽

Brian M. Howard ◽

C. Michael Cawley ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Left Vertebral Artery ◽

Artery Dissection ◽

Critical Flow ◽

Alternative Strategies ◽

Potential Alternative ◽

Endovascular Approach ◽

The Right

The video highlights a challenging case of bilateral vertebral artery dissection presenting with subarachnoid hemorrhage. The patient was found to have a critical flow-limiting stenosis in his dominant right vertebral artery and a ruptured pseudoaneurysm in his left vertebral artery. A single-stage endovascular treatment with stent reconstruction of the right vertebral artery and coil embolization sacrifice of the left side was performed. The case highlights the rationale for treatment and potential alternative strategies.The video can be found here: https://youtu.be/e0U_JE2jISw.

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Terminal Triplication of the Left Vertebral Artery: A Unique Variation

Interventional Neuroradiology ◽

10.1177/159101990701300413 ◽

2007 ◽

Vol 13 (4) ◽

pp. 399-401

Author(s):

P.H. Dissanayake ◽

J.J. Bhattacharya ◽

E.V. Teasdale

Keyword(s):

Vertebral Artery ◽

Ct Angiography ◽

Subclavian Artery ◽

Basilar Artery ◽

Clinical Importance ◽

Aberrant Right Subclavian Artery ◽

Left Vertebral Artery ◽

Unique Case ◽

The Right ◽

Unique Variation

This report describes a unique case of triplication of the terminal left vertebral artery, forming the basilar artery in a 75-year-old male. CT angiography of cranio-cervical vessels also demonstrated the right vertebral artery originating from the right common carotid and an aberrant right subclavian artery. To the best of our knowledge this is the first report of a variation of this nature. The embryology and the clinical importance are discussed.

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Ruptured Dissecting Aneurysm of the Vertebral Artery Revealed by Repeat Angiography

Neurosurgery ◽

10.1227/00006123-198808000-00017 ◽

1988 ◽

Vol 23 (2) ◽

pp. 225-227 ◽

Cited By ~ 24

Author(s):

Yasushi Ito ◽

Ryoji Ishii ◽

Yasuo Suzuki ◽

Masahisa Kikuoka ◽

Kazuhiro Hirano ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Dissecting Aneurysm ◽

Repeat Angiography ◽

The Right ◽

Angiographic Change

ABSTRACT A case of subarachnoid hemorrhage caused by the rupture of a dissecting aneurysm of the vertebral artery is reported. The initial angiogram was normal, and repeat angiography carried out 12 days later revealed a dissecting aneurysm of the right vertebral artery. This angiographic change seems to be due to the progression of minimal dissection that was not found at the time of first angiogram.

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Case Report: Four Early Recurrent Basilar Artery Occlusions Successfully Treated With Mechanical Thrombectomy and Subsequent Vertebral Artery Coil Occlusion

Frontiers in Neurology ◽

10.3389/fneur.2021.698488 ◽

2021 ◽

Vol 12 ◽

Author(s):

Stefan L. Leber ◽

Simon Fandler-Höfler ◽

Markus Kneihsl ◽

Michael Augustin ◽

Hannes Deutschmann ◽

...

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Neurological Deficits ◽

Basilar Artery Occlusion ◽

Stroke Work ◽

Cerebrovascular Events ◽

Coil Occlusion ◽

The Right

We present the case of a middle-aged patient who had four recurrent acute basilar artery occlusions over a period of 3 months, each time successfully treated with mechanical thrombectomy. Extensive stroke work-up showed no obvious stroke etiology aside from a dysplastic right vertebral artery with multifocal stenoses. Treatment with different antiplatelet and anticoagulant regimes did not prevent basilar artery occlusion recurrence. Therefore, transarterial coil occlusion of the V4-segment of the right vertebral artery was performed as ultima ratio without complications. At final discharge, the patient had no persistent neurological deficits. No further cerebrovascular events occurred over a 12-month follow-up period.

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