Endovascular coil trapping for ruptured vertebral artery dissecting aneurysms by using double microcatheters technique in the acute stage

2003 ◽  
Vol 145 (6) ◽  
pp. 447-451 ◽  
Author(s):  
Y. Kai ◽  
J.-I. Hamada ◽  
M. Morioka ◽  
T. Todaka ◽  
T. Mizuno ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Acute Stage ◽  
Dissecting Aneurysms

scholarly journals One-stage Stent-assisted Coil Embolization for Rupture-side-unknown Bilateral Vertebral Artery Dissecting Aneurysms in an Acute Stage: A Case Report

2018 ◽  
Vol 5 (2) ◽  
pp. 45-49
Author(s):  
Mio Terashima ◽  
Yoichi Miura ◽  
Fujimaro Ishida ◽  
Naoki Toma ◽  
Tomohiro Araki ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Acute Stage ◽  
One Stage ◽  
Dissecting Aneurysms

Endovascular Treatment for Ruptured Vertebral Artery Dissecting Aneurysms at the Acute Stage

2013 ◽  
pp. 273-276
Author(s):  
Takeshi Suma ◽  
Tadashi Shibuya ◽  
Nobuo Kutsuna ◽  
Yoshiyuki Takada ◽  
Toshinori Matsuzaki ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Acute Stage ◽  
Dissecting Aneurysms

Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage

2003 ◽  
Vol 99 (6) ◽  
pp. 960-966 ◽  
Author(s):  
Jun-ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Shigetoshi Yano ◽  
Tatemi Todaka ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Acute Stage ◽  
The Other ◽  
Content Type ◽  
Lateral Medullary Syndrome ◽  
Detachable Coils ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. The goal of this study was to implement an algorithm for and assess the multimodal (endovascular and microsurgical) treatment of patients with ruptured dissecting aneurysms of the vertebral artery (VA) during the acute stage. Methods. During a 4-year period, the authors treated 19 ruptured dissecting aneurysms of the VA during the acute stage, within 3 days after the hemorrhage. Factors guiding management decisions were tolerance of the test occlusion and the site of the dissection. The algorithm takes into account these factors to select among treatment options, that is, trapping of the VA with Guglielmi Detachable Coils (GDCs); trapping of the VA and revascularization of the posterior inferior cerebellar artery (PICA); trapping of the VA and VA—posterior cerebral artery (PCA) anastomosis; and trapping of the VA, VA—PCA anastomosis, and revascularization of the PICA. Of the 15 aneurysms without PICA involvement, 14 were treated by trapping of the VA with GDCs and one by trapping of the VA and a VA—PCA bypass. The other four aneurysms with PICA involvement were treated by VA trapping and PICA revascularization. There was no episode of recurrent hemorrhage or ischemia during the posttreatment follow-up period. Although lateral medullary syndrome developed as a permanent complication in one patient, a good recovery was made by the other 18 patients by 6 months after the ictus. Conclusions. The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.

scholarly journals Treatment of Ruptured Vertebral Artery Dissecting Aneurysms

2014 ◽  
Vol 20 (3) ◽  
pp. 304-311 ◽  
Author(s):  
Osamu Hamasaki ◽  
Fusao Ikawa ◽  
Toshikazu Hidaka ◽  
Yasuharu Kurokawa ◽  
Ushio Yonezawa
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Acute Stage ◽  
Anterior Inferior Cerebellar Artery ◽  
Occipital Artery ◽  
Anatomical Location ◽  
Endovascular Occlusion ◽  
Cerebellar Artery ◽  
Dissecting Aneurysms ◽  
Medullary Infarction

We evaluated the outcomes of endovascular or surgical treatment of ruptured vertebral artery dissecting aneurysms (VADAs), and investigated the relations between treatment complications and the development and location of the posterior inferior cerebellar artery (PICA). We treated 14 patients (12 men, two women; mean age, 56.2 years) with ruptured VADAs between March 1999 and June 2012 at our hospital. Six and eight patients had Hunt and Hess grades 1–3 and 4–5, respectively. Twelve patients underwent internal endovascular trapping, one underwent proximal endovascular occlusion alone, and one underwent proximal endovascular occlusion in the acute stage and occipital artery (OA)-PICA anastomosis and surgical trapping in the chronic stage. The types of VADA based on their location relative to the ipsilateral PICA were distal, PICA-involved, and non-PICA in nine, two, and three patients, respectively. The types of PICA based on their development and location were bilateral anterior inferior cerebellar artery (AICA)-PICA, ipsilateral AICA-PICA, extradural, and intradural type in one, two, two, and nine patients, respectively. Two patients with high anatomical risk developed medullary infarction, but their midterm outcomes were better than in previous reports. The modified Rankin scale indicated grades 0–2, 3–5, and 6 in eight, three, and three patients, respectively. A good outcome is often obtained in the treatment of ruptured VADA using internal endovascular trapping, except in the PICA-involved type, even with high-grade subarachnoid hemorrhage. Treatment of the PICA-involved type is controversial. The anatomical location and development of PICA may be predicted by complications with postoperative medullary infarction.

scholarly journals Incidence of Ischemic Complications after Endovascular Treatment for Ruptured Dissecting Vertebral Artery Aneurysms

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 157-162 ◽  
Author(s):  
T. Kudo ◽  
K. Iihara ◽  
T. Satow ◽  
K. Murao ◽  
S. Miyamoto
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Acute Stage ◽  
Radiological Findings ◽  
Complete Obliteration ◽  
Ischemic Complications ◽  
Dissecting Aneurysms

We analyzed the incidence of ischemic complications after internal trapping for ruptured VA dissecting aneurysms. Between April 2001 and August 2005, nine cases of ruptured VA dissecting aneurysms, five in women, “proximal” or distal (distal type) to the origin of the PICA, were treated by internal trapping in the acute stage after SAH. There were four cases of proximal type and five of distal type. The demographics of the patients were reviewed in the medical charts and radiological findings were evaluated by neuroradiologists. The dissected site was completely obliterated and PICA was preserved in all cases. Follow-up angiography performed five to 19 days after treatment revealed complete obliteration of the aneurysm and patency of the PICA. The incidence of perioprocedural ischemic complications for the PICA-distal type (75%) was higher than that for the PICA-proximal type (20%). Here we retrospectively analyzed and discussed the incidence and mechanisms of ischemic complications.

scholarly journals Endovascular Treatment for Ruptured VA Dissecting Aneurysm Involving the Origin of PICA

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 173-179 ◽  
Author(s):  
S. Kobayashi ◽  
H. Karasudani ◽  
Y. Koguchi ◽  
K. Tsuru ◽  
M. Wada ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Acute Stage ◽  
Retrograde Flow ◽  
Cerebellar Artery ◽  
Ischemic Complication ◽  
Platinum Coils ◽  
Dissecting Aneurysms

Ruptured vertebral artery dissecting aneurysms (VADA) re-bleed frequently especially during first 24 hours, which makes the prognosis of the patients with this disease poor. Recently endovascular trapping with detachable platinum coils at an acute stage has been done for preventing re-bleeding. However, for the cases with dissecting aneurysm involving the origin of the posterior inferior cerebellar artery (PICA), these methods are hardly indicated because of the risk of ischemic complication in the PICA territory. We proposed a simple and effective therapeutic method for these cases. We occluded the affected vertebral artery (VA) near its root intending to introduce collateral blood flow from the deep cervical artery into the VA trunk. The controlled antegrade VA flow and retrograde flow from the contralateral VA make a watershed at the dissecting aneurysm, which promotes thrombosis of pseudolumen with preserving the antegrade blood flow of PICA. We treated two cases with ruptured VADA involving PICA, and in both cases thrombosis of aneurysm was obtained without any ischemic complication. This method would be considered as a treatment of choice to the cases with VADA involving PICA.

LVIS-within-enterprise double-stent procedure without coiling beneficial as treatment of unruptured vertebral artery dissecting aneurysms

2021 ◽  
pp. 159101992110251
Author(s):  
Hyun Ho Choi ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Hyun-Seung Kang ◽  
Moon Hee Han
Keyword(s):  
Vertebral Artery ◽  
Clinical Outcomes ◽  
Local Anesthesia ◽  
Thrombus Formation ◽  
Flow Diversion ◽  
Fusiform Aneurysm ◽  
Stent Deployment ◽  
Double Stent ◽  
Dissecting Aneurysms

Stenting of vertebral artery dissecting aneurysms (VADAs) may promote mural apposition of intimal flaps, preserving the patency of injured vessels. Moreover, stent deployment may serve to alter intra-aneurysm flow, inducing saccular thrombus formation, neointimal development, and remodeling of injured vessels. Although an overlapping multistent strategy with coiling has proven successful in this setting, yielding good anatomic and clinical outcomes, coiling may be technically infeasible in some VADAs with unfavorably configured circumferential elevations. Herein, we describe three patients with VADAs for whom coiling was deemed technically problematic. Each underwent double stenting (LVIS within Enterprise), without coil insertion, using local anesthesia. Conventional angiographic follow-up regularly disclosed excellent saccular occlusion and subsequent remodeling of stented arteries. LVIS-within-Enterprise double stenting may be of particular benefit in patients with VADAs, the Enterprise providing outer support to minimize stent bulging (as a fusiform aneurysm) as the inner LVIS reinforces flow diversion.

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