scholarly journals Asymmetry of P1 and vertebral arteries is not related to basilar tip aneurysm development or rupture

2020 ◽  
Author(s):  
Lan Li ◽  
Björn B. Hofmann ◽  
Igor Fischer ◽  
Daniel M. Donaldson ◽  
Adrian Engel ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Morphological Parameters ◽  
Anterior Circulation ◽  
Vertebral Arteries ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Basilar Tip Aneurysm ◽  
The Asymmetry

Abstract Objective Lately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms. Methods Data from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries. Results Patients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms. Conclusion We observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.

Endovascular treatment for acute basilar artery occlusion: descriptive analysis of the experience in a comprehensive stroke centre

2021 ◽  
Keyword(s):  
General Anaesthesia ◽  
Basilar Artery ◽  
Endovascular Therapy ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Significant Difference ◽  
Epidemiological Characteristics

Objectives: To describe the clinical and epidemiological characteristics of patients with basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT) in Aragón, and to compare its anaesthetic management, technical effectivity, security, and prognosis with those of anterior circulation. Methods: 322 patients from the prospective registry of mechanical thrombectomies from Aragon were assessed: 29 with BAO and 293 with an anterior circulation large vessel occlusion. Baseline characteristics, procedural, clinical and safety outcomes variables were compared. Results: Out of 29 patients with BAO that underwent endovascular therapy (62.1% men; average age 69.8 ± 14.05 years) 18 (62.1%) received endovascular therapy (EVT) alone and 11 (37.9%) EVT plus intravenous thrombolysis. Atherothrombotic stroke was the most common etiology (41%). The BAO group had longer Door-to-groin (160 vs 141 min; P = 0.043) and Onset-to-reperfusion times (340 vs 297 min; P = 0.005), and higher use of general anaesthesia (60.7% vs 14.7%; P < 0.01). No statistically significant difference was found for Procedure time (60 vs 50 min; P = 0.231) nor the rate of successful recanalization (72.4% vs 82.7%; P = 0.171). Functional independence at 90 days was significantly worse in the BAO group (17.9% vs 38.2%; P < 0.01). Conclusions: Patients with basilar artery occlusion had higher morbimortality despite similar angiographic results. Mechanical thrombectomy for BAOs is a safe and effective procedure in selected patients. A consensus about the effect of anaesthesia has yet to be reached, for BAO general anaesthesia remains the most frequently used technique.

scholarly journals Influence of the Perianeurysmal Environment on Rupture of Cerebral Aneurysms Preliminary Observation

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 65-70 ◽  
Author(s):  
K. Sugiu ◽  
B. Jean ◽  
D. San Millan Ruiz ◽  
J-B. Martin ◽  
J. Delavelle ◽  
...  
Keyword(s):  
Direct Contact ◽  
Cranial Nerves ◽  
Cerebral Aneurysms ◽  
Average Diameter ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Arteries And Veins ◽  
Aneurysm Shape

We evaluate the perianeurysmal environment and study parameters potentially influencing rupture of cerebral aneurysms. 101 consecutive aneurysm cases were retrospectively evaluated using radiological observation including imaging documents such as MR, CT and DSA studies. Aneurysm contact with perianeurysmal environment was classified and correlated with aneurysm shape, size, location and likely rupture point. Topographic relation of the aneurysm to the cisternal compartment was studied. Presence of contact with the surrounding structures was evaluated for bone, dura, brain, cranial nerves, arteries, and veins. The aneurysm shape and likely rupture point was found to be significantly influenced by the aneurysm environment. Depending on aneurysm type, location and size, the growth pattern also exhibited signs of interaction with the environment. Overall, there was no significant difference in the largest average diameter of the dome of ruptured (7.8 mm) and unruptured (6.7 mm) aneurysms. When compared to unruptured aneurysms (6/42), the presence of a bleb was more frequent in ruptured aneurysm (41/59). The perianeurysmal environment was found to have a significant influence on aneurysmal rupture pattern, whenever direct contact between the aneurysm and the anatomical structures in the perianeurysmal environment was visualized. This influence was independent of aneurysm size. Aneurysm size seems to be a poor indicator for the risk of rupture when compared to shape of the aneurysm and the degree of direct contact with the perianeurysmal environment.

scholarly journals Mechanical thrombectomy for basilar artery occlusion: efficacy, outcomes, and futile recanalization in comparison with the anterior circulation

2019 ◽  
Vol 11 (12) ◽  
pp. 1174-1180 ◽  
Author(s):  
Thomas Raphael Meinel ◽  
Johannes Kaesmacher ◽  
Panagiotis Chaloulos-Iakovidis ◽  
Leonidas Panos ◽  
Pasquale Mordasini ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Favorable Outcome ◽  
Basilar Artery Occlusion ◽  
Secondary Outcome ◽  
Stroke Severity ◽  
Anterior Circulation ◽  
Link Type ◽  
Significant Difference

BackgroundPerforming mechanical thrombectomy (MT) in patients with basilar artery occlusion (BAO) is currently not evidence-based.ObjectiveTo compare patients’ outcome, relative merits of achieving recanalization, and predictors of futile recanalization (FR) between BAO and anterior circulation large vessel occlusion (ACLVO) MT.MethodsIn the multicenter BEYOND-SWIFT registry (NCT03496064), univariate and multivariate (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI) outcome comparisons between BAO (N=165) and ACLVO (N=1574) were performed. The primary outcome was favorable outcome at 90 days (modified Rankin Scale, mRS 0-2). Secondary outcome included mortality, symptomatic intracranial hemorrhage (sICH) and FR. The relative merits of achieving successful recanalization between ACLVO and BAO were evaluated with interaction terms.ResultsMT in BAO was more often technically effective and equally safe in regards to mortality and sICH when compared to ACLVO. When adjusting for baseline differences, there was no significant difference between BAO vs ACLVO regarding rates of favorable outcome (aOR 0.986, 95%-CI 0.553 – 1.758). However, BAO were associated with increased rates of FR (aOR 2.146, 95%-CI 1.267 – 3.633). Predictors for FR were age, stroke severity, maneuver count and intracranial stenting. No significant heterogeneity on the relative merits of achieving successful recanalization on several outcome parameters were observed when comparing BAO and ACLVO.ConclusionsIn selected patients, similar outcomes can be achieved in BAO and ACLVO patients treated with MT. Randomized controlled trials comparing patient selection and interventional strategies seem warranted to avoid FR.Trial registration numberNCT03496064

Transcirculation balloon-assisted stent-supported coil embolization of a basilar tip aneurysm

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Vijay Agarwal ◽  
Ali Zomorodi ◽  
Cameron Mcdougal ◽  
Ranjith Babu ◽  
Adam Back ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Coil Embolization ◽  
Posterior Communicating Artery ◽  
Link Type ◽  
Left Posterior ◽  
Basilar Tip Aneurysm ◽  
The Right

We present the case of a balloon-assisted, stent-supported coil embolization of a basilar tip aneurysm. Initially, a balloon extending from the basilar artery into the right PCA was placed.3 However, even with a more proximal purchase, coils were found to impinge on the left PCA. Subsequently, a transcirculation approach was performed, where the left posterior communicating artery was utilized as a conduit for balloon support and the coils were embolized from the ipsilateral vertebral artery.1 However, after this transcirculation approach was completed, there was a coil tail extruding from the aneurysm. The balloon was then removed over an exchange wire and a horizontal stent advanced, spanning the entire neck of the aneurysm, eliminating the extruded coil.2The video can be found here: http://youtu.be/bMbtZoPnYvo.

Prevalence study of proximal vertebral artery stenosis using high‐resolution contrast‐enhanced magnetic resonance angiography

2005 ◽  
Vol 46 (3) ◽  
pp. 314-321 ◽  
Author(s):  
S. H. Kim ◽  
J. S. Lee ◽  
O. K. Kwon ◽  
M. K. Han ◽  
J. H. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Internal Carotid ◽  
Artery Stenosis ◽  
Anterior Circulation ◽  
Asymptomatic Group ◽  
Vertebral Artery Stenosis ◽  
Symptom Group

Purpose: To evaluate the prevalence of proximal vertebral artery stenosis, compared with those of the distal vertebral/basilar artery and extracranial internal carotid artery, in a large population of stroke and non‐stroke patients. Material and Methods: Nine‐hundred‐and‐thirty‐five patients who underwent high‐resolution contrast‐enhanced magnetic resonance angiography in a regional general hospital were categorized into six groups based on neurological symptoms and disease: an asymptomatic group ( n = 182), a minor symptom group with headache or dizziness ( n = 519), a cardiac group with coronary artery steno‐occlusive disease ( n = 15), a hemorrhagic group with old cerebral hemorrhage ( n = 26), an anterior circulation infarct group ( n = 121), and posterior circulation infarct group ( n = 72). Prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was analyzed. Results: The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 12.9%, 5.5%, and 7.2%, respectively, in the study population, and rose as the age increased ( P<0.0001 for all arteries). The prevalence of stenosis of the proximal vertebral artery, distal vertebral/basilar artery, and internal carotid artery was 3.3%, 0.5%, and 1.1%, respectively, in the asymptomatic group; 8.3%, 2.1%, and 3.7%, respectively, in the minor symptom group; 13.3%, 6.7%, and 6.7%, respectively, in the cardiac group; 19.2%, 7.7%, and 7.7%, respectively, in the hemorrhagic group; 27.3%, 8.3%, and 25.6%, respectively, in the anterior circulation infarct group; and 44.4%, 36.1%, and 16.7%, respectively, in the posterior circulation infarct group. This increasing tendency of stenosis accordingly was statistically significant ( P<0.0001 for all arteries). Conclusion: The prevalence of proximal vertebral artery stenosis was highest, compared with those of the distal vertebral/basilar artery and internal carotid artery, although the clinical significance of proximal vertebral artery stenosis should be investigated in further studies.

scholarly journals Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions

Stroke ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 389-395 ◽  
Author(s):  
Tobias Boeckh-Behrens ◽  
David Pree ◽  
Nina Lummel ◽  
Benjamin Friedrich ◽  
Christian Maegerlein ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Scale Score ◽  
Basilar Artery ◽  
Odds Ratio ◽  
Artery Occlusion ◽  
Low Flow ◽  
Basilar Artery Occlusion ◽  
Modified Rankin Scale ◽  
Flow Conditions ◽  
Vertebral Arteries

Background and Purpose— Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy. Methods— Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients’ characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3. Results— One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10–22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97–17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42–179.00). Conclusions— Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries.

scholarly journals Intimomedial thickness of the vertebral arteries complex: A new useful parameter for the assessment of atheroclerotic process?

2011 ◽  
Vol 68 (9) ◽  
pp. 733-738 ◽  
Author(s):  
Olivera Jovanikic ◽  
Toplica Lepic ◽  
Ranko Raicevic ◽  
Dragana Veljancic ◽  
Andjelka Ristic ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
Mean Value ◽  
Vertebral Arteries ◽  
Significant Difference ◽  
The Common ◽  
Carotid Circulation ◽  
Common Carotid Arteries

Bacground/Aim. An integral part of Doppler ultrasound examination of cervical blood vessels is determination of intimomedial thicknes (IMT) of the common carotid. The aim of the study was to estimate the relations between IMT of the common carotid and vertebral arteries in order to determine if the value of IMT obtained on the vertebral artery could be applied in clinical practice. Methods. We measured IMT in a randomized, prospective and crosssectional study, performed on 50 persons both sexes (29 men and 21 women), at the age from 18 to 79 years (mean age 52.4 ? 17.63 years). All the persons were healthy, what was confirmed with clinical examination and laboratory analyses. Measurements were perfomed from January 2006 until September 2008. Intimomedial thickness was recorded by twodimensional ultrasonography in B-mode on both common carotid arteries: one value was obtained as average of three successeful measurements (measurements were perform on different places). We measured IMT on the first segment of both vertebral arteries, 1.5 cm proximal from the connection of the first and second segments (we got results of the measurement of IMT on the vertebral arteries in the same way: mean value from the three records). Results. (IMT = 0.782 ? 0.248 mm), obtained from 50 healthy persons, was higher than that measured on the vertabral artery on the first segment (IMT = 0.585 ? 0.134 mm). The values of IMT after measurement on two different places were statistically highly different (t = 7.03, SD = 0.028, p < 0.01). Coefficient of variability of IMT values in carotid circulation (CV = 34.4%) was higher than that in vertebral circulation (22.9%). Values of IMT on vertebral arteries were in statistically significant correlation with those in carotid circulation (r = 0.24 and t- = 2.48; p < 0.02). There were no statistically significant difference between IMT measurement on the right and the left side so they were analysed as the same set Conclusion. Values of IMT on the vertebral arteries are one more undependent parameter of doplersonographic examination of cervical vessels, which significantly correlates with IMT values on common carotid artery. Variability of this parameter is lower, and absolute values lower than the same in the common carotid artery. Therefore, this parameter is probably not so sensitive. On the other hand, lower variability of IMT values on the vertebral artery might be of higher specificity for prediction of atherosclerotic progress by the increased values of this parameter than based on IMT values obtained on the common carotid arteries.

Vertebral artery stenting following percutaneous transluminal angioplasty

1996 ◽  
Vol 84 (5) ◽  
pp. 883-887 ◽  
Author(s):  
Gayle S. Storey ◽  
Michael P. Marks ◽  
Michael Dake ◽  
Alexander M. Norbash ◽  
Gary K. Steinberg
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Transluminal Angioplasty ◽  
Posterior Circulation ◽  
Atherosclerotic Vascular Disease ◽  
Anterior Circulation ◽  
Content Type ◽  
Vertebral Arteries ◽  
Atherosclerotic Stenosis

✓ The authors report initial results and follow up using stent placement to treat atherosclerotic stenosis in vertebral arteries. Three patients with severe atherosclerotic vascular disease underwent vertebral artery stent placement using a balloon expandable stent. Medical therapy (aspirin and warfarin) and conventional percutaneous angioplasty failed to resolve the disease and the patients developed symptomatic restenosis within 3 months of angioplasty. Two patients had symptoms of anterior circulation ischemia with carotid artery occlusions and reduced supply to the anterior circulation from the stenosed vertebral arteries. One patient had recurrent posterior circulation symptoms. Stents were successfully placed in all three, resulting in immediate reversal of stenosis and resolution of symptoms. Clinical follow-up study (mean 9 months) has shown no recurrent symptoms in the patient with posterior circulation symptoms, but the two patients with anterior circulation ischemia did develop recurrent symptoms. Angiographic follow up in these two patients at 3 months and 1 year, however, demonstrated continued patency of vertebral artery lumina. They underwent extracranial—intracranial bypass surgery to relieve their symptoms. This experience suggests stents can be placed without complication in the proximal vertebral arteries and may have an adjunctive role in the treatment of atherosclerotic cerebrovascular disease following unsuccessful angioplasty.

Retrograde angioplasty for basilar artery stenosis: bypassing bilateral vertebral artery occlusions

2009 ◽  
Vol 110 (3) ◽  
pp. 427-430 ◽  
Author(s):  
Paul T. L. Chiam ◽  
J Mocco ◽  
Rodney M. Samuelson ◽  
Adnan H. Siddiqui ◽  
L. Nelson Hopkins ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Percutaneous Treatment ◽  
Posterior Communicating Artery ◽  
Direct Access ◽  
Vertebrobasilar Insufficiency ◽  
Similar Technique ◽  
Anterior Circulation ◽  
Basilar Artery Stenosis ◽  
Promising Treatment

Basilar artery angioplasty with or without stenting is an emerging and promising treatment for vertebrobasilar insufficiency that is refractory to medical therapy. The usual approach is via a transfemoral route, with access directly through the vertebral artery (VA). An approach from the anterior circulation via the posterior communicating artery has been reported for optimal stent positioning and deployment across basilar apex aneurysms. No similar technique has been reported for treatment of midbasilar stenosis. The authors report a case of severe symptomatic basilar stenosis in which both VAs were occluded. The only option was to perform retrograde basilar angioplasty via the posterior communicating artery. This useful technique should be part of the armamentarium for the percutaneous treatment of symptomatic vertebrobasilar insufficiency for the occasional patient in whom occlusion or tortuosity precludes direct access to the VA.

149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Daga ◽  
M T Ahmad ◽  
M Taneja
Keyword(s):  
Treatment Option ◽  
Current Literature ◽  
Basilar Artery ◽  
Cerebral Angiography ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Acute Setting ◽  
Post Procedure ◽  
Basilar Artery Stenosis

Abstract The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.

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