Outflow Occlusion with Occipital Artery–Posterior Inferior Cerebellar Artery Bypass for Growing Vertebral Artery Fusiform Aneurysm with Ischemic Onset: A Case Report

AbstractNonsaccular vertebral artery aneurysms involving the posterior inferior cerebellar artery (PICA) are rare. Treatment is considered a significant challenge because of their angiographic and anatomical features, especially in high-riding PICA. Therefore, meticulous preoperative angiographic and anatomical evaluation is necessary. Moreover, consideration of the distance between the cerebellar skull base and caudal loop of the PICA is important. We present two cases of occipital artery-high-riding PICA bypass and discuss important preoperative technical considerations.

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Spontaneous Thrombosis of Ruptured Vertebral Dissecting Aneurysm after Occipital Artery-Posterior Inferior Cerebellar Artery Anastomosis and Proximal Vertebral Artery Occlusion: Case Report.

Surgery for Cerebral Stroke ◽

10.2335/scs.29.430 ◽

2001 ◽

Vol 29 (6) ◽

pp. 430-434

Author(s):

Masahiko KAWANISHI ◽

Keiko IRIE ◽

Nobuyuki KAWAI ◽

Katsuzo KUNISHIO ◽

Seigo NAGAO

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Occipital Artery ◽

Spontaneous Thrombosis ◽

Vertebral Artery Occlusion ◽

Cerebellar Artery

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Blind-Alley Formation and Occipital Artery-Posterior Inferior Cerebellar Artery Bypass for the Treatment of Unclippable Vertebral Artery Aneurysms with Posterior Inferior Cerebellar Artery Involvement

World Neurosurgery ◽

10.1016/j.wneu.2020.02.174 ◽

2020 ◽

Vol 138 ◽

pp. e539-e550

Author(s):

Somkiat Wongsuriyanan ◽

Kitiporn Sriamornrattanakul

Keyword(s):

Vertebral Artery ◽

Artery Bypass ◽

Posterior Inferior Cerebellar Artery ◽

Occipital Artery ◽

Blind Alley ◽

Cerebellar Artery

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OCCIPITAL ARTERY-TO-POSTERIOR INFERIOR CEREBELLAR ARTERY BYPASS FOR TREATMENT OF BILATERAL VERTEBRAL ARTERY OCCLUSION: THE ROLE OF QUANTITATIVE MAGNETIC RESONANCE ANGIOGRAPHY NONINVASIVE OPTIMAL VESSEL ANALYSIS

Neurosurgery ◽

10.1227/01.neu.0000339351.65061.d6 ◽

2009 ◽

Vol 64 (4) ◽

pp. E779-E781 ◽

Cited By ~ 9

Author(s):

Robert M. Starke ◽

Mark Chwajol ◽

Daniel Lefton ◽

Chandranath Sen ◽

Alejandro Berenstein ◽

...

Keyword(s):

Magnetic Resonance ◽

Vertebral Artery ◽

Artery Bypass ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

Occipital Artery ◽

Vertebrobasilar Insufficiency ◽

Vertebral Arteries ◽

Vertebral Artery Occlusion ◽

Cerebellar Artery

Abstract OBJECTIVE Patients with partial or complete bilateral vertebral artery occlusion often present with signs and symptoms of transient ischemic attacks or infarction. Advances in phase contrast magnetic resonance imaging have led to noninvasive assessment of volumetric blood flow rates and direction that help in the workup and management of these patients. CLINICAL PRESENTATION We present the case of a patient with symptoms of vertebrobasilar insufficiency without previous transient ischemic attacks or stroke. Quantitative magnetic resonance angiography (QMRA) demonstrated bilateral vertebral artery occlusion with reversal of flow in the basilar and vertebral arteries to the level of the posterior inferior cerebellar arteries bilaterally. A prominent right posterior communicating artery filled the basilar artery and proximal vertebral arteries. INTERVENTION The presence of reversal and diminished flow in the basilar and vertebral arteries suggested that occipital artery-to-posterior inferior cerebellar artery bypass would improve posterior circulation, relieve symptoms, and reduce the risk of infarction. Postoperative QMRA and angiography confirmed revascularization, and QMRA confirmed correction of blood flow direction. CONCLUSION This case illustrates the potential of QMRA as part of a comprehensive cerebrovascular assessment, operative planning, and follow-up of patients with vertebrobasilar insufficiency.

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Occipital artery to p3 segment of posterior inferior cerebellar artery bypass in treating a complex fusiform aneurysm

BMJ Case Reports ◽

10.1136/bcr-2020-235023 ◽

2020 ◽

Vol 13 (6) ◽

pp. e235023

Author(s):

Peyton L Nisson ◽

Michael A McNamara ◽

Xiaolong Wang ◽

Xinmin Ding

Keyword(s):

Case Report ◽

Artery Bypass ◽

Bypass Graft ◽

Posterior Inferior Cerebellar Artery ◽

Dissecting Aneurysm ◽

Neurological Deficits ◽

Endovascular Coiling ◽

Occipital Artery ◽

Cerebellar Artery ◽

Arterial Bypass Graft

We provide a case report of a 58-year-old man who presented with a ruptured fusiform dissecting aneurysm located at the junction of the vertebral artery and posterior inferior cerebellar artery (PICA). Due to the lesion’s complexity, a two-step approach was planned for revascularisation of PICA using the occipital artery (OA) prior to coiling embolisation. An end-to-side OA–PICA bypass was performed with implantation at the caudal loop of the p3 PICA segment. Fifteen days after the procedure, the aneurysm underwent stent-assisted coiling for successful obliteration of the aneurysm. The patient tolerated this procedure well and now at 1.5 years of follow-up remains free from any neurological deficits (modified Rankin Score 0). This case report illustrates one of the unique scenarios where both the vascular territory involved and morphological features of the aneurysm prohibited the use of more conventional means, necessitating the use of an arterial bypass graft for successful treatment of this lesion. As open vascular surgery is becoming less common in the age of endovascular coiling, our article uniquely reports on the combined use of both endovascular and microsurgical techniques to treat a complex aneurysm of the posterior circulation.

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