Parent vessel occlusion for P2 dissecting aneurysms of the posterior cerebral artery

We present two cases of 17-year-old man and 10-year-old boy presenting with subarachnoid haemorrhage and a history of road traffic accident. One patient had dissecting aneurysm of the posterior cerebral artery (PCA), and the other patient had partially thrombosed aneurysm on CT angiography. On digital subtraction angiography of the second patient, there was formation of PCA pontomesencephalic vein pial arteriovenous fistula (PAVF). Both the patients underwent endovascular treatment: stent-assisted coiling for aneurysm and coiling with parent vessel occlusion for PAVF. There were no procedural complications. Follow-up angiography showed no residual aneurysm or fistula. Trauma is one of the recognised causes of dissection, and intracranial dissections can present as stenotic lesions, aneurysms or fistulas, depending on the pathology. Traumatic dissecting PCA aneurysm has been reported in only two case reports previously, and post-traumatic PAVF in PCA has not been reported.

Download Full-text

GIANT FUSIFORM ANEURYSM ARISING FROM FENESTRATED POSTERIOR CEREBRAL ARTERY AND BASILAR TIP VARIATION

Neurosurgery ◽

10.1227/01.neu.0000338431.70709.81 ◽

2009 ◽

Vol 64 (3) ◽

pp. E564-E565 ◽

Cited By ~ 6

Author(s):

Marco A. Zanini ◽

Vitor M. Pereira ◽

Mauricio Jory ◽

José G.M.P. Caldas

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Superior Cerebellar Artery ◽

Fusiform Aneurysm ◽

Parent Vessel ◽

Vessel Occlusion ◽

Cerebellar Artery ◽

Parent Vessel Occlusion ◽

The Right ◽

Double Origin

Abstract OBJECTIVE A giant fusiform aneurysm in the posterior cerebral artery (PCA) is rare, as is fenestration of the PCA and basilar apex variation. We describe the angiographic and surgical findings of a giant fusiform aneurysm in the P1–P2 PCA segment associated with PCA bilateral fenestration and superior cerebellar artery double origin. CLINICAL PRESENTATION A 26-year-old woman presented with a 2-month history of visual blurring. Digital subtraction angiography showed a giant (2.5 cm) fusiform PCA aneurysm in the right P1–P2 segment. The 3-dimensional view showed a caudal fusion pattern from the upper portion of the basilar artery associated with a bilateral long fenestration of the P1 and P2 segments and superior cerebellar artery double origin. INTERVENTION Surgical trapping of the right P1–P2 segment, including the posterior communicating artery, was performed by a pretemporal approach. Angiograms performed 3 and 13 months after surgery showed complete aneurysm exclusion, and the PCA was permeated and filled the PCA territory. Clinical follow-up at 14 months showed the patient with no deficits and a return to normal life. CONCLUSION To our knowledge, this is the first report of a giant fusiform aneurysm of the PCA associated with P1–P2 segment fenestration and other variations of the basilar apex (bilateral superior cerebellar artery duplication and caudal fusion). Comprehension of the embryology and anatomy of the PCA and its related vessels and branches is fundamental to the decision-making process for a PCA aneurysm, especially when parent vessel occlusion is planned.

Download Full-text

Posterior Cerebral Artery Aneurysms: Parent Vessel Occlusion Being a Viable Option in the Era of Flowdivertors

Neurology India ◽

10.4103/0028-3886.280635 ◽

2020 ◽

Vol 68 (2) ◽

pp. 316

Author(s):

Vivek Singh ◽

RajendraVishnu Phadke ◽

Vivek Agarwal ◽

Sanjay Behari ◽

Zafar Neyaz ◽

...

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Viable Option ◽

Parent Vessel ◽

Vessel Occlusion ◽

Parent Vessel Occlusion

Download Full-text

Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parent vessel occlusion of distal posterior cerebral artery aneurysms

Journal of Neurosurgery ◽

10.3171/2012.4.jns111788 ◽

2012 ◽

Vol 117 (2) ◽

pp. 284-287 ◽

Cited By ~ 12

Author(s):

Xianli Lv ◽

Youxiang Li ◽

Xinjian Yang ◽

Chuhan Jiang ◽

Zhongxue Wu

Keyword(s):

Cerebral Artery ◽

Collateral Circulation ◽

Posterior Cerebral Artery ◽

Parent Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Adult Type ◽

Coil Occlusion ◽

Vascular Insufficiency ◽

Parent Vessel Occlusion

Object The purpose of this study was to report the potential proneness of a fetal-type posterior cerebral artery (PCA) to develop vascular insufficiency in parent vessel occlusion of distal PCA aneurysms. Methods Between January 2005 and January 2011, 19 patients (9 females and 10 males) with 20 distal PCA aneurysms (16 dissecting and 4 saccular) were treated with endovascular parent vessel occlusion. The ages of the patients ranged from 5 to 71 years, with a mean age of 40.2 years. Of the 20 aneurysms, 4 were ruptured and 16 were unruptured. One of the unruptured aneurysms was additional to another ruptured aneurysm, and 15 were incidentally discovered. Five aneurysms were smaller than 10 mm, and the other 15 were 10 mm or larger. Results All aneurysms were successfully treated with simultaneous coil occlusion of the aneurysm and the parent PCA. One patient had hemianopia at the initial presentation, and 2 patients had new persistent hemianopia due to insufficient leptomeningeal collateral circulation; in 16 patients with an intact visual field, no hemianopia developed because there was sufficient leptomeningeal collateral circulation. A fetal-type PCA was involved in all 3 patients with hemianopia, which was initially presented or caused by parent vessel occlusion. However, in the patients without hemianopia, an adult-type PCA was involved in all cases. Conclusions Endovascular treatment via coil occlusion of the aneurysm as well as the parent artery can be used to cure distal PCA aneurysms. A fetal-type PCA could be an important predictive factor for vascular insufficiency in parent vessel occlusion treatment.

Download Full-text

Parent vessel occlusion for traumatic pseudoaneurysm of P3 segment of posterior cerebral artery: A case report and review of literatures

Journal of Medical Colleges of PLA ◽

10.1016/s1000-1948(11)60024-5 ◽

2011 ◽

Vol 26 (1) ◽

pp. 34-39 ◽

Cited By ~ 1

Author(s):

Xu Gaofeng ◽

Xie Wanfu ◽

Li Ruichun ◽

Wang Maode

Keyword(s):

Case Report ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Parent Vessel Occlusion ◽

Traumatic Pseudoaneurysm

Download Full-text

Spontaneous thrombosis of posterior cerebral artery aneurysm with angiographic reappearance

Journal of Neurosurgery ◽

10.3171/jns.1993.79.3.0434 ◽

1993 ◽

Vol 79 (3) ◽

pp. 434-437 ◽

Cited By ~ 26

Author(s):

John L. D. Atkinson ◽

John I. Lane ◽

Harold J. Colbassani ◽

D. Mark E. Llewellyn

Keyword(s):

Mr Imaging ◽

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Brain Infarction ◽

Artery Aneurysm ◽

Parent Vessel ◽

Spontaneous Thrombosis ◽

Vessel Occlusion ◽

Content Type ◽

Parent Vessel Occlusion

✓ The case is presented of a 23-year-old man suffering ischemic brain infarction from spontaneous thrombosis of a left posterior cerebral artery P1–P2 junction aneurysm. Vasospasm and/or partial parent vessel occlusion were documented by magnetic resonance (MR) imaging and angiography. Repeat cerebral angiography and MR imaging 3 months later revealed patency of the posterior cerebral artery and luminal filling of a 1-cm fusiform aneurysm, which was successfully trapped at surgery.

Download Full-text

Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

The Neuroradiology Journal ◽

10.1177/1971400919861406 ◽

2019 ◽

Vol 32 (5) ◽

pp. 353-365 ◽

Cited By ~ 1

Author(s):

Marius G Kaschner ◽

Bastian Kraus ◽

Athanasios Petridis ◽

Bernd Turowski

Keyword(s):

Endovascular Treatment ◽

Favourable Outcome ◽

Modified Rankin Scale ◽

Parent Vessel ◽

Vessel Occlusion ◽

Parent Vessel Occlusion ◽

Aneurysm Occlusion ◽

Vessel Reconstruction ◽

Dissecting Aneurysms

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

Download Full-text

Treatment outcomes in cerebral artery dissection and literature review

Interventional Neuroradiology ◽

10.1177/1591019918755692 ◽

2018 ◽

Vol 24 (3) ◽

pp. 254-262 ◽

Cited By ~ 8

Author(s):

Karanarak Urasyanandana ◽

Dittapong Songsang ◽

Taweesak Aurboonyawat ◽

Ekawut Chankaew ◽

Pattarawit Withayasuk ◽

...

Keyword(s):

Cerebral Artery ◽

Functional Outcomes ◽

Carotid Arteries ◽

Internal Carotid ◽

Parent Artery ◽

Parent Vessel ◽

Vessel Occlusion ◽

Parent Vessel Occlusion ◽

Internal Carotid Arteries ◽

Spontaneous Dissection

Methods Patients with cerebral artery dissections were reviewed in a hospital setting from 2008 to 2015. Clinical presentations, lesion locations, treatment modalities, functional outcomes, and mortality were reviewed. Parent artery occlusion was the first choice for surgery or endovascular treatment of a hemorrhagic dissecting cerebral artery. Endovascular or surgical reconstructive treatment was indicated in patients whose parent artery could not be occluded. Favorable functional outcomes were determined using modified Rankin Scale (mRS) scores of 0–2. Results In total, 61 patients with cerebral artery dissections were admitted to the hospital. Seven (11.5%) had traumatic dissections. All traumatic dissections were located in the internal carotid arteries. Overall favorable outcome rate was about 57% (4/7). Spontaneous cerebral artery dissections were found in 54 patients. No difference in favorable outcomes was observed between parent vessel occlusion and selective occlusion with parent vessel preservation (or vessel reconstruction) (70% and 63%, respectively, p = 1.000). Patients who presented with spontaneous dissection without intracranial hemorrhage had more favorable outcomes than those with intracranial hemorrhage (79% and 52%, respectively, p = 0.045). The mortality rate of patients with spontaneous dissection was 7.4%. Conclusions Most of the traumatic dissections were located on the internal carotid arteries and spontaneous dissections were commonly located on vertebral arteries. Nonhemorrhagic spontaneous cerebral dissections had better functional outcomes after treatment. Endovascular and surgical management were effective treatments by parent vessel occlusion or reconstructions.

Download Full-text

Treatment of a Giant Aneurysm of the Right Middle Cerebral Artery with GDCs after Extracranial to Intracranial Bypass

Interventional Neuroradiology ◽

10.1177/159101999900500109 ◽

1999 ◽

Vol 5 (1) ◽

pp. 51-56 ◽

Cited By ~ 2

Author(s):

E. Castro ◽

F. Fortea ◽

F. Villoria ◽

L. Muñoz ◽

C Benito ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Giant Aneurysm ◽

Endovascular Procedure ◽

Parent Vessel ◽

Vessel Occlusion ◽

Balloon Test Occlusion ◽

Parent Vessel Occlusion ◽

Detachable Coils ◽

The Right

A case of a giant aneurysm of the right middle cerebral artery treated with Guglielmi detachable coils is reported. Extracranial to intracranial bypass had previously been performed and surgical trapping had been attempted. During the endovascular procedure, balloon test occlusion of the middle cerebral artery was performed in order to demonstrate clinical and angiographic tolerance to parent vessel occlusion. A previous occlusion test in the right common carotid artery did not show sufficient flow through the bypass to perform safe parent vessel occlusion. Diagnostic imaging, the endovascular procedure, and haemodynamic aspects in cases in which parent vessel occlusion is required after extracranial-intracranial bypass are described and the literature is reviewed.

Download Full-text

Stent Treatment of Arterial Dissection

Rivista di Neuroradiologia ◽

10.1177/19714009050180s207 ◽

2005 ◽

Vol 18 (2_suppl) ◽

pp. 49-52

Author(s):

J. Berkefeld

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Arteries ◽

Arterial Dissection ◽

Antithrombotic Drugs ◽

Parent Vessel ◽

Vessel Occlusion ◽

Initial Event ◽

Stent Treatment ◽

Parent Vessel Occlusion ◽

Dissecting Aneurysms

Dissections of cerebral arteries are most often treated in a conservative manner with the use of antithrombotic drugs. This is justified by the relatively benign cause of the disease after the initial event. However, there are some exceptions from this rule: Stent treatment of stenotic dissections should be considered in patients who are hemodynamically compromised or recurrently symptomatic. Dissecting pseudoaneurysms must be treated after subarachnoid hemorrhage or in traumatic cases. Parent vessel occlusion is still the best option in this condition. Coiling with soft coils or stenting + coiling may be an alternative in cases without sufficient collaterals or in unruptured dissecting aneurysms.

Download Full-text