Is Vertebral Artery and Posterior Inferior Cerebellar Artery Dominance a Risk Factor for Thromboembolism During Coil Embolization of Unruptured Posterior Circulation Aneurysms?

Background Transbrachial approach is an alternative technique for coil embolization of posterior circulation aneurysms. The purpose of our study was to investigate the anatomical features of the vertebral artery (VA) for transbrachial direct VA cannulation of a guiding catheter (GC) to perform coil embolization of posterior circulation aneurysms. Methods Included in retrospective analysis were patients who underwent transbrachial coil embolization of cerebral aneurysms in the posterior cerebral circulation by direct VA cannulation of a GC from 2007 to 2013. Investigated were patient characteristics, preoperative sizes of aneurysms, aneurysms location, the angle formed by the target VA and the subclavian artery (AVS), and the VA diameter at the level of the fourth cervical vertebral body (VAD) in the side of the transbrachial access route. Results Thirty-one patients with 32 aneurysms met our criteria. The locations of aneurysms were the VA ( n = 16), basilar artery (BA) tip ( n = 10), BA trunk ( n = 3), BA superior cerebellar artery ( n = 1), BA anterior inferior cerebellar artery ( n = 1), and VA posterior inferior cerebellar artery ( n = 1). The right brachial artery was punctured in 27 cases with 28 aneurysms as transbrachial direct cannulation of a GC, and left was in 4 cases with 4 aneurysms. The average AVS, ranging from 45° to 95°, was 77°, and the average VAD, ranging from 3.18 to 4.45 mm, was 3.97 mm. Conclusion For transbrachial direct cannulation of a GC, it seems required that the AVS is about 45° or more and the VAD is about 3.18 mm or more.

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Coiling Using Dual Microcatheter Technique—A Novel Approach

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1730875 ◽

2022 ◽

Author(s):

Arvind Kumar ◽

Swarup Sohan Gandhi ◽

Ashok Gandhi ◽

Trilochan Srivastav ◽

Devendra Purohit

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Left Vertebral Artery ◽

Aneurysm Neck ◽

Novel Technique ◽

Novel Approach ◽

Cerebellar Artery ◽

Posterior Circulation Aneurysms ◽

Flow Through

AbstractPosterior circulation aneurysms are difficult to treat, and if an incorporated artery is arising from the neck of aneurysm, management becomes much more challenging. Here, we are describing a novel technique used to treat a patient with a large, wide-necked left vertebral artery (VA)-posterior inferior cerebellar artery (PICA) junctional aneurysm. PICA seems to be arising from the aneurysm neck, but the aneurysm neck was not very clearly defined. So, we placed a second microcatheter into PICA, which not only allowed the coils to be placed in the aneurysm, without disrupting the flow through PICA but also helpful in assessing the aneurysmal occlusion. This technique allowed coils to be placed successfully without compromising flow through PICA.

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Posterior Circulation Aneurysms: A Critical Appraisal of a Surgical Series in Endovascular Era

Acta Neurochirurgica Supplement - Trends in Cerebrovascular Surgery and Interventions ◽

10.1007/978-3-030-63453-7_6 ◽

2021 ◽

pp. 39-45

Author(s):

Sabino Luzzi ◽

Mattia Del Maestro ◽

Renato Galzio

Keyword(s):

Vertebral Artery ◽

Critical Appraisal ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Cerebellar Artery ◽

Average Patient ◽

Posterior Circulation Aneurysms ◽

The Mean

AbstractThe advent of the endovascular era has apparently decreased the role of microneurosurgery for many of the posterior circulation aneurysms. This study consists of a critical appraisal of a retrospective surgical series regarding posterior circulation aneurysms, targeted to define whether microneurosurgery still has a role for some of these. In 28 years, 157 aneurysms were surgically treated, 98 of which ruptured. The Average patient age was 56.7 ± 14.2 years, while in hemorrhagic cases, the mean Hunt-Hess score was 2.17 ± 0.8. Basilar tip, vertebral artery and proximal posterior inferior cerebellar artery were the most frequently involved sites. The treatment consisted of 128 clippings, 19 trappings, 7 wrappings, and 3 bypasses. A total exclusion was achieved in 88.5% of the aneurysms. An average follow-up of 67.1 ± 61.3 months proved no recurrences. The best results were observed in patients <65 years old who harbored small-to-regular aneurysms of the basilar tip, distal cerebellar arteries, or vertebral artery.Clipping proved to be a definitive and durable treatment for a large part of posterior circulation aneurysms, whereas bypass allows for treating aneurysms not amenable for coiling, stenting, or clipping. The present study confirms that microneurosurgery continues to have a paramount role within neurovascular pathology.

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Transcirculation Endovascular Treatment of Complex Cerebral Aneurysms: Technical Considerations and Preliminary Results

Neurosurgery ◽

10.1227/neu.0b013e3182077f17 ◽

2011 ◽

Vol 68 (3) ◽

pp. 820-830 ◽

Cited By ~ 29

Author(s):

Felipe C Albuquerque ◽

L Fernando Gonzalez ◽

Yin C Hu ◽

C Benjamin Newman ◽

Cameron G McDougall

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Cerebral Aneurysms ◽

Posterior Circulation ◽

Alternative Pathways ◽

Complex Aneurysms ◽

Cerebellar Artery ◽

Kissing Balloon Technique ◽

Posterior Circulation Aneurysms ◽

History Of

Abstract BACKGROUND: Unfavorable anatomy can preclude embolization of intracranial aneurysms. Transcirculation techniques, in which a catheter is navigated from one side of the brain to the other or from the anterior to the posterior circulation, are alternative pathways for primary or balloon- or stent-assisted coiling. OBJECTIVE: We report the largest experience in coil embolization of aneurysms using transcirculation techniques. METHODS: We reviewed our endovascular database from 2006 to 2009 and identified 18 patients who had aneurysms treated with transcirculation techniques. RESULTS: Eight patients had anterior and 10 had posterior circulation aneurysms. Overall, 8 patients were treated with stent-assisted coiling and 9 with balloon-assisted coiling, including 1 patient treated with a “kissing balloon” technique. Of the 9 patients treated with balloon-assistance, 1 also was stented at the conclusion of aneurysm coiling. One patient with a left fourth vertebral artery (V4) aneurysm was treated with coiling alone via a bilateral vertebral artery (VA) approach. In 14 patients, the anterior communicating and posterior communicating arteries were used as conduits. In 4 patients, both VAs were traversed to treat 2 V4 aneurysms and 2 posterior inferior cerebellar artery aneurysms. One patient died as a result of treatment and was the only permanent complication (5.6%). Complete or near-complete (>95%) embolization was achieved in all patients. CONCLUSION: Transcirculation techniques are effective pathways for embolization of complex aneurysms. Although technically challenging, these techniques are associated with an acceptably low rate of complications when compared to the natural history of the treated lesion.

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Beware of Nihilism: Favorable Outcome despite Poor Admission Status in Posterior Circulation Aneurysms after Aneurysmal Subarachnoid Hemorrhage

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1719142 ◽

2021 ◽

Author(s):

Nina Brawanski ◽

Sepide Kashefiolasl ◽

Sae-Yeon Won ◽

Joachim Berkefeld ◽

Elke Hattingen ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Mortality Rate ◽

Cerebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Anterior Circulation ◽

Ruptured Aneurysms ◽

Admission Status ◽

Posterior Circulation Aneurysms

Abstract Objective As shown in a previous study, aneurysm location seems to influence prognosis in patients with subarachnoid hemorrhage (SAH). We compared patients with ruptured aneurysms of anterior and posterior circulation, undergoing coil embolization, concerning differences in outcome and prognostic factors. Methods Patients with SAH were entered into a prospectively collected database. We retrospectively identified 307 patients with aneurysms of the anterior circulation (anterior cerebral artery, carotid bifurcation, and middle cerebral artery) and 244 patients with aneurysms of the posterior circulation (aneurysms of the basilar artery, posterior inferior cerebellar artery, posterior communicating artery and posterior cerebral artery). All patients underwent coil embolization. The outcome was assessed using the modified Rankin Scale (mRS; favorable [mRS 0–2] vs. unfavorable [mRS 3–6]) 6 months after SAH. Results In interventionally treated aneurysms of the anterior and posterior circulation, statistically significant risk factors for poor outcome were worse admission status and severe cerebral vasospasm. If compared with patients with ruptured aneurysms of the anterior circulation, patients with aneurysms of the posterior circulation had a significantly poorer admission status, and suffered significantly more often from an early hydrocephalus. Nonetheless, there were no differences in outcome or mortality rate between the two patient groups. Conclusion Patients with a ruptured aneurysm of the posterior circulation suffer more often from an early hydrocephalus and have a significantly worse admission status, possibly related to the untreated hydrocephalus. Nonetheless, the outcome and the mortality rate were comparable between ruptured anterior and posterior circulation aneurysms, treated by coil embolisation. Therefore, despite the poorer admission status of patients with ruptured posterior circulation aneurysms, treatment of these patients should be considered.

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Stent-assisted coil embolization for an unruptured vertebral artery–posterior inferior cerebellar artery aneurysm with retrograde access via type 1 persistent primitive proatlantal artery: A case report

Interventional Neuroradiology ◽

10.1177/1591019920973848 ◽

2020 ◽

pp. 159101992097384

Author(s):

Yasuhiko Nariai ◽

Tomoji Takigawa ◽

Ryotaro Suzuki ◽

Akio Hyodo ◽

Kensuke Suzuki

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

External Carotid ◽

Proatlantal Artery ◽

Cerebellar Artery ◽

The Right ◽

Pica Aneurysms

Vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysms are rare lesions that are difficult to treat with both endovascular and surgical techniques. Tight angulation of the PICA from VA may make access to the PICA difficult from ipsilateral VA if adjunctive techniques are needed. Recently, the safety and efficacy of retrograde access have been reported. We report a case of endovascular treatment for a VA-PICA aneurysm with a stent-assisted technique using retrograde access via contralateral persistent primitive proatlantal artery (PPA). The patient was a 76-year-old woman with an unruptured VA-PICA aneurysm on the dominant VA side. Coil embolization with a stent-assisted technique using retrograde access seemed appropriate. However, the origin of the left VA was not confirmed. Left common carotid artery angiography demonstrated that the PPA (type 1) branching from external carotid artery joined the VA V4 segment. Retrograde access via the PPA for stenting was performed. A microcatheter for stenting was retrogradely advanced to the right PICA at ease. After deploying the stent, coil insertion was completed from the right VA, and the final angiogram showed adequate occlusion of the aneurysm with preservation of the PICA. Thus, PPA may be an approach route in the treatment of VA-PICA aneurysms with unconfirmed contralateral VA orifice and apparent PPA on angiography, when retrograde access is needed.

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Vertebral Artery Terminating Posterior Inferior Cerebellar Artery (PICA-VA) as a Potential Risk Factor in Cervical Spine Surgery

World Neurosurgery ◽

10.1016/j.wneu.2020.08.003 ◽

2020 ◽

Vol 143 ◽

pp. e535-e540

Author(s):

Takeshi Aoyama ◽

Naoshi Obara

Keyword(s):

Risk Factor ◽

Cervical Spine ◽

Vertebral Artery ◽

Spine Surgery ◽

Potential Risk ◽

Posterior Inferior Cerebellar Artery ◽

Potential Risk Factor ◽

Cervical Spine Surgery ◽

Cerebellar Artery

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Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1639589 ◽

2018 ◽

Vol 37 (01) ◽

pp. 27-37

Author(s):

Vitor Yamaki ◽

Eric Paschoal ◽

Manoel Teixeira ◽

Eberval Figueiredo

Keyword(s):

Surgical Treatment ◽

Posterior Inferior Cerebellar Artery ◽

Cranial Nerves ◽

Posterior Circulation ◽

Surgical Approaches ◽

Superior Cerebellar Artery ◽

Anterior Circulation ◽

Cerebellar Artery ◽

Risk Of Rupture ◽

Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

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Embolization of Posterior Circulation Aneurysms with Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199980040s127 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 127-130 ◽

Cited By ~ 1

Author(s):

K. Kazekawa ◽

T. Fukushima ◽

M. Tomonaga ◽

T. Kawano ◽

T. Kawaguchi ◽

...

Keyword(s):

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Superior Cerebellar Artery ◽

Anterior Inferior Cerebellar Artery ◽

Cerebellar Artery ◽

Long Term Follow Up ◽

Detachable Coils ◽

Posterior Circulation Aneurysms ◽

Vertebrobasilar Junction

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs. In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery. Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.

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Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-012040 ◽

2015 ◽

Vol 8 (10) ◽

pp. 1041-1047 ◽

Cited By ~ 43

Author(s):

Marcus D Mazur ◽

Craig Kilburg ◽

Victor Wang ◽

Philipp Taussky

Keyword(s):

Vertebral Artery ◽

Vessel Wall ◽

Posterior Inferior Cerebellar Artery ◽

Posterior Circulation ◽

Pipeline Embolization Device ◽

Safety And Efficacy ◽

Cerebellar Artery ◽

Flow Through ◽

Flow Diverting Stent

IntroductionPreliminary studies suggest that flow-diverting stents may be suitable for the treatment of aneurysms of the posterior circulation. The safety and efficacy of using flow-diverting stents for vertebral artery (VA) aneurysms is not well defined.ObjectiveTo examine the fate of covering the posterior inferior cerebellar artery (PICA) in patients undergoing placement of a flow-diverting stent for VA aneurysm.MethodsConsecutive patients who underwent placement of a Pipeline Embolization Device (PED) for treatment of an aneurysm of the V4 segment of the VA between April 2012 and June 2015 at our institution were retrospectively evaluated. Angiograms were reviewed to determine the patency of the PICA when the vessel origin was covered by the PED.Results11 patients with VA aneurysms who underwent treatment with the PED were identified. In each case the device covered the origin of the PICA. Follow-up angiography in eight patients demonstrated thrombosis of the aneurysm with patency of the PICA.ConclusionsFlow-diverting stents can be used for the treatment of VA aneurysms. When appropriately sized to the vessel wall and positioned in the VA, the device may cover the origin of the PICA without impairing flow through the branching artery.

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