Brainstem Infarction after Delayed Thrombosis of a Stented Vertebral Artery Fusiform Aneurysm: Case Report

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1280-1285 ◽  
Author(s):  
Elad I. Levy ◽  
Alan S. Boulos ◽  
Bernard R. Bendok ◽  
Stanley H. Kim ◽  
Adnan I. Qureshi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Sudden Onset ◽  
Left Vertebral Artery ◽  
Fusiform Aneurysm ◽  
Parent Vessel ◽  
Brainstem Infarction ◽  
Computed Tomographic ◽  
Cerebellar Artery ◽  
Intracranial Circulation

Abstract OBJECTIVE AND IMPORTANCE Recent technological advances have provided clinicians with stents that can be navigated throughout the tortuous proximal vessels of the posterior intracranial circulation. There have been few reports of fusiform and wide-necked aneurysms treated with stents. Of the known risks involved in stent placement in the intracranial circulation, delayed stent thrombosis has not been well described. CLINICAL PRESENTATION A 34-year-old man who experienced the sudden onset of a severe headache with increasing lethargy was found on computed tomographic imaging to have a subarachnoid hemorrhage. Angiography revealed a left vertebral artery fusiform aneurysm that incorporated the posteroinferior cerebellar artery origin. INTERVENTION A low-porosity Magic Wallstent (Boston Scientific, Natick, MA) was placed in the left vertebral artery across the aneurysm and the origin of the posteroinferior cerebellar artery. Angiography performed 9 days later revealed significant reduction in filling of the aneurysm. The patient returned 3 months after stent placement with severe neurological deterioration from a brainstem infarction caused by complete thrombotic occlusion of the left vertebral artery at the stented segment of the vessel. CONCLUSION Stenting of fusiform aneurysms has provided an alternative to surgical clipping or parent vessel reconstruction. With the increasing frequency of intracranial stent placement for various cerebrovascular disease entities, we must become aware of potential complications associated with these procedures. Such awareness may influence decision-making processes regarding treatment and follow-up care.

Recurrence of a Vertebral Artery Dissecting Pseudoaneurysm after Successful Stent-supported Coil Embolization: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 754-761 ◽  
Author(s):  
Christopher I. MacKay ◽  
Patrick P. Han ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Neck Pain ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Left Vertebral Artery ◽  
Parent Vessel ◽  
Computed Tomographic ◽  
Computed Tomographic Scan

Abstract OBJECTIVE AND IMPORTANCE Dissecting aneurysms of the intracranial vertebral artery are increasingly recognized as a cause of subarachnoid hemorrhage. We present a case involving technical success of the stent-supported coil embolization but with recurrence of the dissecting pseudoaneurysm of the intracranial vertebral artery. The implications for the endovascular management of ruptured dissecting pseudoaneurysms of the intracranial vertebral artery are discussed. CLINICAL PRESENTATION A 36-year-old man with a remote history of head injury had recovered functionally to the point of independent living. He experienced the spontaneous onset of severe head and neck pain, which progressed rapidly to obtundation. A computed tomographic scan of the head revealed subarachnoid hemorrhage centered in the posterior fossa. The patient underwent cerebral angiography, which revealed dilation of the distal left vertebral artery consistent with a dissecting pseudoaneurysm. INTERVENTION Transfemoral access was achieved under general anesthesia, and two overlapping stents (3 mm in diameter and 14 mm long) were placed to cover the entire dissected segment. Follow-up angiography of the left vertebral artery showed the placement of the stents across the neck of the aneurysm; coil placement was satisfactory, with no residual aneurysm filling. Approximately 6 weeks after the patient's initial presentation, he developed the sudden onset of severe neck pain. A computed tomographic scan showed no subarachnoid hemorrhage, but computed tomographic angiography revealed that the previously treated left vertebral artery aneurysm had recurred. Angiography confirmed a recurrent pseudoaneurysm around the previously placed Guglielmi detachable coils. A test balloon occlusion was performed for 30 minutes. The patient's neurological examination was stable throughout the test occlusion period. Guglielmi detachable coil embolization of the left vertebral artery was then performed, sacrificing the artery at the level of the dissection. After the procedure was completed, no new neurological deficits occurred. On the second day after the procedure, the patient was discharged from the hospital. He was alert, oriented, and able to walk. CONCLUSION We appreciate the value of preserving a parent vessel when a dissecting pseudoaneurysm of the intracranial vertebral artery ruptures in patients with inadequate collateral blood flow, in patients with disease involving the contralateral vertebral artery, or in patients with both. However, our case represents a cautionary note that patients treated in this fashion require close clinical follow-up. We suggest that parent vessel occlusion be considered the first option for treatment in patients who will tolerate sacrifice of the parent vessel along its diseased segment. In the future, covered stent technology may resolve this dilemma for many of these patients.

scholarly journals Progressive cervicocranial arteriopathy with dilatations and stenoses: case report

2004 ◽  
Vol 62 (3b) ◽  
pp. 899-902 ◽  
Author(s):  
Adriana Bastos Conforto ◽  
Paulo Puglia Jr ◽  
Fábio Iuji Yamamoto ◽  
Milberto Scaff
Keyword(s):  
Vertebral Artery ◽  
Carotid Arteries ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
Left Vertebral Artery ◽  
Fusiform Aneurysm ◽  
Pathogenetic Mechanism ◽  
Pontine Infarction ◽  
The Right ◽  
Internal Carotid Arteries

We report the case of a 36 year-old woman who presented occlusion of a basilar artery fusiform aneurysm (FA) associated with pontine infarction, and two episodes of subarachnoid hemorrhage possibly due to arterial dissection. She also had asymptomatic FAs in the right middle cerebral and left internal carotid arteries. Over 5 years, lesions suggestive of fibromuscular dysplasia in the right vertebral artery and occlusion of the left vertebral artery were observed. This combination of lesions emphasizes the possibility of a common pathogenetic mechanism causing different degrees of media disruption in cervicocranial arteries.

scholarly journals Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

2019 ◽  
Vol 12 (8) ◽  
pp. e231335 ◽  
Author(s):  
Sean Thomas O’Reilly ◽  
Ian Rennie ◽  
Jim McIlmoyle ◽  
Graham Smyth
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Basilar Artery Thrombosis ◽  
Direct Puncture ◽  
Alternative Approach ◽  
Cerebellar Artery ◽  
First Pass ◽  
The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child

1994 ◽  
Vol 81 (2) ◽  
pp. 304-307 ◽  
Author(s):  
Mazen H. Khayata ◽  
Robert F. Spetzler ◽  
Jan J. A. Mooy ◽  
James M. Herman ◽  
Harold L. Rekate
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Parent Artery ◽  
Content Type ◽  
Cerebellar Artery ◽  
Coil Occlusion ◽  
Surgical Bypass

✓ The case is presented of a 5-year-old child who suffered a subarachnoid hemorrhage from a giant left vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm. Initial treatment consisted of surgical occlusion of the parent vertebral artery combined with a PICA-to-PICA bypass. Because of persistent filling of the aneurysm, the left PICA was occluded at its takeoff from the aneurysm. Endovascular coil occlusion of the aneurysm and the distal left vertebral artery enabled complete elimination of the aneurysm. Follow-up magnetic resonance imaging and arteriography performed 6 months postoperatively showed persistent occlusion and elimination of the mass effect. Combined surgical bypass and endovascular occlusion of the parent artery may be a useful adjunct in the management of these aneurysms.

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

Neurosurgery ◽  
2009 ◽  
Vol 64 (3) ◽  
pp. E564-E565 ◽  
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.

Anastomosis Between the Ascending Pharyngeal Artery and the Posterior Inferior Cerebellar Artery Through the Jugular Foramen

2015 ◽  
Vol 12 (2) ◽  
pp. 163-167
Author(s):  
Khaled Effendi ◽  
Elsa Magro ◽  
Jean-Christophe Gentric ◽  
Tim E Darsaut ◽  
Jean Raymond ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Jugular Foramen ◽  
Left Vertebral Artery ◽  
Cadaveric Specimen ◽  
3 Dimensional ◽  
Ascending Pharyngeal Artery ◽  
Cerebellar Artery ◽  
Direct Anastomosis ◽  
Posterior Division

Abstract BACKGROUND The ascending pharyngeal artery (APA) may, in very rare cases, supply the posterior inferior cerebellar artery (PICA). In reported cases, when such is the case, the ipsilateral vertebral artery (VA) does not supply the PICA, and most of the time it is hypoplastic. OBJECTIVE To describe a unique cadaveric observation of a direct anastomosis between the posterior division (neuromeningeal) of the jugular branch of the APA and the PICA, where the PICA is also supplied by a normal-size VA. METHODS A direct connection between the APA and the PICA was examined in a cadaveric specimen using a 3-dimensional endoscope and a surgical microscope. RESULTS The enlarged jugular branch of the posterior division of the APA entered intracranially via the jugular foramen in its pars vascularis. It then connected directly with the lateral medullary segment of the PICA. The first segment of the PICA originated from a left vertebral artery of normal size and continued its normal course beyond the junction with the jugular branch of the APA. CONCLUSION Both the VA and the jugular branch of the APA may simultaneously supply the PICA territory. Recognition of this anatomic variant is relevant when planning surgical or endovascular treatments.

Ruptured Proximal Lenticulostriate artery Fusiform Aneurysm Presenting with Subarachnoid Hemorrhage: Case Report

Neurosurgery ◽  
2007 ◽  
Vol 60 (5) ◽  
pp. E949-E949 ◽  
Author(s):  
Christopher S. Eddleman ◽  
Daniel Surdell ◽  
Glen Pollock ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Basal Ganglia ◽  
Sudden Onset ◽  
Neurological Deficits ◽  
Fusiform Aneurysm ◽  
Cerebral Angiogram ◽  
Computed Tomographic ◽  
Superior Surface ◽  
Lenticulostriate Artery ◽  
Safe Approach

Abstract OBJECTIVE Lenticulostriate artery aneurysms are rare. When present, distal locations in and around the basal ganglia are more common and often present with intraparenchymal hemorrhage when ruptured. We present a very rare case of a ruptured proximal lenticulostriate fusiform aneurysm presenting with subarachnoid hemorrhage. CLINICAL PRESENTATION We report the case of a 31-year-old healthy man who presented after the sudden onset of headache, nausea, and lethargy without neurological deficits. Cranial computed tomographic scanning demonstrated diffuse subarachnoid hemorrhage, and a cranial computed tomographic angiogram demonstrated a vascular irregularity on the superior surface of the left distal M1 trunk of the middle cerebral artery. A cerebral angiogram demonstrated a left proximal lenticulostriate fusiform aneurysm without evidence of moyamoya-like vessels or vasculitis. No other pathology or infectious etiology was noted. INTERVENTION Endovascular therapy was deemed unsafe, and microsurgical exploration and intervention was the more favorable and safe approach. A standard left pterional craniotomy was performed and the afferent lenticulostriate vessel into the fusiform aneurysm was visualized. Temporary clips were applied to the proximal and distal M1 trunk and miniclips were applied across the afferent portion and fundus of the aneurysm, thus sacrificing the parent lenticulostriate artery. A postoperative computed tomographic scan demonstrated an area of hypodensity in the left basal ganglia. The patient's postoperative right facial and upper extremity weakness improved to normal several days after aneurysmal clipping. CONCLUSION This is the first report of a ruptured proximal lenticulostriate artery fusiform aneurysm, which presented as subarachnoid hemorrhage in a healthy patient without an underlying vascular disease.

scholarly journals Vertebral Dissecting Aneurysm Treated with Wingspan Stent Deployment and Detachable Coils

2009 ◽  
Vol 15 (1) ◽  
pp. 113-116 ◽  
Author(s):  
M. Lv ◽  
X. Lv ◽  
Y. Li ◽  
X. Yang ◽  
Z. Wu
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Stent Placement ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Stent Deployment ◽  
Detachable Coils

We describe the first documented endovascular treatment of vertebral dissecting aneurysm using a Wingspan stent and detachable coils. A 54-year-old man presented with a nonruptured vertebral dissecting aneurysm. Because of the dissecting nature of the vertebral aneurysms, a 3×15-mm Wingspan stent was placed in the left vertebral artery. One month later, several detachable coils were introduced into the aneurysm. Six-month follow-up angiogram confirmed the obliteration. Vertebral dissecting aneurysm can be treated with Wingspan stent placement and detachable coils.

Aneurysm of the Distal Anterior Inferior Cerebellar Artery Unrelated to the Cerebellopontine Angle: Case Report

Neurosurgery ◽  
1991 ◽  
Vol 28 (6) ◽  
pp. 899-903 ◽  
Author(s):  
Katsumaro Oana ◽  
Toshiharu Murakami ◽  
Takaaki Beppu ◽  
Akira Yamaura ◽  
Haruyuki Kanaya
Keyword(s):  
Case Report ◽  
Cerebellopontine Angle ◽  
Lateral Position ◽  
Sudden Onset ◽  
Uneventful Recovery ◽  
Anterior Inferior Cerebellar Artery ◽  
Computed Tomographic ◽  
Suboccipital Craniectomy ◽  
Cerebellar Artery ◽  
Operative Findings

Abstract This is a case report of an unusual aneurysm of the distal anterior inferior cerebellar artery. A 44-year-old woman had a severe frontal headache and vomiting of sudden onset. On the day after admission, the patient began to demonstrate nuchal rigidity and difficulty with upward gaze bilaterally. There were no complaints at this time suggestive of a syndrome of the cerebellopontine angle. A computed tomographic scan revealed an intraventricular hemorrhage of the 3rd and 4th ventricles; however, multiple attempts at four-vessel angiography were required before an aneurysm could be demon-strated. On the 28th hospital day, a suboccipital craniectomy using the retromastoid approach in the lateral position was performed. A saccular aneurysm with a surrounding hematoma in the distal anterior inferior cerebellar artery was found and clipped. The operative findings revealed that the aneurysm was unrelated to the cerebellopontine angle. After surgery, the patient had an uneventful recovery and complete resolution of symptoms.

scholarly journals Successful endovascular treatment of a dissecting aneurysm of vertebral artery associated with double origin of the posterior inferior cerebellar artery

2015 ◽  
Vol 22 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Tetsuya Tsukahara ◽  
Shunichi Fukuda ◽  
Satoru Kawarazaki ◽  
Tomokazu Aoki
Keyword(s):  
Vertebral Artery ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Cerebellar Artery ◽  
Transient Loss ◽  
Magnetic Resonance Imaging Mri ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Double Origin

Background Double origin of the posterior inferior cerebellar artery (DOPICA) has been rarely reported in the literature, with a reported incidence of 1.45%. In contrast, a high concurrence rate of DOPICA and vertebral artery dissecting aneurysm has been reported. Clinical presentation A 61-year old woman presented with vomiting and diplopia with preceding headache. Magnetic resonance imaging (MRI) showed fresh infarction of the left lateral medulla and a vertebral artery dissecting aneurysm of the left vertebral artery. The next day, she exhibited transient loss of consciousness and worsening of headache, and MRI depicted subarachnoid hemorrhage. Four-vessel digital subtraction angiography showed a posterior inferior cerebellar artery (PICA) arising both intracranially and extracranially from the left vertebral artery. Although the dissecting lesion involved the V3 and V4 portion, it did not involve an extracranially originating PICA. Internal trapping of the V3 and V4 portion was chosen as the extracranial channel was expected to supply the PICA territory. This procedure was safely performed. Conclusion Early endovascular intervention should be considered in the treatment of dissecting aneurysm of vertebral artery associated with DOPICA for patients with relatively long lesions even in unruptured cases.

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