Stent-Assisted Parent Artery Occlusion of Giant Cerebrovascular Aneurysms to Avoid Mass Effect

2009 ◽  
Vol 19 (4) ◽  
pp. 370-374 ◽  
Author(s):  
Syed I. Hussain ◽  
John R. Lynch ◽  
Thomas Wolfe ◽  
Brian-Fred Fitzsimmons ◽  
Osama O. Zaidat
Keyword(s):  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion

scholarly journals Current Strategies in the Treatment of Intracranial Large and Giant Aneurysms

2021 ◽  
pp. 19-26
Author(s):  
Matthias Gmeiner ◽  
Andreas Gruber
Keyword(s):  
Treatment Strategies ◽  
High Volume ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Active Management ◽  
Definitive Treatment ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Parent Artery Occlusion ◽  
Large And Giant Aneurysms

AbstractIntroduction: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery.Methods: The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies.Results: In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Both reconstructive (clipping, coiling, stent-assisted coiling, flow diversion [FD]) and deconstructive techniques (parent artery occlusion [PAO], PAO in conjunction with bypass surgery, and strategies of flow modification) are available to achieve definitive treatment with acceptable morbidity.Conclusions: Patients harboring such lesions should be managed at high-volume cerebrovascular centers by multidisciplinary teams trained in all techniques of open and endovascular neurosurgery.

Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992

1997 ◽  
Vol 87 (2) ◽  
pp. 141-162 ◽  
Author(s):  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Collateral Vessels ◽  
Proximal Occlusion

✓ The paucity of information about giant fusiform intracranial aneurysms prompted this review of 120 surgically treated patients. Twenty-five aneurysms were located in the anterior and 95 in the posterior circulation. Six patients suffered from atherosclerosis and only three others had a known arteriopathy. The remaining 111 patients presented with aneurysms resulting from an unknown arterial disorder; these patients were much younger than those harboring atherosclerotic aneurysms. Mass effect occurred in only 50% of cases and hemorrhage in 20%. Eight aneurysms caused transient ischemic attacks. Hunterian proximal occlusion or trapping were dominant among the treatment methods. In contrast to the management of giant saccular aneurysms, the usual thrombotic occlusion of a giant fusiform aneurysm after proximal parent artery occlusion requires the presence of two collateral circulations to prevent infarction, one for the end vessels and another for the perforating vessels that arise from the aneurysm. Although there was some reliance on the circle of Willis and on collateral vessels manufactured at surgery, the extent of natural leptomeningeal and perforating collateral, thalamic, lenticulostriate, and brainstem vessels was astonishing and formerly unknown to the authors. Good outcome occurred in 76% of patients with aneurysms in the anterior circulation; two of the six cases with poor results included patients who were already hemiplegic. Ninety percent of patients with posterior cerebral aneurysms fared well. Only 67% of patients with basilar or vertebral aneurysms had good outcomes, although more (17%) of these patients were in poor condition preoperatively because of brainstem compression.

scholarly journals Embolic stroke secondary to spontaneous thrombosis of unruptured intracranial aneurysm: Report of three cases

2015 ◽  
Vol 22 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Antonio Arauz ◽  
Hernán M Patiño-Rodríguez ◽  
Mónica Chavarría-Medina ◽  
Mayra Becerril ◽  
José G Merino ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Stroke Recurrence ◽  
Parent Artery ◽  
Spontaneous Thrombosis ◽  
Unruptured Intracranial Aneurysm ◽  
Risk Of Bleeding ◽  
Parent Artery Occlusion

Intracranial aneurysms uncommonly present with ischemic stroke. Parent artery occlusion due to local extension of the luminal thrombus, aneurysms ejecting emboli to distal arteries, or increased mass effect have been described as possible pathogenic mechanisms. Guidelines for the management of these patients are absent. We present the clinical outcome and radiological characteristics of three patients with spontaneous thrombosis of intracranial aneurysms as a cause of ischemic stroke. This information is relevant given the possible benign history in terms of stroke recurrence and risk of bleeding.

Endovascular Treatment of Posterior Circulation Fusiform Aneurysms: Single-Center Experience in 31 Patients

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. 274-283 ◽  
Author(s):  
Guy Raphaeli ◽  
Laurent Collignon ◽  
Olivier De Witte ◽  
Boris Lubicz
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Excellent Outcome ◽  
Parent Artery Occlusion ◽  
Asymptomatic Patients ◽  
Cranial Nerve Palsies

Abstract BACKGROUND: Posterior circulation fusiform aneurysms are rare but difficult to treat. OBJECTIVE: To report our experience with endovascular treatment of posterior circulation fusiform aneurysms. METHODS: A retrospective review of our prospectively maintained database identified all posterior circulation fusiform aneurysms treated by endovascular approach over a 6-year period. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: From March 2004 to March 2010, 31 patients were identified: 11 asymptomatic patients, 9 who presented with a subarachnoid hemorrhage, 6 with a stroke, and 5 with a mass effect. All but 1 patient (97%), who died before being treated, were successfully treated by parent artery occlusion (n = 10), stenting plus coiling (n = 10), or stenting alone with conventional or flow-diverting stents (n = 10). Twenty-two patients showed a good or an excellent outcome (73%); 3 had a fair or a poor outcome (10%); and 5 patients died (17%). These 8 patients initially presented with severe subarachnoid hemorrhage or mass effect. Procedure-related morbidity includes only one patient who kept a worsening of cranial nerve palsies. There was no definitive procedure-related morbidity or mortality. Immediate aneurysm occlusion was incomplete in 20 cases (67%) and complete in 10 cases (33%). Mean follow-up of 20 months in 23 patients showed 12 further thromboses, 9 stable results, and 2 flow reductions. Final results included 19 complete occlusions (83%) and 4 incomplete occlusions (17%). CONCLUSION: Posterior circulation fusiform aneurysms may be treated by different endovascular approaches with satisfying clinical and anatomical results in most cases. However, patients who present with severe subarachnoid hemorrhage or mass effect still have a poor prognosis.

Treatment of large and giant fusiform intracranial aneurysms with Guglielmi detachable coils

1996 ◽  
Vol 84 (1) ◽  
pp. 55-62 ◽  
Author(s):  
Y. Pierre Gobin ◽  
Fernando Viñuela ◽  
John H. Gurian ◽  
Guido Guglielmi ◽  
Gary R. Duckwiler ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Guglielmi Detachable Coils ◽  
Parent Vessel ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Detachable Coils ◽  
Fine Print

✓ Results in nine patients with large or giant fusiform intracranial aneurysms that were treated with Guglielmi detachable coils (GDCs) are reported. There were six males and three females between the ages of 12 and 63. Four patients presented with subarachnoid hemorrhage (SAH) and four with mass effect; in one patient the aneurysm was asymptomatic and located in an arterial feeder of an arteriovenous malformation. Five aneurysms were supratentorial and four were in the posterior fossa. Five were giant and four were large. Selective occlusion with preservation of the parent artery was attempted in three cases, and complete occlusion of the aneurysm and the parent artery was performed in six patients. The tolerance to parent artery occlusion was assessed by angiography, balloon test occlusion, and amytal testing. Six aneurysms were permanently occluded and two partially recanalized. In one case, GDC embolization was not possible. The four patients who presented with SAH made an excellent clinical recovery. Three of the four patients presenting with mass effect recovered completely and one remained unchanged. The patient with an incidental aneurysm remained asymptomatic. There were no permanent complications. In conclusion, GDCs were useful for the occlusion of large and giant intradural fusiform aneurysms. Occlusion of the aneurysm and the parent artery afforded the greatest opportunity for a complete cure. Advantages of GDCs compared to balloons include: occlusion of a shorter segment of normal artery, no traction on the parent vessel, and safer and easier catheterization techniques.

Peripheral intracranial aneurysms: management challenges in 60 consecutive cases

2009 ◽  
Vol 110 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Eric S. Nussbaum ◽  
Michael T. Madison ◽  
James K. Goddard ◽  
Jeffrey P. Lassig ◽  
Leslie A. Nussbaum
Keyword(s):  
Intracranial Aneurysms ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Branch Points ◽  
Aneurysm Neck ◽  
Vertebrobasilar System ◽  
Parent Artery Occlusion ◽  
Major Branch ◽  
Proximal Occlusion

Object The authors report the management and outcomes of 55 patients with 60 intracranial aneurysms arising distal to the major branch points of the circle of Willis and vertebrobasilar system. Methods Between July 1997 and December 2006, the authors' neurovascular service treated 2021 intracranial aneurysms in 1850 patients. The database was reviewed retrospectively to identify peripherally located intracranial aneurysms. Aneurysms that were mycotic and aneurysms that were associated with either an arteriovenous malformation or an atrial myxoma were excluded from review. Results The authors encountered 60 peripheral intracranial aneurysms in 55 patients. There were 42 small, 7 large, and 11 giant lesions. Forty-one (68%) were unruptured, and 19 (32%) had bled. Fifty-three aneurysms were treated surgically by using direct clip reconstruction in 26, trapping or proximal occlusion with distal revascularization in 21, excision with end-to-end anastomosis in 3, and circumferential wrap/clip reconstruction in 3. Coils were used to treat 6 aneurysms, and 1 was treated by endovascular parent artery occlusion. Overall, 49 patients had good outcomes, 4 were left with new neurological deficits, and 2 died. Conclusions Peripherally situated intracranial aneurysms are rare lesions that present unique management challenges. Despite the fact that in the authors' experience these lesions were rarely treatable with simple clipping of the aneurysm neck or endovascular coil occlusion, preservation of the parent artery was possible in most cases, and the majority of patients had a good outcome.

Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

2021 ◽  
pp. neurintsurg-2021-017554.rep
Author(s):  
Giovanni Barchetti ◽  
Loris Di Clemente ◽  
Mauro Mazzetto ◽  
Mariano Zanusso ◽  
Paola Ferrarese ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Successful Treatment ◽  
Expectant Management ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Microsurgical Clipping ◽  
Parent Artery Occlusion ◽  
The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

scholarly journals A Combined Approach to Treatment of the Dissecting Middle Cerebral Artery Fusiform Aneurysm

2009 ◽  
Vol 15 (3) ◽  
pp. 349-354 ◽  
Author(s):  
T. Hrbáč ◽  
P. Drábek ◽  
P. Klement ◽  
V. Procházka
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Neurological Sequelae ◽  
Parent Artery Occlusion ◽  
Aneurysm Embolization ◽  
Mca Aneurysm ◽  
One Year

A fusiform aneurysm in the terminal M1 middle cerebral artery (MCA) segment was treated by a construction of a high-flow arterial extracranial-intracranial (EC-IC) bypass. Due to severe bypass vasospasms, local vasodilating agents together with percutaneous angioplasty and stent implantation were applied, but failed due to subsequent bypass occlusion. To remedy this complication a new bypass was created from a segment of the saphenous vein, followed by MCA aneurysm embolization and parent artery occlusion. One year after the surgery, the venous bypass remains patent and the aneurysm occluded, with the patient fully active, without any neurological sequelae.

scholarly journals Treatment of Intracranial Aneurysm with Bare Stent Only

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 75-78 ◽  
Author(s):  
Michael Mu Huo Teng ◽  
Chao-Bao Luo ◽  
Feng-Chi Chang ◽  
Harsan Harsan
Keyword(s):  
Intracranial Aneurysm ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Surgical Clipping ◽  
Parent Artery Occlusion ◽  
Typical Treatment ◽  
Dissecting Aneurysms

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.

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