Republished: Treatment of wide-necked basilar tip aneurysm not amenable to Y-stenting using the PulseRider device

2015 ◽  
Vol 8 (9) ◽  
pp. e37-e37 ◽  
Author(s):  
Sunil A Sheth ◽  
Nirav S Patel ◽  
Ameera F Ismail ◽  
Dena Freeman ◽  
Gary Duckwiler ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Parent Vessel ◽  
Basilar Tip Aneurysm

Endovascular treatment of broad-necked bifurcation aneurysms remains challenging. Stent-assisted coiling has been successful but requires catheterization of the branches off the parent vessel. We present the case of a patient who failed primary and stent-assisted coiling of a large basilar tip aneurysm because the morphology of the aneurysm precluded successful distal catheterization of the posterior cerebral artery (PCA) branches. Using the PulseRider device, which does not require catheterization of bifurcation branches, we were able to treat the aneurysm successfully.

scholarly journals Endovascular Occlusion of the Posterior Cerebral Artery in the Treatment of P2 Ruptured Aneurysms

2007 ◽  
Vol 13 (2) ◽  
pp. 127-132 ◽  
Author(s):  
E. Cotroneo ◽  
R. Gigli ◽  
G. Guglielmi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Parent Vessel ◽  
Ruptured Aneurysms ◽  
Endovascular Occlusion ◽  
Platinum Coils

Four cases of posterior cerebral artery (PCA) aneurysms are described. The aneurysms were located at the P2 segment of PCA. All cases presented with a subarachnoid hemorrhage (SAH). Endovascular treatment was performed, with occlusion of the aneurysm and parent vessel, using platinum coils. Two patients developed a homonymus lateral hemianopia after treatment.

Acute occlusion of the fetal posterior cerebral artery: diagnosis and management paradigms

2021 ◽  
pp. 197140092110193
Author(s):  
Mohamad Abdalkader ◽  
Anurag Sahoo ◽  
Julie G Shulman ◽  
Elie Sader ◽  
Courtney Takahashi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Mechanical Thrombectomy ◽  
Posterior Cerebral Artery ◽  
Management Strategies ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Cerebral Artery Occlusion

Background and purpose The diagnosis and management of acute fetal posterior cerebral artery occlusion are challenging. While endovascular treatment is established for anterior circulation large vessel occlusion stroke, little is known about the course of acute fetal posterior cerebral artery occlusions. We report the clinical course, radiological findings and management considerations of acute fetal posterior cerebral artery occlusion stroke. Methods We performed a retrospective review of consecutive patients presenting with acute large vessel occlusion who underwent cerebral angiogram and/or mechanical thrombectomy between January 2015 and January 2021. Patients diagnosed with fetal posterior cerebral artery occlusion were included. Demographic data, clinical presentation, imaging findings and management strategies were reviewed. Results Between January 2015 and January 2021, three patients with fetal posterior cerebral artery occlusion were identified from 400 patients who underwent angiogram and/or mechanical thrombectomy for acute stroke (0.75%). The first patient presented with concomitant fetal posterior cerebral artery and middle cerebral artery occlusions. Thrombectomy was performed with recanalisation of the fetal posterior cerebral artery but the patient died from malignant oedema. The second patient presented with isolated fetal posterior cerebral artery occlusion. No endovascular intervention was performed and the patient was disabled from malignant posterior cerebral artery infarct. The third patient presented with carotid occlusion and was found to have fetal posterior cerebral artery occlusion after internal carotid artery recanalisation. No further intervention was performed. The patient was left with residual contralateral homonymous hemianopia and mild left sided weakness. Conclusion Fetal posterior cerebral artery occlusion is a rare, but potentially disabling, cause of ischaemic stroke. Endovascular treatment is feasible. Further investigation is needed to compare the efficacy of medical versus endovascular management strategies.

Traumatic dissecting pathology of posterior cerebral artery: a report of two cases—aneurysm and pial arteriovenous fistula

2021 ◽  
Vol 14 (5) ◽  
pp. e237722
Author(s):  
Vignesh Selvamurugan ◽  
Surya Nandan Prasad ◽  
Vivek Singh ◽  
Zafar Neyaz
Keyword(s):  
Arteriovenous Fistula ◽  
Cerebral Artery ◽  
Road Traffic ◽  
Posterior Cerebral Artery ◽  
Case Reports ◽  
Dissecting Aneurysm ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Pial Arteriovenous Fistula

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.

scholarly journals Applications of the Columbus steerable guidewire

2021 ◽  
pp. neurintsurg-2021-018120
Author(s):  
Alexander von Hessling ◽  
Tomás Reyes del Castillo ◽  
Lutz Lehmann ◽  
Justus Erasmus Roos ◽  
Grzegorz Karwacki
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Curvature Radius ◽  
Content Type ◽  
Complex Aneurysm ◽  
Media Player ◽  
First Case ◽  
Great Support ◽  
Basilar Tip Aneurysm ◽  
Video Player

The Columbus steerable guidewire (Rapid Medical, Israel) is a 0.014 inch guidewire with a remotely controlled deflectable tip intended for neuronavigational purposes. 1 The tip can be shaped by pulling or pushing the handle. Pulling the handle decreases the radius (from 4 mm to 2 mm) and curves the tip, while pushing the handle increases the curvature radius and straightens the tip until it bends in the opposite direction. The amount of deflection is at the discretion of the operator. Video 1 The response of the Columbus guidewire to rotational movements is inferior to that of standard wires, and the tip is very soft and malleable but brings great support when bent. We present two cases where the Columbus guidewire was used. In the first case, the Columbus enabled us to probe a posterior cerebral artery arising from a giant basilar tip aneurysm without wall contact. In the second case, the Columbus was used as a secondary wire to help cannulate the pericallosal artery in a patient with a recurrent anterior complex aneurysm; this subsequently permitted successful stent-assisted coiling of the aneurysm.Video 1

Endovascular Treatment of Complex Distal Posterior Cerebral Artery Aneurysms with the Pipeline Embolization Device

2017 ◽  
Vol 107 ◽  
pp. 1043.e1-1043.e5 ◽  
Author(s):  
Paul Mazaris ◽  
Tapan Mehta ◽  
Mohammed Hussain ◽  
Violiza Inoa ◽  
Justin Singer ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Pipeline Embolization Device

scholarly journals Endovascular treatment of posterior cerebral artery aneurysms: a single center's experience of 55 cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1094-1105 ◽  
Author(s):  
Xuanfeng Qin ◽  
Feng Xu ◽  
Yashengjiang Maimaiti ◽  
Yongtao Zheng ◽  
Bin Xu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Attractive Alternative ◽  
Parent Artery ◽  
Parent Artery Occlusion

OBJECTIVE Aneurysms of the posterior cerebral artery (PCA) are uncommon. To date, a limited number of studies have examined the outcomes of endovascular treatment for PCA aneurysms. The authors' aim in this study is to report their experience with the endovascular treatment of PCA aneurysms. METHODS Between January 2007 and December 2014, 55 patients with 59 PCA aneurysms were treated using the endovascular approach at the authors' institution. Twenty-three patients had 25 saccular aneurysms, and 32 patients had 34 fusiform/dissecting aneurysms. The endovascular modalities included the following: 1) selective occlusion of the aneurysm (n = 22); 2) complete occlusion of the aneurysm and the parent artery (n = 20); 3) parent artery occlusion (n = 6); 4) partial coiling of the aneurysm and the parent artery (n = 5); and 5) occlusion of the dissecting aneurysm sac (n = 2). RESULTS The immediate angiographic results included 45 complete occlusions (82%), 2 nearly complete occlusions (4%), and 8 incomplete occlusions (14%). The mean follow-up period of 21.8 months in 46 patients showed 37 stable results, 6 further thromboses, and 3 recurrences. The final results included 41 complete occlusions (89%), 2 nearly complete occlusions (4%), and 3 incomplete occlusions (7%). Procedure-related complications included the following: 1) rebleeding (n = 1); 2) infarction (n = 4); and 3) perforation (n = 1). There was 1 (1.8%) procedure-related death due to rebleeding, and 2 (3.6%) non–procedure-related deaths due to severe subarachnoid hemorrhage. Clinical outcomes were excellent (Glasgow Outcome Scale 5) in 47 of 49 patients at the long-term follow-up. CONCLUSIONS PCA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiological outcomes. However, patients who present with severe SAH still have an overall poor prognosis. Partial coiling of the aneurysm and the parent artery is an attractive alternative treatment for patients who may not tolerate parent artery occlusion. Further study with a larger case series is necessary for validation of the durability and efficacy of this treatment.

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

2009 ◽  
Vol 71 (3) ◽  
pp. 319-325 ◽  
Author(s):  
Xianli Lv ◽  
Youxiang Li ◽  
Chuhan Jiang ◽  
Xinjian Yang ◽  
Zhongxue Wu
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Dissecting 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.

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