Republished: Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms

2016 ◽  
Vol 9 (5) ◽  
pp. e18-e18 ◽  
Author(s):  
Albert Ho Yuen Chiu ◽  
Rajalakshmi Ramesh ◽  
Jason Wenderoth ◽  
Mark Davies ◽  
Andrew Cheung
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Dissecting Aneurysm ◽  
Flow Diversion ◽  
Left Vertebral Artery ◽  
World Federation ◽  
First Case ◽  
Grade 5 ◽  
Vertebral Artery Dissecting Aneurysm

Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.

Subarachnoid hemorrhage in a case of segmental arterial mediolysis with coexisting intracranial and intraabdominal aneurysms

2012 ◽  
Vol 116 (5) ◽  
pp. 948-951 ◽  
Author(s):  
Ryosuke Matsuda ◽  
Yasuo Hironaka ◽  
Yasuhiro Takeshima ◽  
Young-Su Park ◽  
Hiroyuki Nakase
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Distal Portion ◽  
Dissecting Aneurysm ◽  
Arterial System ◽  
Left Vertebral Artery ◽  
Retroperitoneal Hemorrhage ◽  
Segmental Arterial Mediolysis ◽  
History Of ◽  
The Right ◽  
Distal Anterior Cerebral Artery

The authors report the rare case of a 58-year-old man with segmental arterial mediolysis (SAM) with associated intracranial and intraabdominal aneurysms, who suffered subarachnoid hemorrhage (SAH) due to rupture of an intracranial aneurysm. This disease primarily involves the intraabdominal arterial system, resulting in intraabdominal and retroperitoneal hemorrhage in most cases. The patient presented with severe headache and vomiting. The CT scans of the head revealed SAH. Cerebral angiography revealed 3 aneurysms: 1 in the right distal anterior cerebral artery (ACA), 1 in the distal portion of the A1 segment of the right ACA, and 1 in the left vertebral artery. The patient had a history of multiple intraabdominal aneurysms involving the splenic, gastroepiploic, gastroduodenal, and bilateral renal arteries. He underwent a right frontotemporal craniotomy and fibrin coating of the dissecting aneurysm in the distal portion of the A1 segment of the right ACA, which was the cause of the hemorrhage. Follow-up revealed no significant changes in the residual intracranial and intraabdominal aneurysms. An SAH due to SAM with associated multiple intraabdominal aneurysms is extremely rare. The authors describe their particular case and review the literature pertaining to SAM with associated intracranial and intraabdominal aneurysms.

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.

scholarly journals Early recanalization of acute occluded vertebral artery dissecting aneurysm after subarachnoid hemorrhage: two cases

Nosotchu ◽  
2018 ◽  
Vol 40 (3) ◽  
pp. 179-184
Author(s):  
Yusuke Ebiko ◽  
Yosuke Ishii ◽  
Yoshio Suyama ◽  
Hiroshi Aihara ◽  
Shinichi Wakabayashi
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Dissecting Aneurysm ◽  
Vertebral Artery Dissecting Aneurysm

scholarly journals Vertebral Artery Dissecting Aneurysm Causing Central Tapia’s Syndrome: A Case Report

2021 ◽  
Author(s):  
Yong Woo Shim ◽  
Jung Hyun Park ◽  
Sung-Tae Kim ◽  
Jin Wook Baek ◽  
Hyun Gon Lee ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Dissecting Aneurysm ◽  
Flow Diversion ◽  
Rare Presentation ◽  
Central Type ◽  
Tapia’S Syndrome ◽  
The Right ◽  
Vertebral Artery Dissecting Aneurysm

The central type of Tapia’s syndrome is an extremely rare presentation, characterized by unilateral paralysis of the vagal and hypoglossal nerves, contralateral hemiparesis, or hemihypesthesia. This report describes a case of a middle-aged patient who developed central Tapia’s syndrome due to a right vertebral artery dissecting aneurysm (VADA). The patient complained about swallowing difficulty and odynophagia. Right vocal cord paralysis, mild tongue deviation to the right side, left hypesthesia, and decreased temperature sensation with left hemiparesis were observed in neurologic exams. A right VADA and compression of the medulla oblongata due to the VADA were diagnosed on magnetic resonance imaging. Endovascular flow diversion of the right VADA was performed. After 1 year, all neurological symptoms and vocal cord paralysis were nearly resolved, but left hypesthesia remained with decreased nociception. We present and discuss how a VADA caused those symptoms and propose endovascular flow diversion as a treatment option.

scholarly journals Endovascular Treatment of Ruptured Vertebral Artery Dissecting Aneurysm in Fibromuscular Dysplasia

2019 ◽  
Vol 38 (02) ◽  
pp. 149-152
Author(s):  
Luana Antunes Maranha Gatto ◽  
Diego do Monte Rodrigues Seabra ◽  
Jennyfer Paulla Galdino Chaves ◽  
Gelson Luis Koppe ◽  
Zeferino Demartini
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Fibromuscular Dysplasia ◽  
Imaging Techniques ◽  
Dissecting Aneurysm ◽  
Renal Arteries ◽  
Good Outcome ◽  
Vertebral Artery Dissecting Aneurysm

Background Fibromuscular dysplasia (FMD) affects predominantly the cervical and renal arteries and may cause the classical angiographic pattern of string-of-beads. The diagnosis is increasing with the advances of imaging techniques. Case Report A 37-year-old man presenting with subarachnoid hemorrhage due to a dissecting aneurysm of the vertebral artery was treated by angioplasty with stent, with good outcome. All of the cervical and renal arteries were diseased and showed dysplasia and/or ectasias. Conclusions There are no guidelines or protocols to treat patients with FMD.

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