Republished: Delayed ischemic stroke due to stent marker band occlusion after stent-assisted coiling

2018 ◽  
Vol 10 (8) ◽  
pp. e20-e20
Author(s):  
Shuhei Kawabata ◽  
Hirotoshi Imamura ◽  
Keita Suzuki ◽  
Shoichi Tani ◽  
Hidemitsu Adachi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basilar Artery ◽  
Cone Beam Ct ◽  
Artery Aneurysm ◽  
Post Treatment ◽  
Ischemic Infarction ◽  
Perforating Artery ◽  
Marker Band ◽  
Posterior Communicating Artery Aneurysm ◽  
The Right

A middle-aged patient with an internal carotid-posterior communicating artery aneurysm and basilar artery tip aneurysm was treated by stent-assisted coiling. One ischemic infarction and two transient ischemic attacks occurred with the same symptoms (inability to walk unassisted and tendency to fall to the left) during the first 2 years post-treatment. The ischemic infarction was found in the right side of the pons, consistent with the vascular territory of the stent-containing vessel. The cause of the delayed ischemic stroke was investigated on DSA and cone beam CT, which revealed that the proximal end of the stent, one marker band, was just covering a small perforating artery of the basilar artery trunk. The present case suggests that marker band occlusion can induce delayed ischemic stroke. To prevent this complication, it is important to evaluate the perforating vessels preoperatively and carefully deploy a stent for the marker band to avoid occlusion of large perforating vessels. Post-treatment evaluation is also important because dual antiplatelet therapy will be required for a longer period if an artery is occluded by a marker band.

scholarly journals Fusiform Lenticulostriate Artery Aneurysm with Subarachnoid Hemorrhage: The Role for Superselective Angiography in Treatment Planning

2010 ◽  
Vol 16 (3) ◽  
pp. 259-263 ◽  
Author(s):  
P.S. Kochar ◽  
W.F. Morrish ◽  
M.E. Hudon ◽  
J.H. Wong ◽  
M. Goyal
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Treatment Planning ◽  
Artery Aneurysm ◽  
Cerebral Angiogram ◽  
Perforating Artery ◽  
Ct Angiogram ◽  
Superselective Angiography ◽  
Lenticulostriate Artery ◽  
The Right ◽  
Exact Origin

Aneurysms of the lenticulostriatal perforating arteries are rare and either involve the middle cerebral artery-perforator junction or are located distally in basal ganglia. We describe a rare ruptured fusiform lenticulostriatal perforating artery aneurysm arising from a proximal M2 MCA branch, discerned on superselective microcatheter angiography, presenting solely with subarachnoid hemorrhage (SAH). A 50-year-old previously healthy man presented with diffuse SAH and negative CT angiogram. Cerebral angiogram demonstrated a 2 mm fusiform aneurysm presumably arising from the right lateral lenticulostriate perforator but the exact origin of the perforator was unclear. Superselective angiography was required to precisely delineate the aneurysm and its vessel of origin and directly influenced treatment planning (surgical trapping). Superselective microcatheter angiography provides both an option for endovascular therapy as well as more accurate delineation for surgical planning for these rare aneurysms.

Acute Spinal Epidural Hematoma and Cranial Interdural Hematoma Due to a Rupture of a Posterior Communicating Artery Aneurysm: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. E1000-E1004 ◽  
Author(s):  
Andrea Bartoli ◽  
Marc Kotowski ◽  
Vitor Mendes Pereira ◽  
Karl Schaller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Epidural Hematoma ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Spinal Epidural Hematoma ◽  
Anterior Communicating Artery ◽  
Posterior Communicating Artery Aneurysm ◽  
The Right ◽  
Spinal Epidural

Abstract BACKGROUND AND IMPORTANCE: We describe an unusual presentation of a ruptured aneurysm of the posterior communicating artery with an acute intracranial hematoma between the dural layers associated with an acute spinal epidural hematoma descending to L1. CLINICAL PRESENTATION: A 35-year-old woman presented 3 hours after ictus with a postcoital headache, neck stiffness, and bilateral abducens cranial nerve palsy. No other neurological deficits were present. Clinically, she had a subarachnoid hemorrhage World Federation of Neurosurgical Societies grade 1. CT scan demonstrates an acute subdural hematoma, extending from the right parasellar region, around the clivus, tentorium, and falx. Angio-CT showed a posterior communicating artery aneurysm and an anterior communicating artery aneurysm and an extension of the hematoma to the cervical spine. This justified a spinal and cerebral MRI that confirmed an extension of the hematoma to the epidural space at the cervical, thoracic, and lumbar levels. Three-dimensional digital subtraction angiography confirmed aneurysms on the right posterior communicating artery and on the anterior communicating artery. Both aneurysms were completely occluded by coiling. With reference to the concept of the cranial subdural compartment described in studies conducted using an electron microscope, this group of hematomas was classified as interdural. CONCLUSION: Ruptured aneurysm of the posterior communicating artery may cause cranial acute interdural hematoma with a typical subarachnoid hemorrhage clinical presentation, and it rarely can extend to spinal epidural space.

Detection of Angiographically Occult Ruptured Basilar Sidewall Perforator Aneurysm by Vessel Wall MR Imaging

2020 ◽  
pp. 194187442096364
Author(s):  
Mougnyan Cox ◽  
Jae W. Song ◽  
Seyed Ali Nabavizadeh ◽  
David Kung ◽  
Laurie Loevner ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Basilar Artery ◽  
Vessel Wall ◽  
Imaging Techniques ◽  
Artery Aneurysm ◽  
High Morbidity ◽  
Computed Tomographic ◽  
Ruptured Aneurysms ◽  
Intracranial Vessel ◽  
The Right

Basilar artery perforator aneurysms are rare with a prevalence of less than 1%. These are particularly challenging to detect given their small size and tendency to intermittently thrombose. We describe a case of a ruptured basilar artery sidewall perforator aneurysm that was angiographically occult on computed tomographic angiogram and cerebral catheter angiogram. One day after the initial diagnostic work-up, intracranial vessel wall MR imaging (VWI) was performed which revealed a small outpouching along the right posterolateral basilar arterial wall with a punctate enhancing focus suggestive of a thrombosed basilar perforator artery aneurysm. Thrombus within the small aneurysm sac likely contributed to the poor opacification of the aneurysm sac on conventional lumen-based imaging techniques. Ruptured aneurysms have high morbidity and mortality due to their tendency to rebleed, making their expedient detection and treatment imperative. This case highlights the role VWI can play in detecting small ruptured aneurysms that intermittently thrombose and are otherwise challenging to diagnose with conventional vessel imaging.

scholarly journals Partial Clipping Occlusion Including Rupture Point Is an Effective Strategy for Ruptured Giant Fusiform Basilar Artery Aneurysm: A Technical Case Report

2021 ◽  
Vol 12 ◽  
Author(s):  
Tsuyoshi Izumo ◽  
Takashi Fujimoto ◽  
Yoichi Morofuji ◽  
Yohei Tateishi ◽  
Takayuki Matsuo
Keyword(s):  
Basilar Artery ◽  
Artery Aneurysm ◽  
Imaging Studies ◽  
Postoperative Course ◽  
Off Label ◽  
Complex Aneurysms ◽  
Anterior Transpetrosal Approach ◽  
Basilar Artery Aneurysm ◽  
Conscious Level ◽  
The Right

Treatment of fusiform basilar artery aneurysms is still challenging today. The authors present a case of a patient with a ruptured giant fusiform basilar artery aneurysm successfully treated by clipping occlusion of the rupture point. A 62-year-old man suddenly fell into a coma due to subarachnoid hemorrhage (SAH) with a ruptured giant fusiform basilar artery aneurysm with a bleb on the right shoulder. We considered treating the lesion with stent-assisted coil embolization because of the aneurysm's shape, but we had to give up because stents were off-label in the acute phase SAH in our country. Instead, we successfully performed clipping surgery to partially occlude the aneurysm, including the rupture point via the anterior transpetrosal approach. His postoperative course was uneventful, without rerupture of the aneurysm, and his conscious level tended to improve. The postoperative imaging studies showed no complications and disappearance of the rupture point of the aneurysm. Although direct surgery for the giant fusiform basilar artery aneurysms is one of the challenging operations, it is an essential and highly effective treatment as a last resort for complex aneurysms if other treatments are not available.

Microsurgical removal of Onyx HD-500 from an aneurysm for relief of brainstem compression

2010 ◽  
Vol 113 (4) ◽  
pp. 770-773 ◽  
Author(s):  
Katrin Van Loock ◽  
Tomas Menovsky ◽  
Maurits H. Voormolen ◽  
Mark Plazier ◽  
Paul Parizel ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Mass Effect ◽  
Posterior Communicating Artery ◽  
Cerebral Peduncle ◽  
Aneurysm Wall ◽  
Brainstem Compression ◽  
Successful Removal ◽  
Posterior Communicating Artery Aneurysm ◽  
The Right ◽  
Temporary Clipping

The authors report the successful removal of Onyx HD-500 from an aneurysm sac by means of ultrasonic aspiration. This 46-year-old woman presented with progressive spasms of her left arm and leg due to mass effect and compression on the right cerebral peduncle 5 years after endovascular treatment of an unruptured giant posterior communicating artery aneurysm with Onyx HD-500. No filling of the aneurysm was detected on angiography. The patient underwent a right pterional craniotomy and the aneurysm was opened to remove the Onyx mass. However, contrary to expectations, the aneurysm was still patent, filling with blood between the Onyx mass and the aneurysm wall. Under temporary clipping of the carotid artery, the Onyx mass within the aneurysm was removed in a piecemeal fashion using an ultrasonic aspirator and the aneurysm was then successfully clipped. The patient experienced significant improvement of the spasm after surgery. Angiography showed complete occlusion of the posterior communicating artery aneurysm. It is rarely necessary to remove embolization material such as Onyx HD-500, and little is known about the most appropriate surgical technique. This case report demonstrates that removal can be safely accomplished by means of ultrasonic aspiration.

scholarly journals Case report: Intracranial Arterial Dolichoectasia

2021 ◽  
Author(s):  
Lorena Dellagnesi Depieri ◽  
Lorena Souza Viana
Keyword(s):  
Basilar Artery ◽  
Incidental Finding ◽  
Artery Aneurysm ◽  
Spontaneous Remission ◽  
Treatment Method ◽  
Neurological Complications ◽  
Focal Neurological Deficit ◽  
Life Threatening Illness ◽  
Adjacent Structures ◽  
The Right

Introduction: Intracranial arterial dolichoectasia (IADE) is a diameter increase and/ or a long and tortuous path in one or more Intracranial arterial. Most patients keep asymptomatic and eventually present neurological complications (ischemia, bleeding or compression of adjacent structures). At around 12% of the patients with stroke present this kind of intracranial dilated, which 80% are in the posterior cerebral circulation, mainly in basilar artery. Objective: Report an unusual case of IADE refractory to the clinical treatment. Method: The information was obtained by reviewing the medical record, after the patient’s consent. Result: Patient, 51, male, hypertensive and dyslipidemic, with abdominal aortic aneurysm surgery and an incidental diagnosis in 2015 of fusiform basilar artery aneurysm, presented in March 2020 after cervical flexion, dysarthria, horizontal diplopia when looking to the right and ptosis to the left. The computed cranial angiotomography showed a basilar artery of 1.8 cm diameter fusiform aneurysm, compressing the pons and medulla oblongata, with no signs of ischemia or bleeding. He was discharged from hospital with clopidogrel without deficits, however, after 30 days, manifested a new focal neurological deficit with spontaneous remission. During the investigation a skull resonance was presented without ischemia, transcranial doppler with circulatory delay and without embolization. In view of the recurrence, an exchange in clopidogrel for ticagrelor was decided, which was kept stable for 30 days. Conclusion: IADE may be an incidental finding or even a life-threatening illness. Thus, these cases remain a major challenge in clinical practice and in interventional radiology.

scholarly journals Segmental myoclonus and basilar artery giant aneurysm case report

1992 ◽  
Vol 50 (4) ◽  
pp. 528-530
Author(s):  
J. Pitágoras de Mattos ◽  
Ana L. Zuma de Rosso ◽  
Eduardo Zayen ◽  
Sérgio A. P. Novis
Keyword(s):  
Ischemic Stroke ◽  
Essential Hypertension ◽  
Case Report ◽  
Angina Pectoris ◽  
Ct Scan ◽  
Basilar Artery ◽  
Giant Aneurysm ◽  
Neurologic Examination ◽  
Babinski Sign ◽  
The Right

A 70 years-old man was admitted at our hospital because of unstable angina pectoris. He had essential hypertension and right hemiplegia from a ischemic stroke two years before admission. On neurologic examination, it was found mental disorientation, unstable emotionality, right spastic hemiparesis with right Babinski sign, and segmental myoclonus affecting the superior lip and the palate (palatal nystagmus) on the right side. On the CT scan, a giant aneurysm of the basilar artery was detected. We conclude that the segmental myoclonus could be explained by ischemic lesions in the Guillain - Mollaret triangle.

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