Retrograde thrombectomy of basilar artery thrombus through the posterior communicating artery

2021 ◽  
pp. neurintsurg-2021-017965
Author(s):  
Omar Kass-Hout ◽  
Tibor Becske
Keyword(s):  
Basilar Artery ◽  
Balloon Occlusion ◽  
Posterior Communicating Artery ◽  
Unique Case ◽  
Content Type ◽  
Vertebral Arteries ◽  
Stent Retrieval ◽  
Vertebrobasilar Junction ◽  
The Right ◽  
Video Player

Transcirculation thrombectomy through the communicating arteries of the circle of Willis has been previously described as a bailout in cases where direct thrombectomy is not feasible.1–3 Here we present a unique case where a retrograde thrombectomy of the proximal basilar artery was performed using the right posterior communicating artery (PCOM) in a patient with bilateral occlusions of the vertebral arteries, believed to be chronic. This was done using a quadriaxial system with multiple concentric catheters to minimize the ledge effect and achieve smooth and safe transition of the catheters from anterior to posterior circulations. A combination of stent retrieval, aspiration and balloon occlusion guide catheters helped retrieve the thrombus, while minimizing emboli in new territory (ENT). The patient had complete resolution of symptoms. The thrombus is believed to be due to stasis at the vertebrobasilar junction and competing flow, hence, the patient was started on anticoagulation. (video 1)Video 1

Association between an aplastic basilar artery, unaccompanied by a primitive carotid—vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery

2004 ◽  
Vol 100 (5) ◽  
pp. 946-949 ◽  
Author(s):  
Sanjay Behari ◽  
Himanshu Krishna ◽  
Marakani V. Kiran Kumar ◽  
Vijay Sawlani ◽  
Rajendra V. Phadke ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Posterior Communicating Artery ◽  
Cerebral Vasculature ◽  
Hemodynamic Changes ◽  
Meningeal Irritation ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Transsylvian Approach ◽  
The Right ◽  
Fine Print

✓ Basilar artery (BA) aplasia when unaccompanied by a primitive carotid—vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.

scholarly journals Acutely ruptured basilar artery bifurcation aneurysm, treated with simultaneous Cascade and Comaneci temporary-assisted coiling

2020 ◽  
pp. neurintsurg-2020-016320
Author(s):  
Alexander Sirakov ◽  
Radoslav Raychev ◽  
Pervinder Bhogal ◽  
Stanimir Sirakov
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Cerebral Aneurysms ◽  
Content Type ◽  
Compliant Structure ◽  
Bifurcation Aneurysm ◽  
Vessel Patency ◽  
Endovascular Coil Embolization ◽  
Video Player ◽  
Temporary Stent

Temporary stent-assisted coiling is an eligible approach for the treatment of acutely ruptured complex cerebral aneurysms. Improved material properties and industrial advances in braiding technology have led to the introduction of new stent-like devices to augment endovascular coil embolization. Such technology includes the Cascade and Comaneci neck-bridging devices. Both devices are manually controlled, non-occlusive and fully retrievable neck-bridging temporary implants. The braided nature and the ultra-thin wire, compliant structure of their bridging meshes helps maintain target vessel patency during coil embolization. In this video (video 1) we demonstrate the straightforward combination of two temporary neck-bridging devices for the embolization of an acutely ruptured aneurysm of the basilar artery. Technical success and complete embolization of the aneurysm were recorded at the final angiography. In this technical video we discuss the technical nuances of the Comaneci and Cascade coil embolization.Video 1

Transcirculation balloon-assisted stent-supported coil embolization of a basilar tip aneurysm

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Vijay Agarwal ◽  
Ali Zomorodi ◽  
Cameron Mcdougal ◽  
Ranjith Babu ◽  
Adam Back ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Coil Embolization ◽  
Posterior Communicating Artery ◽  
Link Type ◽  
Left Posterior ◽  
Basilar Tip Aneurysm ◽  
The Right

We present the case of a balloon-assisted, stent-supported coil embolization of a basilar tip aneurysm. Initially, a balloon extending from the basilar artery into the right PCA was placed.3 However, even with a more proximal purchase, coils were found to impinge on the left PCA. Subsequently, a transcirculation approach was performed, where the left posterior communicating artery was utilized as a conduit for balloon support and the coils were embolized from the ipsilateral vertebral artery.1 However, after this transcirculation approach was completed, there was a coil tail extruding from the aneurysm. The balloon was then removed over an exchange wire and a horizontal stent advanced, spanning the entire neck of the aneurysm, eliminating the extruded coil.2The video can be found here: http://youtu.be/bMbtZoPnYvo.

Enlargement of basilar artery aneurysms following balloon occlusion — “water-hammer effect”

1991 ◽  
Vol 75 (6) ◽  
pp. 963-968 ◽  
Author(s):  
Eddie S. K. Kwan ◽  
Carl B. Heilman ◽  
William A. Shucart ◽  
Richard P. Klucznik
Keyword(s):  
Basilar Artery ◽  
Water Hammer ◽  
Balloon Occlusion ◽  
Successful Therapy ◽  
Content Type ◽  
Aneurysm Neck ◽  
Water Hammer Effect ◽  
Fine Print

✓ Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a “water-hammer effect” and the possibility of hemorrhage following subtotal occlusion.

scholarly journals Terminal Triplication of the Left Vertebral Artery: A Unique Variation

2007 ◽  
Vol 13 (4) ◽  
pp. 399-401
Author(s):  
P.H. Dissanayake ◽  
J.J. Bhattacharya ◽  
E.V. Teasdale
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Subclavian Artery ◽  
Basilar Artery ◽  
Clinical Importance ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Unique Case ◽  
The Right ◽  
Unique Variation

This report describes a unique case of triplication of the terminal left vertebral artery, forming the basilar artery in a 75-year-old male. CT angiography of cranio-cervical vessels also demonstrated the right vertebral artery originating from the right common carotid and an aberrant right subclavian artery. To the best of our knowledge this is the first report of a variation of this nature. The embryology and the clinical importance are discussed.

Fatal paradoxical muscle embolization in traumatic carotid-cavernous fistula repair

1976 ◽  
Vol 44 (4) ◽  
pp. 513-516 ◽  
Author(s):  
William F. McCormick ◽  
Patrick J. Kelly ◽  
Mohammed Sarwar
Keyword(s):  
Internal Carotid ◽  
Brain Infarction ◽  
Cerebral Arteries ◽  
Fistula Repair ◽  
Carotid Cavernous Fistula ◽  
Unique Case ◽  
Content Type ◽  
Cavernous Fistula ◽  
Middle Cerebral Arteries ◽  
The Right

✓ A unique case of fatal paradoxical muscle embolism in a patient with a traumatic carotid-cavernous fistula is described. The muscle plug intended to occlude a left-sided fistula passed through the large fistula, bypassed the lungs by way of a patent foramen ovale, and embolized through the right carotid artery to lodge in the internal carotid and middle cerebral arteries producing fatal brain infarction.

scholarly journals Anomalous Origins of Bilateral Vertebral Arteries in a Child with down Syndrome and Moyamoya Disease

2012 ◽  
Vol 18 (3) ◽  
pp. 259-263 ◽  
Author(s):  
A. Mishra ◽  
H. Pendharkar ◽  
E.R. Jayadaevan ◽  
N. Bodhey
Keyword(s):  
Down Syndrome ◽  
Carotid Artery ◽  
Vertebral Artery ◽  
Moyamoya Disease ◽  
Surgical Procedures ◽  
Aberrant Right Subclavian Artery ◽  
Unique Case ◽  
Vertebral Arteries ◽  
The Right ◽  
Intracranial Circulation

Variations in vertebral artery origin and course are well-described in the literature. The origin of right vertebral artery from the right common carotid artery is an extremely rare variant. We describe a unique case of a child with Down syndrome with variant origins of bilateral vertebral artery, an aberrant right subclavian artery and concomitant Moyamoya disease of intracranial circulation. The presence of variations of the origin and course of craniocervical arteries might have profound implications in angiographic and surgical procedures and hence it is of great importance to be aware of such a possibility.

Chiari malformation with compression of the medulla oblongata by the vertebral arteries

1992 ◽  
Vol 77 (2) ◽  
pp. 307-309 ◽  
Author(s):  
Tomoko Kobayashi ◽  
Akira Ogawa ◽  
Motonobu Kameyama ◽  
Hiroshi Uenohara ◽  
Takashi Yoshimoto
Keyword(s):  
Medulla Oblongata ◽  
Chiari Malformation ◽  
Posterior Fossa Decompression ◽  
Resonance Imaging ◽  
Unique Case ◽  
Motor Weakness ◽  
Content Type ◽  
Vertebral Arteries ◽  
Unsteady Gait ◽  
Vascular Decompression

✓ A unique case is reported of Chiari malformation and compression of the medulla oblongata by both vertebral arteries. A 39-year-old woman complained of unsteady gait and motor weakness of the legs, and magnetic resonance imaging revealed the malformation and compression. Vascular decompression of the vertebral arteries was performed using synthetic (Gore-tex) vascular strips following posterior fossa decompression.

Emergency balloon occlusion for massive epistaxis due to traumatic carotid-cavernous aneurysm

1988 ◽  
Vol 68 (1) ◽  
pp. 142-144 ◽  
Author(s):  
Richard K. Simpson ◽  
Richard L. Harper ◽  
R. Nick Bryan
Keyword(s):  
Head Injury ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Traumatic Aneurysm ◽  
Acute Hemorrhage ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ A patient with a giant traumatic aneurysm of the right internal carotid artery presented with recurrent massive epistaxis 30 years after a head injury. During an episode of acute hemorrhage, this patient was effectively treated with occlusion of the internal carotid artery circulation by a detachable inflatable balloon.

Proximal intracranial internal carotid artery branches: prevalence and importance for balloon occlusion test

2005 ◽  
Vol 102 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Jason W. Allen ◽  
Anthony J. G. Alastra ◽  
Peter K. Nelson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Balloon Occlusion ◽  
Content Type ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
The Right ◽  
Fine Print

Object. The aim of this study was to determine the prevalence of angiographically identifiable skull base arterial branches that potentially serve as collateral conduits during a balloon occlusion test (BOT) of the internal carotid artery (ICA). The authors posited that neurological deficits in patients who had previously tolerated the occlusion test may be attributable to an unrecognized collateral support through these channels (operant during proximal ICA BOT) when permanent ICA occlusion was performed more distally. Methods. In 481 cases (962 ICAs), cerebral angiograms obtained during routine Wada testing were retrospectively reviewed. Two hundred sixty-one patients had at least one angiographically identifiable ICA branch; 109 patients had two or more branches. A meningohypophyseal branch of the cavernous ICA was identified on the right side in 108 patients and on the left in 122. A vidian artery originated from the petrous portion of the ICA on the right side in 58 patients and on the left in 85. The inferolateral trunk revealed itself as a branch of the cavernous ICA on the right side in 17 patients and on the left in 33. A caroticotympanic artery arose from a left cavernous ICA. A persistent trigeminal artery was situated on the right side in two patients and on the left in three. More than half of the patients had angiographically identifiable and perhaps hemodynamically significant skull base branches of the ICA, and approximately one quarter had more than one identifiable branch. Conclusions. The authors recommend that patients be screened during angiography studies performed prior to BOT in branches of the proximal intracranial ICA and that the site of BOT be moved distally if such branches are identified.

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