Stent-Assisted Angioplasty of Spontaneous Bilateral Extracranial Vertebral Dissections under Intravascular Ultrasound Guidance

The authors here report a case of stent-assisted angioplasty under intravascular ultrasound (IVUS) guidance for the treatment of spontaneous bilateral extracranial vertebral artery (VA) dissection. A 47-year-old woman presented with spontaneous severe posterior neck pain. Examinations revealed bilateral extracranial VA dissection, which was thought to be the reason for her symptom. However, since the pain was gradually worsening even after sufficient medical treatment, she underwent stent angioplasty under IVUS guidance, following which her symptoms improved. We propose that stent placement under IVUS guidance is a safe and feasible method for treating extracranial VA dissections. Since the intravascular environment is seen in real time with IVUS, this technique is useful for confirming a true lumen and evaluating appropriate stent apposition. More clinical experience with this technique is required and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

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Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection

Journal of Neurosurgery ◽

10.3171/jns.2008.109.12.1113 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1113-1118 ◽

Cited By ~ 10

Author(s):

Won-Ki Yoon ◽

Young-Woo Kim ◽

Sang-Don Kim ◽

Ik-Seong Park ◽

Min-Woo Baik ◽

...

Keyword(s):

Vertebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Intravascular Ultrasonography ◽

Stent Angioplasty ◽

Posterior Neck ◽

Extracranial Vertebral Artery ◽

The Right

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved. To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

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Contrast-less stent placement for vertebral artery origin stenosis

Interventional Neuroradiology ◽

10.1177/1591019916677960 ◽

2016 ◽

Vol 23 (1) ◽

pp. 79-83 ◽

Cited By ~ 4

Author(s):

Shinzo Ota ◽

Yoshinobu Sekihara ◽

Takahiro Himeno ◽

Yasue Tanaka ◽

Tatsuya Ohtonari

Keyword(s):

Renal Function ◽

Contrast Medium ◽

Vertebral Artery ◽

Intravascular Ultrasound ◽

Male Patient ◽

Stent Placement

We performed stent placement under intravascular ultrasound (IVUS), without the use of contrast medium, in a male patient in his 70s who had vertebral artery origin stenosis and decreased renal function. Satisfactory dilatation was achieved without complications, and the patient remained asymptomatic at 2 years of follow-up. We now report the details of this procedure. Stent placement under IVUS guidance may be useful in patients in whom contrast medium is contraindicated.

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An unusual case of a giant extracranial vertebral artery aneurysm

Vascular ◽

10.1177/1708538119843403 ◽

2019 ◽

Vol 27 (4) ◽

pp. 427-429 ◽

Cited By ~ 1

Author(s):

Abd Elaziz A Suliman ◽

Hytham KS Hamid ◽

Salwa O Mekki

Keyword(s):

Vertebral Artery ◽

Symptomatic Relief ◽

Artery Aneurysm ◽

Giant Aneurysm ◽

Mass Effect ◽

Posterior Neck ◽

Post Traumatic ◽

Extracranial Vertebral Artery ◽

The Right ◽

Significant Mass Effect

Objective Extracranial vertebral artery (VA) aneurysms are rare and are often post-traumatic secondary to penetrating or blunt injuries. Primary extracranial VA aneurysms are far less common. Most of these lesions are located in the proximal (V1) and middle (V2) segments of the VA. Method We report an extremely rare case of a giant aneurysm of the extracranial vertebral artery in a 50-year-old woman who presented with a right posterior neck swelling, headache and pain at the site of the mass. Angiography confirmed aneurysm of V3 segment of the right VA. Treatment included ligation of the artery and aneurysmectomy. Result Magnetic resonance angiography at 12 months showed obliterated proximal segment of the right VA with no obvious flow distally. Conclusion Aneurysms of the extracranial VA are clinically relevant because of the associated risks of rupture and distal embolization. For patients with rupture, pending rupture or a significant mass effect due to a giant lesion, surgery is the treatment modality of choice to attain symptomatic relief.

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Extracranial vertebral artery rupture likely secondary to “cupping therapy” superimposed on spontaneous dissection

Interventional Neuroradiology ◽

10.1177/1591019916659264 ◽

2016 ◽

Vol 22 (6) ◽

pp. 728-731 ◽

Cited By ~ 3

Author(s):

Jae Young Choi ◽

Chae Wook Huh ◽

Chang Hwa Choi ◽

Jae Il Lee

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Rare Case ◽

Cupping Therapy ◽

Oriental Medicine ◽

Common Location ◽

Posterior Neck ◽

Extracranial Vertebral Artery ◽

Spontaneous Dissection

The extracranial vertebral artery (VA) is vulnerable to dissection and the V3 segment is the most common location for dissection. Dissection accounts for about 2% of all ischemic strokes and can occur after trauma or chiropractic neck maneuvers. We report an extremely rare case of spontaneous extracranial VA dissection presenting with posterior neck hematoma aggravated after cupping therapy, a treatment in traditional Oriental medicine. We treated the patient successfully by endovascular treatment without any complication.

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Intravascular Ultrasound to Assess Extracranial Vertebral Artery Restenosis: Case Report

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2007.00220.x ◽

2008 ◽

Vol 18 (3) ◽

pp. 336-339 ◽

Cited By ~ 4

Author(s):

Rishi Gupta ◽

Archit Bhatt ◽

Mounzer Kassab ◽

Arshad Majid

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Intravascular Ultrasound ◽

Extracranial Vertebral Artery

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Poster 328: Bilateral Vertebral Artery Dissection, Spinal Cord Infarct and Brainstem Stroke in a Patient with Posterior Neck Pain Before Cervical Manipulation: A Case Report

PM&R ◽

10.1016/j.pmrj.2017.08.268 ◽

2017 ◽

Vol 9 ◽

pp. S236-S236

Author(s):

Sima C. Patel

Keyword(s):

Spinal Cord ◽

Case Report ◽

Neck Pain ◽

Vertebral Artery ◽

Vertebral Artery Dissection ◽

Artery Dissection ◽

Brainstem Stroke ◽

Spinal Cord Infarct ◽

Posterior Neck ◽

Cervical Manipulation

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P3587Tip detection method using the new short-tip IVUS with pull-back system which facilitates the 3D wiring technique in percutaneous coronary intervention for chronic total occlusion

European Heart Journal ◽

10.1093/eurheartj/ehz745.0447 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Tanaka ◽

A Okamura ◽

M Iwakura ◽

H Nagai ◽

A Sumiyoshi ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Intravascular Ultrasound ◽

Chronic Total Occlusion ◽

Distal Part ◽

Detection Method ◽

Coronary Intervention ◽

Procedure Time ◽

True Lumen ◽

Total Occlusion ◽

Percutaneous Coronary

Abstract Background The strategy of intravascular ultrasound (IVUS)-guided wiring for CTO PCI, that is, leading the second guidewire into the true lumen under observing by IVUS from subintimal space, is the last resort. We developed the angiography-based 3D wiring method. During establishment of the angiography-based 3D wiring method, we deduced that observation of the guidewire tip as well as the shaft named “The tip detection method” simplifies and facilitates 3D wiring under IVUS-guided wiring. Therefore, we produced New CTO IVUS which is the upgraded version of Navifocus WR IVUS by adding the pull-back transducer system. This pull-back system enables us to detect the tip as well as the shaft of the second guidewire in real time (tip detection method), which facilitates the 3D wiring technique under IVUS-guided wiring. Objective We evaluated the efficacy of the tip detection method during 3D wiring for CTO PCI with New CTO IVUS. Method We created a target pinpoint penetration model and performed the procedures using an experimental heartbeat model. The target (a tube with a lumen 0.6 mm in diameter) was placed in the distal part of a CTO 20 mm in length made of 2.5% agar. After the second guidewire (Conquest-12g) was advanced into the CTO lesion to within 5mm of the target using the angiography-based wiring, IVUS-guided wiring was performed by using Navifocus WR or New CTO IVUS each five times. Result The frequency of the puncture time was reduced using the new CTO IVUS compared to the Navifocus WR (1.7±0.8 vs. 28.8±23.2, p=0.17). The procedure time was significantly shorter using the new CTO IVUS compared to the Navifocus WR (103±61 vs. 459±373 seconds, p=0.04). Conclusion The tip detection method during 3D wiring with the new short tip IVUS with the pull-back system enables us to easily perform 3D wiring and will change the CTO PCI strategy.

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