scholarly journals Endovascular Management of Unused Fenestrations or Branches in Fenestrated/Branched Aortic Endograft

2021 ◽  
pp. 152660282110457
Author(s):  
Kong Teng Tan ◽  
Sebastian Charles Mafeld ◽  
Thomas Fook Lindsay
Keyword(s):  
Target Vessel ◽  
Endovascular Management ◽  
Endovascular Techniques ◽  
Vessel Occlusion ◽  
Aortic Pathology

Fenestrated and branched aortic endograft (F/B EVAR) has become a widely accepted technique in the management of aneurysmal aortic pathology. However, intra-procedurally in some situations, there are F/B that remain unused because of target vessel occlusion or failure to cannulate the target artery. Leaving the F/B open will result in an ongoing endoleak, unless treated at the time. Herein we described the necessary considerations and several endovascular techniques to occlude these fenestrations and branches in this situation.

An unusual ischaemic presentation of thrombosed intracranial mycotic aneurysm with subsequent subarachnoid haemorrhage

2020 ◽  
Vol 13 (10) ◽  
pp. e237044
Author(s):  
Patrick Brown ◽  
Daniel Fulks
Keyword(s):  
Clinical Outcome ◽  
Subarachnoid Haemorrhage ◽  
Mycotic Aneurysm ◽  
Unusual Case ◽  
Endovascular Management ◽  
Coil Embolisation ◽  
Vessel Occlusion ◽  
Aneurysmal Rupture ◽  
Excellent Clinical Outcome

We present an unusual case of acute ischaemic stroke secondary to thrombosed mycotic aneurysm with subsequent early aneurysmal rupture and subarachnoid haemorrhage, successfully treated with endovascular coil embolisation of the thrombosed segment. Imaging correlates are presented demonstrating successful endovascular management despite vessel occlusion precluding angiographic visualisation of the aneurysmal segment. Imaging and clinical follow-up is provided demonstrating durable occlusion and excellent clinical outcome with full functional recovery.

scholarly journals Reasons for Failed Mechanical Thrombectomy in Posterior Circulation Ischemic Stroke Patients

2020 ◽  
Author(s):  
Charlotte S. Weyland ◽  
Ulf Neuberger ◽  
Arne Potreck ◽  
Johannes A. R. Pfaff ◽  
Simon Nagel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mortality Rate ◽  
Vascular Access ◽  
High Mortality ◽  
Mechanical Thrombectomy ◽  
Posterior Circulation ◽  
Target Vessel ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke Etiology

Abstract Background and Purpose To determine reasons for failed recanalization in mechanical thrombectomy (MT) of the posterior circulation. Methods Retrospective single center analysis of reasons for MT failure in the posterior circulation. Failed MTs were categorized according to the reason for procedure failure in failed vascular access, failed passage of the target vessel occlusion and MT failure after passing the occluded target vessel. Patient characteristics were compared between failed and successful MT. Results Patients with failed MT (30/218 patients, 13.8%) were categorized into futile vascular access (13/30, 43.3%), abortive passage of the target vessel occlusion (6/30, 20.0%) and MT failure after passing the vessel occlusion (11/30, 36.7%). In 188/218 (86.2%) successful MTs alternative vascular access, local intra-arterial (i.a.) thrombolysis and emergency stent-assisted PTA prevented 65 MT failures. Patients with failed MT showed a higher NIHSS at discharge, a higher pc-ASPECTS in follow-up imaging, a higher mRS 90 days after stroke onset and a high mortality rate of 77.0% (mRS at 90 days, median (IQR): 6 (6–6) vs. 4 (2–6) for successful MT, p-value < 0.001). Co-morbidities and stroke etiology were not different compared to sufficient recanalization with atherosclerotic disease as the leading stroke etiology in both groups. Conclusion Failure of MT in posterior circulation ischemic stroke patients is associated with a high mortality rate. Reasons for MT failure are diverse with futile vascular access and MT failure after passing the vessel occlusion as the leading causes. Alternative vascular access, local i.a. thrombolysis and stent-assisted PTA can prevent MT failure.

Decision Making in Surgery for Nonsaccular Posterior Inferior Cerebellar Artery Aneurysms With Special Reference to Intraoperative Assessment of Collateral Blood Flow and Neurophysiological Function

2017 ◽  
Vol 14 (4) ◽  
pp. 422-431 ◽  
Author(s):  
Alessandro Narducci ◽  
Ran Xu ◽  
Peter Vajkoczy
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Neurophysiological Monitoring ◽  
Occipital Artery ◽  
Pica Pica ◽  
Endovascular Techniques ◽  
Vessel Occlusion ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Intraoperative Test ◽  
Time Assessment

Abstract BACKGROUND Posterior inferior cerebellar artery (PICA) aneurysms represent a challenging pathology. PICA sacrifice is often necessary, due to the high proportion of nonsaccular aneurysms that can be found in this location. Several treatments are available, but the infrequency of these aneurysms and the increasing number of endovascular techniques have limited the development of a standardized algorithm for cases in which open surgery is indicated. OBJECTIVE We present our series of nonsaccular PICA aneurysms, in the attempt to define an algorithm for their surgical management. METHODS We retrospectively reviewed the operation database, identifying patients harboring nonsaccular PICA aneurysms who were surgically treated at our institution from 2007 to 2016. RESULTS During a 9-yr period, 17 patients harboring 18 nonsaccular PICA aneurysms were surgically treated at our institution. Fourteen (7.7%) aneurysms were located within the proximal PICA (including those located at the vertebral artery–PICA junction), and 4 were located distally. We performed PICA revascularization in 8 (57.1%) cases of proximal aneurysms (n = 4, PICA–PICA bypass; n = 4, occipital artery–PICA bypass). We based our decision whether to perform bypass on intraoperative test occlusion with indocyanine green (ICG) videoangiography and neurophysiological monitoring. In no cases, bypass was necessary for distal aneurysms. CONCLUSION For nonsaccular PICA aneurysms, in which vessel occlusion is often necessary, it is possible to adopt a selective use of revascularization techniques. Intraoperative occlusion test with ICG videoangiography and neurophysiological monitoring provides reliable indications, allowing real-time assessment of collateral circulation.

scholarly journals Arterial grafts do not counteract target vessel occlusion

2013 ◽  
Vol 44 (5) ◽  
pp. e320-e324 ◽  
Author(s):  
K. Bartnes ◽  
S. E. Hermansen ◽  
O. Dahl-Eriksen ◽  
R. Bahar ◽  
R. Busund ◽  
...  
Keyword(s):  
Target Vessel ◽  
Vessel Occlusion ◽  
Arterial Grafts

scholarly journals Endovascular Management for P2 Aneurysms of the Posterior Cerebral Artery

2009 ◽  
Vol 15 (3) ◽  
pp. 341-348 ◽  
Author(s):  
X. Lv ◽  
Y. Li ◽  
C. Jiang ◽  
Z. Wu
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Effective Treatment ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Endovascular Management ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Presenting Symptoms ◽  
Parent Vessel Occlusion

This study evaluated the outcomes of endovascular management for P2-segment aneurysms. From 2003 to 2008, 14 consecutive patients with P2 aneurysms were treated endovascularly by proximal P2 segment occlusion at our institution. The aneurysms included 12 P2a and two P2p aneurysms. Presenting symptoms were caused by subarachnoid hemorrhage (SAH) in six patients, stroke in five, and isolated headaches in three. Mean follow-up was 14 months. Twelve aneurysms were treated with proximal P2 segment occlusion without parent artery revascularization. Twelve aneurysms were at the P2a and two aneurysms at the P2p. Two patients developed hemianopsia after the procedure and one recovered completely within six months follow-up with one still persistent at 22-month follow-up. Proximal parent vessel occlusion was a relatively safe, effective treatment for P2 aneurysms that posed low risk for early or delayed ischemia or infarction.

scholarly journals Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

2019 ◽  
Vol 11 (10) ◽  
pp. 1055-1062 ◽  
Author(s):  
Yasha Kayan ◽  
Philip M Meyers ◽  
Charles J Prestigiacomo ◽  
Peter Kan ◽  
Justin F Fraser
Keyword(s):  
Posterior Circulation ◽  
Large Vessel ◽  
Expert Consensus ◽  
Large Vessel Occlusion ◽  
Review Of The Literature ◽  
Endovascular Techniques ◽  
Vessel Occlusion ◽  
Published Evidence ◽  
Standards And Guidelines

BackgroundThe aim of this publication is to provide a detailed update on the diagnosis, treatment, and endovascular techniques for posterior circulation emergent large vessel occlusion (pc-ELVO).MethodsWe performed a review of the literature to specifically evaluate this disease and its treatments.ResultsData were analyzed, and recommendations were reported based on the strength of the published evidence and expert consensus.ConclusionWhile many questions about pc-ELVO remain to be studied, there is evidence to support particular practices in its evaluation and treatment.

CONTROVERSIES IN THE ENDOVASCULAR MANAGEMENT OF CEREBRAL VASOSPASM AFTER INTRACRANIAL ANEURYSM RUPTURE AND FUTURE DIRECTIONS FOR THERAPEUTIC APPROACHES

Neurosurgery ◽  
2008 ◽  
Vol 62 (4) ◽  
pp. 897-907 ◽  
Author(s):  
Ricardo J. Komotar ◽  
Brad E. Zacharia ◽  
Marc L. Otten ◽  
J Mocco ◽  
Sean D. Lavine
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Aneurysm Rupture ◽  
Endovascular Management ◽  
Therapeutic Approaches ◽  
Endovascular Techniques ◽  
Arterial Infusion ◽  
Future Directions ◽  
Maximal Medical Therapy

Abstract CEREBRAL VASOSPASM IS one of the leading causes of morbidity and mortality after aneurysmal subarachnoid hemorrhage. Despite maximal medical therapy, however, up to 15% of patients surviving the ictus of subarachnoid hemorrhage experience stroke or death from vasospasm. For those cases of vasospasm that are refractory to medical treatment, endovascular techniques are frequently used, including balloon angioplasty with or without intra-arterial infusion of vasodilators, combined endovascular modalities, and aortic balloon devices. In this article, we review each of these therapies and their expanding role in the management of this condition. Moving forward, rigorous prospective outcome assessments after endovascular treatment of cerebral vasospasm are necessary to clearly delineate the efficacy and indications for these techniques.

scholarly journals Indications and practical application of strategies in the endovascular management of intracranial aneurysms

2013 ◽  
Vol 20 (3) ◽  
pp. 221-239
Author(s):  
Marco Antonio Zenteno ◽  
Jorge Arturo Santos-Franco ◽  
Ángel Lee ◽  
Fernando Vinuela ◽  
Jose-Maria Modenesi Freitas ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Endovascular Management ◽  
Practical Application ◽  
Endovascular Techniques ◽  
Endovascular Technique ◽  
Rational Choices ◽  
Pros And Cons

Abstract The occlusion of intracranial aneurysms is more successful and stable by properly planning the approach and application of endovascular techniques. The next step is a relentless analysis of the different indications of endovascular treatment, tailoring a strategy suitable for the specific case, and making more rational choices for the management of aneurysms. Indications and strategies according to the analysis of the aneurysmal complex are given, as well as pros and cons of the endovascular technique according to different anatomical locations

Endovascular Management of Cerebral Vasospasm

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S3-139-S3-147 ◽  
Author(s):  
Marike Zwienenberg-Lee ◽  
Jonathan Hartman ◽  
Nancy Rudisill ◽  
Jan Paul Muizelaar
Keyword(s):  
Clinical Significance ◽  
Cerebral Vasospasm ◽  
Endovascular Therapy ◽  
Balloon Angioplasty ◽  
Cerebral Aneurysms ◽  
Endovascular Management ◽  
Endovascular Techniques ◽  
Arterial Infusion ◽  
The Past

Abstract CEREBRAL VASOSPASM REMAINS a leading cause of death and disability in patients with ruptured cerebral aneurysms. The development of endovascular intervention in the past two decades has shown promising results in the treatment of vasospasm. Endovascular techniques that have been used in humans include intra-arterial infusion of vasorelaxants and direct mechanical dilation with transluminal balloon angioplasty. This article reviews the current indications and role of endovascular therapy in the management of cerebral vasospasm, its clinical significance, and potential future therapies.

scholarly journals Clinical case of successful staged treatment of patients with aneurysms of the thoracic and abdominal aorta and adenocarcinoma of the stomach

2018 ◽  
Vol 5 (4) ◽  
pp. 53-59
Author(s):  
M. A. Chernyavskiy ◽  
A. A. Gusev ◽  
I. N. Danilov ◽  
I. V. Basek
Keyword(s):  
Clinical Case ◽  
Infrarenal Aorta ◽  
Endovascular Techniques ◽  
The Third ◽  
Large Size ◽  
Multi Stage ◽  
Aortic Pathology ◽  
Thoracic And Abdominal ◽  
Staged Treatment ◽  
Oncological Pathology

А clinical case of treatment of a patient with isolated saccular aneurysm of the aortic arch and aneurysm of the infrarenal aorta of large size is presented. As a сoncomitant pathology, gastric adenocarcinoma was revealed. Multi-stage surgical treatment was performed. The first stage included left-sided carotid-subclavian bypass, the second –TEVAR, the third — EVAR. The final stage was an extended gastrectomy with lymphodissection. No complications were found during the treatment. The technique of operations is described, explanations on the chosen tactics of treatment are given. The conclusion is made about the advantage of endovascular techniques in the treatment of aortic pathology in patients with oncological pathology.

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