Endovascular Treatment of Giant P1/P2 Aneurysm by Direct Puncture of the Vertebral Artery

Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative. The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach. According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.

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Combined microsurgical PICA-PICA bypass and endovascular parent artery occlusion for a ruptured dissecting vertebral artery aneurysm

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14526 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video3 ◽

Cited By ~ 6

Author(s):

Robert M. Starke ◽

Dale Ding ◽

Christopher R. Durst ◽

R. Webster Crowley ◽

Kenneth C. Liu

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Distal Portion ◽

Artery Occlusion ◽

Parent Artery ◽

Treatment Technique ◽

Pica Pica ◽

Parent Artery Occlusion ◽

The Right

Dissecting vertebral artery (VA) aneurysms are difficult to obliterate when the parent artery cannot be safely occluded. In this video, we demonstrate a combined microsurgical and endovascular treatment technique for a ruptured, dissecting VA aneurysm incorporating the origin of the posterior inferior cerebellar artery (PICA). We first performed a PICA-PICA side-to-side bypass to preserve flow through the right PICA. An endovascular approach was then utilized to embolize the proximal portion of the aneurysm from the right VA and the distal portion of the aneurysm from the left VA.The video can be found here: http://youtu.be/dkkKsX2BiJI.

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Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection

Interventional Neuroradiology ◽

10.1177/159101990300900209 ◽

2003 ◽

Vol 9 (2) ◽

pp. 193-198 ◽

Cited By ~ 1

Author(s):

M. Szajner ◽

K. Obszaska ◽

A. Nestorowicz ◽

M. Szczerbo-Trojanowska

Keyword(s):

Artery Occlusion ◽

Endovascular Embolization ◽

Superior Cerebellar Artery ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Cerebellar Artery ◽

Peripheral Aneurysms ◽

Embolic Materials ◽

The Right ◽

Wide Neck

Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n-BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

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Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017554.rep ◽

2021 ◽

pp. neurintsurg-2021-017554.rep

Author(s):

Giovanni Barchetti ◽

Loris Di Clemente ◽

Mauro Mazzetto ◽

Mariano Zanusso ◽

Paola Ferrarese ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Successful Treatment ◽

Expectant Management ◽

Flow Diverter ◽

Artery Occlusion ◽

Parent Artery ◽

Microsurgical Clipping ◽

Parent Artery Occlusion ◽

The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

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Balloon Migration into a Giant Carotid Aneurysm after Parent Artery Occlusion Using Detachable Balloons

Interventional Neuroradiology ◽

10.1177/159101999800400410 ◽

1998 ◽

Vol 4 (4) ◽

pp. 323-328 ◽

Cited By ~ 2

Author(s):

A. Uchino ◽

P.K. Maurer ◽

H.S. Brara ◽

Y. Numaguchi

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Occlusion Technique ◽

Large Aneurysm ◽

The Right

We treated a 70-year-old man with a giant paraophthalmic region aneurysm of the right internal carotid artery using the parent artery occlusion technique with three detachable balloons. Initially, the patient did well, but migration of the distal balloon into the aneurysm was detected seven months later. This report suggests that initial parent artery occlusion using balloons will not always induce permanent thrombosis of a large aneurysm, because the occlusion and thrombosis is strictly dependant on the position of the balloons that are used, and adjunct use of coils may be indicated.

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Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage

Neurosurgery ◽

10.1097/00006123-200210000-00013 ◽

2002 ◽

Vol 51 (4) ◽

pp. 930-938 ◽

Cited By ~ 26

Author(s):

Isao Naito ◽

Tomoyuki Iwai ◽

Tomio Sasaki

Keyword(s):

Subarachnoid Hemorrhage ◽

Vertebral Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Ischemic Insult ◽

Double Lumen ◽

String Sign ◽

Parent Artery Occlusion ◽

Aneurysmal Dilation

Abstract OBJECTIVE The clinical and angiographic follow-up results for intracranial vertebral artery (VA) dissections that initially presented without subarachnoid hemorrhage (SAH) were retrospectively investigated, to clarify their management. METHODS Twenty-one patients with VA dissections that initially presented without SAH were studied. Initial angiography revealed aneurysmal dilation in 11 cases (typical pearl-and-string sign in 8 cases, aneurysmal dilation only in 2, and aneurysmal dilation with double-lumen sign in 1), occlusion in 7, double-lumen sign in 2, and string-like stenosis in 1. Nine patients (six with pearl-and-string sign, one with occlusion with aneurysmal dilations, and two with double-lumen sign), including three patients who experienced subsequent SAH, underwent endovascular proximal parent artery occlusion. The other 12 patients were treated conservatively. All patients were monitored with magnetic resonance angiography or digital subtraction angiography. RESULTS Three patients experienced subsequent SAH, 1 day (two patients) or 51 months after onset. Follow-up angiographic assessments of the 20 patients demonstrated complete resolution in five cases, reduction of aneurysmal dilation in one case, and partial recanalization in one case. However, enlargement or formation of an aneurysmal dilation was recognized in four cases and progression of dissection was observed in one case. Eighteen patients experienced good recoveries, and three patients demonstrated moderate disabilities as a result of the initial ischemic insult. CONCLUSION The risk of bleeding from unruptured VA dissections is higher than previously considered. Therefore, endovascular treatment should be considered for patients with VA dissections with relatively large or growing aneurysmal dilations.

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Treatment of vertebral artery aneurysms with transposition of the posterior inferior cerebellar artery to the vertebral artery combined with parent artery occlusion

Journal of Neurosurgery ◽

10.3171/jns.2006.105.5.781 ◽

2006 ◽

Vol 105 (5) ◽

pp. 781-784 ◽

Cited By ~ 11

Author(s):

Kuniaki Ogasawara ◽

Yoshitaka Kubo ◽

Nobuhiko Tomitsuka ◽

Masayuki Sasoh ◽

Yasunari Otawara ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

The Other ◽

Parent Artery ◽

Pica Pica ◽

Suboccipital Craniectomy ◽

Parent Artery Occlusion ◽

Cerebellar Artery ◽

Good Patency

✓ The authors describe transposition of the posterior inferior cerebellar artery (PICA) to the vertebral artery (VA) combined with parent artery occlusion for the treatment of VA aneurysms in cases in which a clip could not be applied because of the origin of the ipsilateral PICA. The aneurysm is trapped through a lower lateral suboccipital craniectomy. The PICA is then cut just distal to the aneurysm, and the PICA and VA proximal to the aneurysm are anastomosed in an end-to-end or end-to-side fashion. The surgical procedure was successfully performed in two patients, each of whom had hypoplastic occipital arteries (OAs). The PICA contralateral to the lesion was hypoplastic in one patient and distant to the ipsilateral PICA in the other patient. Mild transient dysphagia developed postoperatively in one patient due to glossopharyngeal and vagus nerve palsy, and the other patient had an uneventful postoperative course. In both patients, postoperative cerebral angiography demonstrated good patency of the transposed PICA. These results show that transposition of the PICA to the VA is a useful procedure for the reconstruction of the PICA when parent artery occlusion is necessary to exclude a VA aneurysm involving the origin of the PICA and when OA–PICA anastomosis or PICA–PICA anastomosis cannot be performed.

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Ruptured Vertebral Artery Dissecting Aneurysm Associated with Parent Artery Occlusion: Report of 2 Cases

Surgery for Cerebral Stroke ◽

10.2335/scs.32.138 ◽

2004 ◽

Vol 32 (2) ◽

pp. 138-142

Author(s):

Yuji HONDA ◽

Toshihiro YASUI ◽

Masaki KOMIYAMA ◽

Kazuhiro YAMANAKA ◽

Yasuhiro MATSUSAKA ◽

...

Keyword(s):

Vertebral Artery ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Vertebral Artery Dissecting Aneurysm

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Clinical and angiographic follow-up of coronary artery fistula interventions in children: techniques and classification revisited

Cardiology in the Young ◽

10.1017/s1047951114000614 ◽

2014 ◽

Vol 25 (4) ◽

pp. 670-680 ◽

Cited By ~ 6

Author(s):

Bhavesh Thakkar ◽

Nehal Patel ◽

Vishal Poptani ◽

Tarun Madan ◽

Tarandip Saluja ◽

...

Keyword(s):

Coronary Artery ◽

Transcatheter Closure ◽

Coronary Artery Fistula ◽

Artery Occlusion ◽

Parent Artery ◽

Surgical Closure ◽

Parent Artery Occlusion ◽

Angiographic Data ◽

The Right

AbstractBackground: Transcatheter closure of coronary artery fistula has emerged as a safe and effective alternative to surgery. However, follow-up angiographic data after closure of the coronary artery fistula is extremely limited. We report our clinical and angiographic follow-up of children who underwent either transcatheter or surgical closure. Method: Clinical profile, echocardiography parameters, and closure technique were retrospectively reviewed from the hospital charts. Since 2007, 15 children have been intervened and followed up with electrocardiography, echocardiography, and angiography. Results: A total of 15 children (six girls), with mean age of 6.7±5.4 years and weighing 16.3±9.8 kg, underwent successful closure (transcatheter=13, surgical=2) without periprocedural complication. Coronary artery fistula arose from the right (n=7) and left coronary artery (n=8) and drained into the right atrium or the right ventricle. Transcatheter closure was carried out using a duct occluder. Of the patients, two underwent surgical closure of the fistula on a beating heart. At 31.8±18.7 months follow-up, all the children were asymptomatic and had no evidence of myocardial ischaemia or infarction. However, follow-up angiography revealed thrombotic occlusion of fistula with the patent parent coronary artery in those having branch coronary artery fistula, and five of seven patients with parent coronary artery fistula had near-complete occlusion of fistula extending into the native coronary artery. Conclusion: Follow-up angiography revealed a high incidence of parent artery occlusion when the fistula was arising from the native artery and not from one of its branches. Coronary artery fistula intervention of the parent coronary artery fistula always carries the potential risk of ischaemia, unless the distal-most exiting segment is the primary site of occlusion.

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Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery

Neurointervention ◽

10.5469/neuroint.2019.00276 ◽

2020 ◽

Vol 15 (2) ◽

pp. 84-88

Author(s):

Toshitsugu Terakado ◽

Yasunobu Nakai ◽

Go Ikeda ◽

Kazuaki Tsukada ◽

Sho Hanai ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Careful Attention ◽

Parent Artery Occlusion ◽

Cerebellar Artery ◽

Vertebral Artery Dissecting Aneurysm ◽

Vertebral Artery Stenting

We herein report a case of a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery that was treated using the stent-jack technique. After parent artery occlusion of the distal vertebral artery, stenting of the posterior inferior cerebellar artery was performed. Further coiling was needed because distal vertebral artery recanalization occurred due to transformation of the coil mass. The stent-jack technique for a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery is effective; however, careful attention to recanalization after stenting is needed due to transformation of the coil mass.

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Treatment of Unruptured Vertebral Artery Aneurysm Involving Posterior Inferior Cerebellar Artery With Pipeline Embolization Device

Frontiers in Neurology ◽

10.3389/fneur.2021.622457 ◽

2021 ◽

Vol 12 ◽

Author(s):

Weiqi Fu ◽

Huijian Ge ◽

Gang Luo ◽

Xiangyu Meng ◽

Jiejun Wang ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Artery Occlusion ◽

Parent Artery ◽

Pipeline Embolization Device ◽

Complete Occlusion ◽

Parent Artery Occlusion ◽

Cerebellar Artery

Background: Treatment of unruptured vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA) is challenging. The experience of pipeline embolization device (PED) therapy for these lesions is still limited.Objective: To evaluate the safety and efficacy of the PED for unruptured vertebral artery aneurysm involving PICA.Methods: Thirty-two patients with unruptured vertebral artery aneurysm involving PICA underwent treatment with PED were retrospectively identified. Procedure-related complications, PICA patency, clinical, and angiographic outcomes were analyzed.Results: Thirty-two aneurysms were successfully treated without any procedure-related complications. Images were available in 30 patients (93.8%) during a period of 3–26 months follow-up (average 8.4 months), which confirmed complete occlusion in 17 patients (56.5%), near-complete occlusion in 9 patients (30%), and incomplete occlusion in one patient (3.3%). Parent artery occlusion (PAO) was occurred in 3 patients (10%). Twenty-eight of 30 PICA remained patent. The two occlusions of PICA were secondary to PAO. At a mean of 20.7 months (range 7–50 months) clinical follow-up, all the patients achieved a favorable outcome without any new neurological deficit.Conclusion: PED seems to be a safe and effective alternative endovascular option for patients with unruptured vertebral artery aneurysm involving PICA.

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