scholarly journals Dissection of the Distal Vertebral Artery Treated by Modified Parent Artery Trapping and a Contralateral Stent Barricade

2010 ◽  
Vol 16 (2) ◽  
pp. 171-174 ◽  
Author(s):  
C-W. Ryu ◽  
J-S. Koh ◽  
E-J. Kim
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Treatment Method ◽  
Dissecting Aneurysm ◽  
Side Branch ◽  
Parent Artery ◽  
Vertebrobasilar Junction ◽  
Dissecting Aneurysms ◽  
Vertebral Dissection

Endovascular trapping is the preferred treatment method for a vertebral dissecting aneurysm. We describe a case of ruptured dissecting aneurysms located just proximal to the vertebrobasilar junction treated by trapping the dissecting segment and barricading the basilar artery with a stent to protect against coil protrusion. Modified parent artery trapping with a stent barricade allows preservation of the adjoining confluent zone or side branch during endovascular trapping of the vertebral dissection.

Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery

2012 ◽  
Vol 116 (4) ◽  
pp. 882-887 ◽  
Author(s):  
Tsz Wai Yeung ◽  
Vincent Lai ◽  
Hin Yue Lau ◽  
Wai Lun Poon ◽  
Chong Boon Tan ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Side Branch ◽  
Definitive Treatment ◽  
Attractive Alternative ◽  
Parent Artery ◽  
Stent Patency ◽  
Long Term Outcome ◽  
Dissecting Aneurysms

Object Use of a flow-diverting device has shown promising short-term results in the management of vertebral artery (VA) dissecting aneurysms, but there is still uncertainty regarding its long-term efficacy and safety. The authors report their initial experience with respect to the potential utility and long-term clinical outcomes of using a flow-diverting device in the treatment of unruptured dissecting VA aneurysms. Methods The authors conducted a retrospective review of all cases of unruptured intracranial VA dissecting aneurysms treated at their institution (Tuen Mun Hospital) with a flow-diverting device. They describe the clinical presentations and angiographic features of the cases and report the clinical outcome (with modified Rankin Scale [mRS] scores) at most recent follow-up, as well as results of the latest angiographic assessment, with particular focus on in-stent patency and side-branch occlusion. Results A total of 4 aneurysms were successfully obliterated by using flow-diverting devices alone. Two devices were deployed in a telescoping fashion in each of 2 aneurysms, whereas only 1 device was inserted in each of the other 2 aneurysms. No periprocedural complication was encountered. No patient showed any angiographic evidence of recurrence, in-stent thrombosis, or side-branch occlusion in angiographic reassessment at a mean of 22 months after treatment (range 18–24 months). As of the most recent clinical follow-up (mean 30 months after treatment, range 24–37 months), all patients had favorable outcomes (mRS Score 0). Conclusions Reconstruction using a flow-diverting device is an attractive alternative in definitive treatment of dissecting VA aneurysms, demonstrating favorable long-term clinical and angiographic outcomes and the ability to maintain parent artery and side-branch patency. It is particularly useful in cases with eloquent side-branch or dominant VA involvement.

scholarly journals Endovascular reconstructive treatment using a fill-and-tunnel technique for a fusiform vertebral artery dissecting aneurysm with ipsilateral dominance

2019 ◽  
Vol 25 (5) ◽  
pp. 539-547
Author(s):  
Jun Kyeung Ko ◽  
Sang Weon Lee ◽  
Chang Hwa Choi ◽  
Tae Hong Lee
Keyword(s):  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Dissecting Aneurysm ◽  
Maximum Diameter ◽  
Parent Artery ◽  
Complete Occlusion ◽  
Average Maximum ◽  
Tunnel Technique ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Dissecting Aneurysms

Background Fusiform dissecting aneurysms involving the dominant vertebral artery with poor collaterals are challenging to treat. The purpose of this study was to present an initial experience with a fill and tunnel technique for reconstructive endovascular treatment of these conditions. Methods A total of 13 patients, 11 men and 2 women, each with a fusiform vertebral artery dissecting aneurysm not amenable to internal trapping of the parent artery, underwent reconstructive endovascular treatment using a fill and tunnel technique between January 2012 and December 2015. The safety, feasibility, and clinical and angiographic outcomes of these procedures were retrospectively evaluated. Results The average maximum diameter of the fusiform aneurysms was 12.1 mm. Five were ruptured. Three aneurysms were treated with a single stent and the remaining 10 aneurysms required double-stent placement. Treatment was technically successful in all 13 patients, achieving complete occlusion ( n = 10, 76.9%) and near-complete occlusion ( n = 3, 23.1%). No procedure-related complications occurred in any patient. There were no delayed thromboembolic or hemorrhagic complications during the follow-up period (mean, 19.0 months). Angiographic follow-ups (mean, 9.1 months) showed stable occlusion in 90.9% (10/11) and asymptomatic in-stent occlusion in one patient (9.1%, 1/11). At the end of the observation period (mean, 19.0 months), all patients had excellent clinical outcomes (modified Rankin Scale (mRS) 0, 92.3%, 12/13), except one (mRS 4), resulting from poor preoperative status. Conclusions This retrospective study demonstrated that endovascular reconstruction using a fill-and-tunnel technique was a technically safe, feasible, and clinically effective treatment method for fusiform vertebral artery dissecting aneurysms with ipsilateral dominance.

scholarly journals Clinical Results and Pathological Findings of Stent-Assisted Coil Embolization for Basilar Artery Trunk Dissecting Aneurysms

2003 ◽  
Vol 9 (1_suppl) ◽  
pp. 95-99 ◽  
Author(s):  
H. Nagashima ◽  
K. Hongo ◽  
Y. Matsumoto ◽  
F. Oya ◽  
S. Kobayashi ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Pathological Finding ◽  
Clinical Results ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Thromboembolic Complications ◽  
Pathological Findings ◽  
Effective Treatment Option ◽  
Dissecting Aneurysms

Stent-assisted coil embolization is a new method for treating dissecting or fusiform aneurysm, especially the aneurysms arising from the basilar artery trunk or dominant vertebral artery. At present, this technique is considered as an effective treatment option to obliterate such aneurysm keeping the parent artery patent. Several authors reported the effectiveness and excellent radiological result of this treatment, but fewer reports focus on the limitations of this technique. We treated two patients with a basilar artery trunk dissecting aneurysm with this technique. Transient ischemic symptoms were observed in one patient and haemorrhagic and thromboembolic complications were observed the other. We lost the latter patient due to postoperative complications, and the pathological finding was achieved by autopsy. We report the clinical and pathological findings in the two cases and investigate the efficacy and limitations of this technique.

Endovascular parent vessel sacrifice in ruptured dissecting vertebral and posterior inferior cerebellar artery aneurysms: clinical outcomes and review of the literature

2015 ◽  
Vol 8 (8) ◽  
pp. 796-801 ◽  
Author(s):  
Thomas P Madaelil ◽  
Adam N Wallace ◽  
Arindam N Chatterjee ◽  
Gregory J Zipfel ◽  
Ralph G Dacey ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Treatment Method ◽  
Aneurysm Rupture ◽  
Dissecting Aneurysm ◽  
Parent Vessel ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Dissecting Aneurysms

BackgroundRuptured intracranial dissecting aneurysms must be secured quickly to prevent re-hemorrhage. Endovascular sacrifice of the diseased segment is a well-established treatment method, however postoperative outcomes of symptomatic stroke and re-hemorrhage rates are not well reported, particularly for the perforator-rich distal vertebral artery or proximal posterior inferior cerebellar artery (PICA).MethodsWe retrospectively reviewed cases of ruptured distal vertebral artery or PICA dissecting aneurysms that underwent endovascular treatment. Diagnosis was based on the presence of subarachnoid hemorrhage on initial CT imaging and of a dissecting aneurysm on catheter angiography. Patients with vertebral artery aneurysms were selected for coil embolization of the diseased arterial segment based on the adequacy of flow to the basilar artery from the contralateral vertebral artery. Patients with PICA aneurysms were generally treated only if they were poor surgical candidates. Outcomes included symptomatic and asymptomatic procedure-related cerebral infarction, recurrent aneurysm rupture, angiographic aneurysm recurrence, and estimated modified Rankin Scale (mRS).ResultsDuring the study period, 12 patients with dissecting aneurysms involving the distal vertebral artery (n=10) or PICA (n=2) were treated with endovascular sacrifice. Two patients suffered an ischemic infarction, one of whom was symptomatic (8.3%). One patient (8.3%) died prior to hospital discharge. No aneurysm recurrence was identified on follow-up imaging. Ten patients (83%) made a good recovery (mRS ≤2). Median clinical and imaging follow-up periods were 41.7 months (range 0–126.4 months) and 14.3 months (range 0.03–88.6 months), respectively.ConclusionsIn patients with good collateral circulation, endovascular sacrifice may be the preferred treatment for acutely ruptured dissecting aneurysms involving the distal vertebral artery.

A clinicopathological study of dissecting aneurysms of the intracranial vertebral artery

1991 ◽  
Vol 75 (6) ◽  
pp. 874-882 ◽  
Author(s):  
Osamu Sasaki ◽  
Hiroshi Ogawa ◽  
Tetsuo Koike ◽  
Takayuki Koizumi ◽  
Ryuichi Tanaka
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Arterial Wall ◽  
Vertebral Artery Dissection ◽  
Intramural Hematoma ◽  
Artery Dissection ◽  
Content Type ◽  
Causative Factors ◽  
Dissecting Aneurysms ◽  
Vertebral Dissection

✓ Five autopsied cases of dissecting aneurysms of the intracranial vertebral artery are reported and the literature is reviewed to clarify the clinicopathological correlations. In an autopsy series of 110 patients with subarachnoid hemorrhage (SAH), the incidence of this entity was 4.5%, with all five cases progressing rapidly to death from massive SAH. Cases of intracranial vertebral dissection can be divided clearly into two groups based on the clinical and pathological features. In the first group, the dissection is confined to the vertebral artery and a massive SAH develops caused by the rupture of the arterial wall. The plane of dissection is mainly subadventitial. In the second group, brain-stem infarction develops resulting from luminal occlusion by intramural hematoma. The plane of dissection is mainly subintimal, with the dissection extending to the basilar artery. The condition in the second group affects patients at a younger age. If the lesion is localized within the vertebral artery and does not extend to the basilar artery, the disease seems not to be fatal. The clinical features of the vertebral dissection are largely determined by the plane and extension of dissection. Vertebral artery dissection is due to many causative factors including hypertension, congenital or degenerative changes in the arterial wall, and anatomical and pathological characteristics of the vertebral artery.

scholarly journals Dissecting Aneurysm of the Basilar Arterial Trunk Presenting with Pontine Infarction

2007 ◽  
Vol 13 (4) ◽  
pp. 381-384 ◽  
Author(s):  
Y.-G. Jang ◽  
C.W. Ryu ◽  
J.S. Kim ◽  
E.Y. Cha ◽  
H.W. Pyun ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
High Morbidity ◽  
Complete Disappearance ◽  
Collateral Flow ◽  
Arterial Trunk ◽  
Pontine Infarction ◽  
Diseased Segment ◽  
Procedural Complication

Dissecting basilar aneurysms have rarely been reported but are associated with high morbidity and mortality. Therefore, controversy exists as to the proper management of such lesions because their natural course is not well understood. We describe a 50-year-old man with a dissecting aneurysm involving the lower basilar trunk who presented with pontine infarction corresponding to the aneurysmal sac location. We obliterated the dissecting basilar aneurysm by coil embolization of the aneurysmal sac as well as the diseased segment of the basilar trunk after confirmation of collateral filling of the basilar artery through the posterior communicating artery. The patient recovered without any procedural complication. Eight month follow-up revealed complete disappearance of the aneurysm without symptom recurrence together with preservation of collateral flow in the distal basilar artery. Obliteration of the parent artery as well as the aneurysmal sac with coils could be considered in a lower basilar aneurysm of a dissecting nature.

Stent-assisted coil embolization followed by a stent-within-a-stent technique for ruptured dissecting aneurysms of the intracranial vertebrobasilar artery

2009 ◽  
Vol 111 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Sang Hyun Suh ◽  
Byung Moon Kim ◽  
Sung Il Park ◽  
Dong Ik Kim ◽  
Yong Sam Shin ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Therapeutic Option ◽  
Direct Consequence ◽  
Treatment Method ◽  
Dissecting Aneurysm ◽  
High Rate ◽  
Parent Artery ◽  
Vertebrobasilar Artery ◽  
Complete Obliteration

Object A ruptured dissecting aneurysm of the vertebrobasilar artery (VBA-DA) is a well-known cause of acute subarachnoid hemorrhage (SAH) with a high rate of early rebleeding. Internal trapping of the parent artery, including the dissected segment, is one of the most reliable techniques to prevent rebleeding. However, for a ruptured VBA-DA not suitable for internal trapping, the optimal treatment method has not been well established. The authors describe their experience in treating ruptured VBA-DAs not amenable to internal trapping of the parent artery with stent-assisted coil embolization (SAC) followed by a stent-within-a-stent (SWS) technique. Methods Eleven patients—6 men and 5 women with a mean age of 48 years and each with a ruptured VBA-DA not amenable to internal trapping of the parent artery—underwent an SAC-SWS between November 2005 and October 2007. The feasibility and clinical and angiographic outcomes of this combined procedure were retrospectively evaluated. Results The SAC-SWS was successful without any treatment-related complications in all 11 patients. Immediate posttreatment angiograms revealed complete obliteration of the DA sac in 3 patients, near-complete obliteration in 7, and partial obliteration in 1. One patient died as a direct consequence of the initial SAH. All 10 surviving patients had excellent clinical outcomes (Glasgow Outcome Scale Score 5) without posttreatment rebleeding during a follow-up period of 8–24 months (mean follow-up 15 months). Angiographic follow-up at 6–12 months after treatment was possible at least once in all surviving patients. Nine VBA-DAs showed complete obliteration; the other aneurysm, which had appeared partially obliterated immediately after treatment, demonstrated progressive obliteration on 2 consecutive follow-up angiography studies. There was no in-stent stenosis or occlusion of the branch or perforating vessels. Conclusions The SAC-SWS technique seems to be a feasible and effective reconstructive treatment option for a ruptured VBA-DA. The technique may be considered as an alternative therapeutic option in selected patients with ruptured VBA-DAs unsuitable for internal trapping of the parent artery.

scholarly journals Treatment of Intracranial Aneurysm with Bare Stent Only

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 75-78 ◽  
Author(s):  
Michael Mu Huo Teng ◽  
Chao-Bao Luo ◽  
Feng-Chi Chang ◽  
Harsan Harsan
Keyword(s):  
Intracranial Aneurysm ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Surgical Clipping ◽  
Parent Artery Occlusion ◽  
Typical Treatment ◽  
Dissecting Aneurysms

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.

Sign in / Sign up

Export Citation Format

Share Document