Advancing Marksman into contralateral vertebral artery in the treatment of intradural vertebral artery dissecting aneurysm with Pipeline

Unruptured vertebral arteries dissecting aneurysms have a benign clinical course. The most common symptoms compromise headache, neck pain, dizziness and vomiting. The optimal endovascular treatment option remains controversial. Reconstructive techniques have many advantages over deconstructive ones since the advent of flow diverters such as the Pipeline embolization device (PED). Here, we present a case successfully treated with a PED through a combination of the radial access and advancement of the Marksman catheter into the contralateral vertebral artery due to the special angio-architecture of the patient.

Download Full-text

Reconstructive endovascular treatment of a ruptured vertebral artery dissecting aneurysm using the Pipeline embolization device

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2012-010358 ◽

2012 ◽

Vol 5 (4) ◽

pp. e20-e20 ◽

Cited By ~ 37

Author(s):

Andrew F Ducruet ◽

R Webster Crowley ◽

Felipe C Albuquerque ◽

Cameron G McDougall

Keyword(s):

Endovascular Treatment ◽

Vertebral Artery ◽

Dissecting Aneurysm ◽

Pipeline Embolization Device ◽

Vertebral Artery Dissecting Aneurysm

Download Full-text

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

Interventional Neuroradiology ◽

10.1177/1591019919846616 ◽

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.

Download Full-text

Reconstructive endovascular treatment of the V4 segment of a vertebral artery dissecting aneurysm with the Willis covered stent: A retrospective study

Interventional Neuroradiology ◽

10.1177/1591019918824413 ◽

2019 ◽

Vol 25 (5) ◽

pp. 548-555 ◽

Cited By ~ 2

Author(s):

Sishi Xiang ◽

Guilin Li ◽

Chuan He ◽

Jian Ren ◽

Hongqi Zhang

Keyword(s):

Vertebral Artery ◽

Covered Stent ◽

Dissecting Aneurysm ◽

Definitive Treatment ◽

Attractive Alternative ◽

Covered Stents ◽

Technical Success Rate ◽

Vertebral Artery Dissecting Aneurysm ◽

Dissecting Aneurysms

Objective Preliminary studies suggest that Willis covered stents may be suitable for the treatment of aneurysms of the internal carotid artery (ICA), but their efficacy and safety in vertebral artery (VA) dissecting aneurysms need further investigation. Methods Consecutive patients who underwent placement of a Willis covered stent for treatment of an aneurysm of the V4 segment of the VA between September 2015 and December 2017 at our institution were retrospectively reviewed. The efficacy, complications, angiographic and clinical follow-up results were collected and analyzed. Results Sixteen covered stents were successfully implanted into the VA in 12 patients with 12 dissecting aneurysms. The technical success rate of stenting placement was 100%. Complete occlusion was achieved in 11 patients immediately after stent placement, with transient endoleak in one aneurysm. Angiographic follow-up (9.9 ± 4.0 months, mean±SD) was performed in nine patients and demonstrated complete stabilization of the obliterated aneurysm. Clinical follow-up (20.1 ± 9.6 months, mean±SD) demonstrated full recovery in 11 patients, and one patient suffered from acute myocardial infarction. Conclusion Reconstruction using a Willis covered stent is an efficient, safe and attractive alternative for the definitive treatment of intracranial VA dissecting aneurysms; longer follow-up and expanded clinical trials are needed for further validation of this technique.

Download Full-text

Inadvertent Complication of a Pipeline Embolization Device for Treatment with Vertebral Artery Dissecting Aneurysm : Distal Tip Fracture of Delivery Wire

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2016.59.5.521 ◽

2016 ◽

Vol 59 (5) ◽

pp. 521 ◽

Cited By ~ 1

Author(s):

Jung Soo Park ◽

Hyo Sung Kwak ◽

Jong Myong Lee

Keyword(s):

Vertebral Artery ◽

Dissecting Aneurysm ◽

Pipeline Embolization Device ◽

Vertebral Artery Dissecting Aneurysm

Download Full-text

A Case of Migration of Pipeline Embolization Device Causing Rupture during Treatment of an Unruptured Vertebral Artery Dissecting Aneurysm

Soonchunhyang Medical Science ◽

10.15746/sms.21.027 ◽

2021 ◽

Vol 27 (2) ◽

pp. 110-113

Author(s):

Sung Ho Kim ◽

Dong Kyu Yeo ◽

Gwang Soo Lee

Keyword(s):

Vertebral Artery ◽

Intracranial Aneurysms ◽

Rare Complication ◽

Stent Migration ◽

Dissecting Aneurysm ◽

Potential Complication ◽

Pipeline Embolization Device ◽

New Treatment ◽

Vertebral Artery Dissecting Aneurysm ◽

Perforating Arteries

Endoluminal reconstruction of an intracranial aneurysm using flow-diverting devices, such as the pipeline embolization device (PED), is a new treatment modality with good clinical outcomes. The device was originally indicated for challenging cases, such as wide-necked large or giant aneurysms, and is gaining popularity as a reliable treatment for nearly all intracranial aneurysms. The overall complication rate of flow-diverting devices use is 17.0%, including occlusion of side-branching or perforating arteries, rerupture of the aneurysm, in-stent thrombosis, and, rarely, stent migration. We report a rare complication of the PED: delayed migration of the PED after successful stent implantation during treatment of an unruptured vertebral artery dissecting aneurysm, which resulted in rupture of the aneurysm. Further, we discuss technical steps that can be taken to prevent this potential complication.

Download Full-text

Endovascular coil oclusion of spontaneous ruptured vertebral artery dissecting aneurysm

Romanian Neurosurgery ◽

10.1515/romneu-2017-0004 ◽

2017 ◽

Vol 31 (1) ◽

pp. 25-31

Author(s):

A. Chiriac ◽

Georgian Ion ◽

N. Dobrin ◽

Z. Faiyad ◽

I. Poeata

Keyword(s):

Vertebral Artery ◽

Pathological Condition ◽

Dissecting Aneurysm ◽

Posterior Circulation ◽

Vascular Lesions ◽

Guglielmi Detachable Coils ◽

Advantages And Disadvantages ◽

Detachable Coils ◽

Vertebral Artery Dissecting Aneurysm ◽

Dissecting Aneurysms

Abstract Spontaneous dissecting aneurysm of vertebral artery is known as a rare pathological condition causing a subarachnoid hemorrhage in the posterior circulation. The treatment of ruptured vertebral artery dissecting aneurysms is still an important subject of debates in the literature. We present a particular case of ruptured vertebral artery dissecting aneurysms that was treated by only endovascular Guglielmi detachable coils occlusion. A brief review of technical possibilities of treatment of these types of vascular lesions, with their advantages and disadvantages are discussed.

Download Full-text

Four Cases of Intracranial Vertebral Artery Dissecting Aneurysm Presenting with Headache and Neck Pain as the only Manifestation.

Surgery for Cerebral Stroke ◽

10.2335/scs.29.172 ◽

2001 ◽

Vol 29 (3) ◽

pp. 172-177 ◽

Cited By ~ 4

Author(s):

Akihiro TAKAHASHI ◽

Nobuaki ISHII ◽

Katsuyuki ASAOKA ◽

Naruyoshi HORIUCHI ◽

Satoshi KURODA ◽

...

Keyword(s):

Neck Pain ◽

Vertebral Artery ◽

Dissecting Aneurysm ◽

Vertebral Artery Dissecting Aneurysm ◽

Headache And Neck Pain

Download Full-text

Case 26 Extracranial Left Vertebral Artery Dissecting Aneurysm Following Basilar Artery Stenting

Neurosonology and Neuroimaging of Stroke ◽

10.1055/b-0036-141803 ◽

2017 ◽

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Dissecting Aneurysm ◽

Left Vertebral Artery ◽

Vertebral Artery Dissecting Aneurysm

Download Full-text

Treatment of Dissecting Distal Vertebral Artery (V4) Aneurysms With Flow Diverters

Operative Neurosurgery ◽

10.1093/ons/opx180 ◽

2017 ◽

Vol 15 (1) ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Jacquelyn A Corley ◽

Ali Zomorodi ◽

L Fernando Gonzalez

Keyword(s):

Vertebral Artery ◽

Neurological Deficits ◽

Medication Regimen ◽

Antiplatelet Medication ◽

Average Improvement ◽

Multiple Challenges ◽

Partial Thrombosis ◽

Flow Diverters ◽

Dissecting Aneurysms

Abstract BACKGROUND Dissecting aneurysms of the intracranial vertebral arteries are rare; however, treatment of these presents multiple challenges, including high risk of rebleeding, development of thromboembolic strokes, and progressive partial thrombosis. Flow diverters, such as Pipeline Endovascular Devices (PEDs; Covidien, Medtronic Inc, Dublin, Ireland), have emerged as a potential treatment option. OBJECTIVE To present our experience with patients treated at our institution with PEDs for dissecting distal vertebral artery (V4 segment) aneurysms. METHODS A retrospective search of our prospectively maintained database was performed between January 2014 and December 2016. We queried our database for all patients treated with PED for dissecting aneurysms of the V4 segment. Information was gathered including demographics, the location and morphology of the aneurysm, the clinical presentation, specific form of treatment, complications, antiplatelet medication regimen, and follow-up time. RESULTS There were a total of 9 patients with dissecting V4 aneurysms treated with PED during the study period. All were treated initially with an average of 1.2 PEDs. All patients were followed with at least one repeat diagnostic angiogram and there was no residual aneurysm seen in 8 of 9 cases. In those that presented with neurological deficits, there was an average improvement in modified Rankin Scale of 2.85 points. CONCLUSION PED is a safe and effective tool that can be used to treat ruptured dissecting aneurysms of this specific segment of the posterior circulation, but it does require close management of antiplatelet therapy in the setting of subarachnoid hemorrhage and close angiographic follow-up.

Download Full-text