Recurrent posterior circulation infarcts secondary to vertebral artery external compression treated with endovascular deconstruction

When multiple, recurrent infarcts occur in spite of maximal medical management, the level of suspicion for atypical vascular injury should be heightened. We present a case of a patient who presented with recurrent posterior circulation infarcts despite optimized medical management. On imaging, he was found to have external anatomical vertebral artery muscular and/or osseous compression leading to repetitive vascular injury and strokes. Recurrent intimal injury and vertebral artery to intracranial emboli despite anticoagulation and subsequent dual antiplatelet therapy necessitated definitive operative management. Surgical bypass, external surgical decompression, reconstructive endovascular, and deconstructive endovascular techniques were carefully considered. A deconstructive endovascular approach was chosen as the least morbid option. The use of endovascular plugs such as a microvascular plug provides a quick and effective means of achieving a therapeutic parent artery occlusion in lieu of traditional coil occlusion. Although reserved as a last resort, parent artery occlusion can be a viable option to treat recurrent strokes, particularly in a nondominant vertebral artery.

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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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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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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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Treatment of vertebral artery aneurysms with posterior inferior cerebellar artery-posterior inferior cerebellar artery anastomosis combined with parent artery occlusion

Surgical Neurology ◽

10.1016/j.surneu.2003.06.001 ◽

2004 ◽

Vol 61 (2) ◽

pp. 185-188 ◽

Cited By ~ 22

Author(s):

Shunsuke Kakino ◽

Kuniaki Ogasawara ◽

Yoshitaka Kubo ◽

Yasunari Otawara ◽

Nobuhiko Tomizuka ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Cerebellar Artery

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Ruptured Vertebral Artery Dissecting Aneurysm Associated With Parent Artery Occlusion-Case Report-

Neurologia medico-chirurgica ◽

10.2176/nmc.43.298 ◽

2003 ◽

Vol 43 (6) ◽

pp. 298-300 ◽

Cited By ~ 4

Author(s):

Kyoji SAKAI ◽

Masahiro KAMEDA ◽

Takaho TANIMOTO ◽

Kaoru TERASAKA ◽

Hiroshi SUGATANI ◽

...

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Vertebral Artery Dissecting Aneurysm

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Hemifacial spasm caused by vertebral artery aneurysm treated by endovascular coil embolization

Surgical Neurology International ◽

10.25259/sni_564_2020 ◽

2020 ◽

Vol 11 ◽

pp. 431

Author(s):

Yu Iida ◽

Kentaro Mori ◽

Yosuke Kawahara ◽

Issei Fukui ◽

Katsuya Abe ◽

...

Keyword(s):

Vertebral Artery ◽

Hemifacial Spasm ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Artery Occlusion ◽

Parent Artery ◽

Aneurysm Neck ◽

Parent Artery Occlusion ◽

Endovascular Coil Embolization

Background: Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. Case Description: A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. Conclusion: Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

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