An unusual case of a giant extracranial vertebral artery aneurysm

Vascular ◽  
2019 ◽  
Vol 27 (4) ◽  
pp. 427-429 ◽  
Author(s):  
Abd Elaziz A Suliman ◽  
Hytham KS Hamid ◽  
Salwa O Mekki
Keyword(s):  
Vertebral Artery ◽  
Symptomatic Relief ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Mass Effect ◽  
Posterior Neck ◽  
Post Traumatic ◽  
Extracranial Vertebral Artery ◽  
The Right ◽  
Significant Mass Effect

Objective Extracranial vertebral artery (VA) aneurysms are rare and are often post-traumatic secondary to penetrating or blunt injuries. Primary extracranial VA aneurysms are far less common. Most of these lesions are located in the proximal (V1) and middle (V2) segments of the VA. Method We report an extremely rare case of a giant aneurysm of the extracranial vertebral artery in a 50-year-old woman who presented with a right posterior neck swelling, headache and pain at the site of the mass. Angiography confirmed aneurysm of V3 segment of the right VA. Treatment included ligation of the artery and aneurysmectomy. Result Magnetic resonance angiography at 12 months showed obliterated proximal segment of the right VA with no obvious flow distally. Conclusion Aneurysms of the extracranial VA are clinically relevant because of the associated risks of rupture and distal embolization. For patients with rupture, pending rupture or a significant mass effect due to a giant lesion, surgery is the treatment modality of choice to attain symptomatic relief.

scholarly journals Trapping and Thrombectomy of Giant Thrombosed Vertebral Artery Aneurysm via Bilateral Subocciptal Approach – Technical Note

2020 ◽  
Vol 2 (2) ◽  
pp. 66-70
Author(s):  
Pritam Gurung ◽  
Yoshihiro Kuga ◽  
Yuji Kodama ◽  
Katsushi Taomoto ◽  
Hideyuki Ohnishi
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Distal Portion ◽  
Technical Note ◽  
Neurological Deficits ◽  
Occipital Artery ◽  
Parent Artery ◽  
The Right ◽  
Suboccipital Approach

Background: Giant aneurysms arising from the vertebral artery (VA) are rare; they represent 4% to 6% of all intracranial giant aneurysm. The natural history of thrombosed aneurysms is extremely poor. Most such lesions progressively enlarge and result in irreversible progression of neurological deficits and fatal sequelae through resultant compression of the brainstem. We present the clinical experience of giant thrombosed vertebral artery aneurysm successfully treated via a bilateral suboccipital approach. A 62 –year-old woman presented with slight dysarthria and ataxia for one year. Neurological examination showed right lateral gaze nystagmus, bilateral absent corneal reflex, absent gag reflex, bilateral dysdiadochokinesia, poor right finger nose test, and slightly poor tandem gait. MRI showed a 27 mm giant thrombosed left VA aneurysm with brain stem compression. We performed trapping of the aneurysm and thrombectomy through a bilateral suboccipital approach. First, the distal portion was clipped from the left side. Next, the proximal portion was approached from the right side. Thrombectomy was performed and after shrinkage of the aneurysm, the clips were applied involving some part of the aneurysm just distal to PICA. Conclusion: The optimum treatment for aneurysm of this type is thought to be complete obliteration of the parent artery with trapping and thrombectomy to decompress the brainstem. Sometimes if PICA could not be preserved Occipital artery (OA)-PICA bypass should be considered.

Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection

2008 ◽  
Vol 109 (6) ◽  
pp. 1113-1118 ◽  
Author(s):  
Won-Ki Yoon ◽  
Young-Woo Kim ◽  
Sang-Don Kim ◽  
Ik-Seong Park ◽  
Min-Woo Baik ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Intravascular Ultrasonography ◽  
Stent Angioplasty ◽  
Posterior Neck ◽  
Extracranial Vertebral Artery ◽  
The Right

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved. To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

scholarly journals Chronic fusiform extracranial vertebral artery aneurysm with recurrent posterior circulation emboli: Case report and review of the literature

2021 ◽  
pp. 159101992110185
Author(s):  
Katherine Evans ◽  
Ralf-Björn Lindert ◽  
Richard Dyde ◽  
George H Tse
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Vascular Plug ◽  
Procedural Complication ◽  
Independent Life ◽  
Extracranial Vertebral Artery ◽  
Aneurysm Occlusion ◽  
The Right ◽  
Proximal Occlusion

We report a case of a 64-year-old man with a fusiform right extracranial vertebral artery aneurysm, spanning over half the extra-cranial V2 (foraminal) segment, presenting with recurrent multi-focal posterior circulation embolic ischaemic stroke. The patient was treated with endovascular embolisation of the right vertebral artery to prevent further thrombo-embolic events. Distal and proximal occlusion of the aneurysmal vertebral artery was performed with a micro-vascular plug with partial aneurysm sack embolisation to aid thrombosis and reduce the risk of recanalisation. Two months post procedure MR angiography confirmed successful aneurysm occlusion with no post-procedural complication. The patient returned to his normal independent life. Endovascular treatment with vessel sacrifice is an effective treatment with low morbidity and we believe the MVP device to be a efficacious option in the vertebral artery.

Giant right coronary artery aneurysm

2020 ◽  
Vol 28 ◽  
pp. 1-3
Author(s):  
Alexandre Bonfim ◽  
Ronald Souza ◽  
Sérgio Beraldo ◽  
Frederico Nunes ◽  
Daniel Beraldo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Clinical Course ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Artery Disease ◽  
The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

Giant Pseudoaneurysm of the Extracranial Vertebral Artery Successfully Treated Using Intraoperative Balloon Catheters

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 738-742 ◽  
Author(s):  
Junya Hanakita ◽  
Hideyuki Suwa ◽  
Kiyoshi Nishihara ◽  
Koji Iihara ◽  
Hiroshi Sakaida
Keyword(s):  
Vertebral Artery ◽  
Cardiac Pacemaker ◽  
Innominate Artery ◽  
Anatomical Location ◽  
High Morbidity ◽  
Vertebrobasilar System ◽  
Balloon Catheters ◽  
Extracranial Vertebral Artery ◽  
The Right ◽  
Giant Pseudoaneurysm

Abstract Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.

scholarly journals Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Davide Strambo ◽  
Luca Peruzzotti-Jametti ◽  
Aurora Semerano ◽  
Giovanna Fanelli ◽  
Franco Simionato ◽  
...  
Keyword(s):  
Blood Flow ◽  
Vertebral Artery ◽  
Color Doppler ◽  
Artery Aneurysm ◽  
Neurofibromatosis Type ◽  
Distal Portion ◽  
Embolic Stroke ◽  
Left Vertebral Artery ◽  
Stroke Recurrence ◽  
Extracranial Vertebral Artery

Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1) came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.

scholarly journals Neurosurgery (Neuro Interventional)

2015 ◽  
Vol 42 (S1) ◽  
pp. S43-S44
Author(s):  
JJ Shankar ◽  
L Hodgson
Keyword(s):  
Vertebral Artery ◽  
Retrospective Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
The Third ◽  
Cerebellar Artery ◽  
Incomplete Coverage ◽  
Negative Findings ◽  
The Right

Purpose: CTA is becoming the frontline modality to reveal aneurysms in patients with SAH. However, in about 20% of SAH patients no aneurysm is found. In these cases, intra-arterial DSA is still performed. Our aim was to evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. Materials and Method: We conducted a retrospective analysis of all DSA performed from August 2010 to July 2014 in patients with various indications. We selected patient who presented with SAH and had a negative CTA. Findings of the CTA were compared with DSA. Results: 857 DSA were performed during the study period. 51(5.95%) patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. Of these, only 3(5.9%) of patients had positive findings on the DSA. One patient had a posterior inferior cerebellar artery aneurysm on the DSA, not seen on CTA due to the incomplete coverage of the head. Second patient’ CTA did not show any evidence of aneurysm. DSA showed suspicious dissection of the right vertebral artery, potentially iatrogenic. The third patient’s DSA showed suspicious tiny protuberance from left ICA, possibly infundibulum. Conclusion: In patients with SAH, negative CTA findings are reliable in ruling out aneurysms in any pattern of SAH on CT.

scholarly journals Intractable Scapular Pain Due to Undiagnosed Osteoid Osteoma: A Case Report

2020 ◽  
Vol 11 (03) ◽  
pp. 489-491
Author(s):  
Karthika Veerapaneni ◽  
Poornachand Veerapaneni ◽  
Nidhi Kapoor ◽  
Rohan S Samant ◽  
Sisira Yadala ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Osteoid Osteoma ◽  
Diagnostic Testing ◽  
Mass Effect ◽  
Decompression Surgery ◽  
Tissue Mass ◽  
Neurology Clinic ◽  
Radiolucent Lesion ◽  
The Right

AbstractA 36-year-old female patient presented to our stroke neurology clinic for progressively worsening intractable, sharp, shooting interscapular pain radiating to the right shoulder and neck, which she had experienced for 4 years. She had previously seen an orthopedist and was referred to a neurosurgeon for surgical intervention after an MRI of the cervical spine showed the C3–C4 right vertebral artery loop protruding into the right C3–C4 neural foramen and compressing the exiting C4 nerve root. MR neurography showed a stable tortuous right vertebral artery loop, causing a mass effect on the dorsal root ganglion. A neuroforaminal decompression surgery was planned. However, the patient visited our stroke neurology clinic for a second opinion before surgery. An MRI of the thoracic spine showed an enhancing soft tissue mass at the right T4–T5 pedicles and adjacent body. A chest CT with contrast showed a 1 cm radiolucent lesion in the superior articular facet of T5, which represented a nidus. A technetium bone scan showed focal increased uptake within the right T5 pedicle, which is indicative of osteoid osteoma. The patient underwent laminectomy/resection and was pain-free at a 6-month follow-up; biopsy confirmed osteoid osteoma. This case illustrates the importance of neurolocalization during diagnostic testing.

scholarly journals Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Lampis C. Stavrinou ◽  
George Stranjalis ◽  
Pantelis C. Stavrinou ◽  
N. Bontozoglou ◽  
Damianos E. Sakas
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Clinical History ◽  
Cervical Radiculopathy ◽  
Artery Occlusion ◽  
Transverse Foramen ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Extracranial Vertebral Artery ◽  
Cervical Root

Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge.Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine.Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion.Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.

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