scholarly journals Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment

2020 ◽  
Vol 33 (2) ◽  
pp. 112-117
Author(s):  
Xianli Lv ◽  
Jianjun Yu ◽  
Wei Zhang ◽  
Xuelian Zhao ◽  
Huifang Zhang
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Dissection ◽  
Parent Artery ◽  
Low Profile ◽  
Coil Occlusion ◽  
Weber Syndrome ◽  
Ischemic Complication ◽  
Cerebral Artery Dissection

Objective Acute hemorrhagic cerebral artery dissection may show a subtle stenosis and bulge on an angiogram, for which diagnosis and treatment are difficult. This report describes seven cases of acute hemorrhagic cerebral artery dissection treated by endovascular techniques. Patients and methods From January 2018 to April 2019, seven patients (22–76 years old) were diagnosed with subarachnoid hemorrhage caused by cerebral artery dissection. Six patients were treated by low-profile visualized intraluminal support stent-assisted coiling and there was a sacrifice of the posterior cerebral artery in one patient. Cerebral angiography results were obtained immediately after intervention and at follow-up. Clinical outcome was evaluated by a modified Rankin Scale score. Results Four dissections were angiographic changes of subtle stenosis and small bulges; three were apparent angiographic changes of stenosis or fusiform morphologies. All seven aneurysms were completely obliterated, a low-profile visualized intraluminal support stent was used in six patients and coil occlusion of the parent artery in one patient. Complications occurred in two cases of proximal posterior cerebral artery dissection. One bleeding complication was observed intra-procedure and one ischemic complication was observed after stent-assisted coiling. The angiographic and clinical follow-up was obtained at 3–8 months in five patients. Good recovery was achieved for six patients (modified Rankin Score 0); one patient who presented Weber syndrome caused by ischemic complication had a modified Rankin Score of two at 8 months follow-up. Conclusion Hemorrhagic cerebral artery dissection may show subtle stenosis, small bulges or fusiform morphologies on angiograms. Treatment of proximal posterior cerebral artery dissection is challenging. Endovascular reconstruction with a low-profile visualized intraluminal support stent was effective depending on the angiographic morphology.

scholarly journals Posterior cerebral artery dissection

2001 ◽  
Vol 10 (11) ◽  
pp. 711-717 ◽  
Author(s):  
Kenichiro Ono ◽  
Tadashi Inohara ◽  
Toshiki Shirotani ◽  
Akira Shimizu ◽  
Hidetoshi Ooigawa ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Dissection ◽  
Cerebral Artery Dissection

Posterior cerebral artery dissection on a serial magnetic resonance angiography

2012 ◽  
Vol 34 (5) ◽  
pp. 396-399 ◽  
Author(s):  
Toshiki Takenouchi ◽  
Sachiko Shimozato ◽  
Hirokazu Fujiwara ◽  
Suketaka Momoshima ◽  
Takao Takahashi
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Dissection ◽  
Cerebral Artery Dissection

scholarly journals Endovascular treatment of posterior cerebral artery aneurysms: a single center's experience of 55 cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1094-1105 ◽  
Author(s):  
Xuanfeng Qin ◽  
Feng Xu ◽  
Yashengjiang Maimaiti ◽  
Yongtao Zheng ◽  
Bin Xu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Attractive Alternative ◽  
Parent Artery ◽  
Parent Artery Occlusion

OBJECTIVE Aneurysms of the posterior cerebral artery (PCA) are uncommon. To date, a limited number of studies have examined the outcomes of endovascular treatment for PCA aneurysms. The authors' aim in this study is to report their experience with the endovascular treatment of PCA aneurysms. METHODS Between January 2007 and December 2014, 55 patients with 59 PCA aneurysms were treated using the endovascular approach at the authors' institution. Twenty-three patients had 25 saccular aneurysms, and 32 patients had 34 fusiform/dissecting aneurysms. The endovascular modalities included the following: 1) selective occlusion of the aneurysm (n = 22); 2) complete occlusion of the aneurysm and the parent artery (n = 20); 3) parent artery occlusion (n = 6); 4) partial coiling of the aneurysm and the parent artery (n = 5); and 5) occlusion of the dissecting aneurysm sac (n = 2). RESULTS The immediate angiographic results included 45 complete occlusions (82%), 2 nearly complete occlusions (4%), and 8 incomplete occlusions (14%). The mean follow-up period of 21.8 months in 46 patients showed 37 stable results, 6 further thromboses, and 3 recurrences. The final results included 41 complete occlusions (89%), 2 nearly complete occlusions (4%), and 3 incomplete occlusions (7%). Procedure-related complications included the following: 1) rebleeding (n = 1); 2) infarction (n = 4); and 3) perforation (n = 1). There was 1 (1.8%) procedure-related death due to rebleeding, and 2 (3.6%) non–procedure-related deaths due to severe subarachnoid hemorrhage. Clinical outcomes were excellent (Glasgow Outcome Scale 5) in 47 of 49 patients at the long-term follow-up. CONCLUSIONS PCA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiological outcomes. However, patients who present with severe SAH still have an overall poor prognosis. Partial coiling of the aneurysm and the parent artery is an attractive alternative treatment for patients who may not tolerate parent artery occlusion. Further study with a larger case series is necessary for validation of the durability and efficacy of this treatment.

Potential proneness of fetal-type posterior cerebral artery to vascular insufficiency in parent vessel occlusion of distal posterior cerebral artery aneurysms

2012 ◽  
Vol 117 (2) ◽  
pp. 284-287 ◽  
Author(s):  
Xianli Lv ◽  
Youxiang Li ◽  
Xinjian Yang ◽  
Chuhan Jiang ◽  
Zhongxue Wu
Keyword(s):  
Cerebral Artery ◽  
Collateral Circulation ◽  
Posterior Cerebral Artery ◽  
Parent Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Adult Type ◽  
Coil Occlusion ◽  
Vascular Insufficiency ◽  
Parent Vessel Occlusion

Object The purpose of this study was to report the potential proneness of a fetal-type posterior cerebral artery (PCA) to develop vascular insufficiency in parent vessel occlusion of distal PCA aneurysms. Methods Between January 2005 and January 2011, 19 patients (9 females and 10 males) with 20 distal PCA aneurysms (16 dissecting and 4 saccular) were treated with endovascular parent vessel occlusion. The ages of the patients ranged from 5 to 71 years, with a mean age of 40.2 years. Of the 20 aneurysms, 4 were ruptured and 16 were unruptured. One of the unruptured aneurysms was additional to another ruptured aneurysm, and 15 were incidentally discovered. Five aneurysms were smaller than 10 mm, and the other 15 were 10 mm or larger. Results All aneurysms were successfully treated with simultaneous coil occlusion of the aneurysm and the parent PCA. One patient had hemianopia at the initial presentation, and 2 patients had new persistent hemianopia due to insufficient leptomeningeal collateral circulation; in 16 patients with an intact visual field, no hemianopia developed because there was sufficient leptomeningeal collateral circulation. A fetal-type PCA was involved in all 3 patients with hemianopia, which was initially presented or caused by parent vessel occlusion. However, in the patients without hemianopia, an adult-type PCA was involved in all cases. Conclusions Endovascular treatment via coil occlusion of the aneurysm as well as the parent artery can be used to cure distal PCA aneurysms. A fetal-type PCA could be an important predictive factor for vascular insufficiency in parent vessel occlusion treatment.

scholarly journals Stent-assisted coil embolization of a recurrent posterior cerebral artery aneurysm following surgical clipping

2016 ◽  
Vol 30 (1) ◽  
pp. 99-103 ◽  
Author(s):  
Tomonori Takeshita ◽  
Tomoaki Nagamine ◽  
Kohei Ishihara ◽  
Yasuhiko Kaku
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Surgical Clipping ◽  
Substantial Risk ◽  
Multiple Recurrences ◽  
Cerebral Artery Aneurysm

Posterior cerebral artery (PCA) aneurysms are rare, and direct surgery of these is considered difficult. Coil embolization of PCA aneurysms is becoming popular. However, it is difficult to completely obliterate the aneurysm while preserving the flow of the parent artery in large or giant PCA aneurysms with a wide neck with this technique. We report a case of a large and wide-necked PCA aneurysm with multiple recurrences following successful surgical clipping and coil embolization. A 77-year-old man with a large unruptured right PCA (P2) aneurysm was successfully treated by surgical clipping. Postoperative digital subtraction angiography (DSA) showed complete aneurismal occlusion. Four years afterward, the aneurysm recurred and grew toward the contralateral. Surgical retreatment of this complicated aneurysm was considered difficult, with a substantial risk of complications. Therefore, the aneurysm was treated with an endovascular procedure. Because simple coil embolization was not expected to achieve satisfactory obliteration of the aneurysm with preservation of parent artery patency, we used stent-assisted coil embolization. The patient tolerated the treatment well. On DSA obtained six months after the first endovascular treatment, coil compaction and recanalization of the aneurysm were detected. A second coil embolization was successfully performed without any complications. The aneurysm was stable during the next six-month follow-up. Stent-assisted coil embolization may be feasible and effective for such postoperatively complicated aneurysms.

scholarly journals Fetal-type posterior cerebral artery: the pitfall of parent artery occlusion for ruptured P2 segment and distal aneurysms

2015 ◽  
Vol 123 (4) ◽  
pp. 906-914 ◽  
Author(s):  
Jing Xu ◽  
Liang Xu ◽  
Ziheng Wu ◽  
Xianyi Chen ◽  
Jun Yu ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Occlusion ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Adult Type ◽  
Endovascular Occlusion ◽  
Parent Artery Occlusion ◽  
Ruptured Intracranial Aneurysm

OBJECT P2 segment and distal aneurysms are rare lesions of the cerebrovascular system. The efficacy and safety of endovascular occlusion for these types of aneurysms remain controversial. The aim of this study was to reveal risk factors for endovascular parent artery occlusion of ruptured P2 segment and distal aneurysms. METHODS Between March 2010 and November 2012, 812 patients with a ruptured intracranial aneurysm were admitted to the authors' hospital. Among them, 11 patients presented with P2 segment and distal posterior cerebral artery (PCA) aneurysms. These patients were subjected to endovascular treatment. Periprocedural data and clinical and angiographic records were studied retrospectively. RESULTS Of the patients with a ruptured PCA aneurysm, 2 of them underwent selective aneurismal coiling, and the remaining patients were treated with simultaneous occlusion of the parent artery. Patients with an adult-type PCA (n = 6), treated with either selective coiling or simultaneous parent artery occlusion, had no serious neurological deficits on follow-up. Four patients with a fetal-type PCA that was also occluded intraoperatively exhibited newly developed permanent paralysis and hemianopsia. However, 1 patient with a fetal-type PCA aneurysm that was selectively coiled recovered without complications. No recanalization was observed in any of the treated aneurysms. CONCLUSIONS Endovascular occlusion of an aneurysm and its parent artery is a safe and effective method for managing adult-type P2 segment and distal aneurysms. However, the authors' clinical data suggest that this method is of high risk for patients with fetal-type PCA aneurysms.

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