Double-balloon Trapping Technique for Embolization of a Large Wide-necked Superior Cerebellar Artery Aneurysm: Case Report

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONSE291-ONSE292 ◽  
Author(s):  
Michael E. Kelly ◽  
Vivek Gonugunta ◽  
Henry H. Woo ◽  
Raymond Turner ◽  
David Fiorella
Keyword(s):  
Artery Aneurysm ◽  
Endovascular Embolization ◽  
Anatomic Reconstruction ◽  
Superior Cerebellar Artery ◽  
Complete Occlusion ◽  
Aneurysm Neck ◽  
Double Balloon ◽  
Cerebellar Artery ◽  
The Right

Abstract Objective: To describe a novel double-balloon trapping technique for endovascular embolization of a broad-based saccular aneurysm of the superior cerebellar artery. Clinical Presentation: A 62-year-old man with a history of diabetes, coronary artery disease, and smoking presented with a syncopal episode. Catheter angiography revealed a large (11.7 × 9.4 × 11.2 mm) right superior cerebellar artery (SCA) aneurysm with a 7-mm neck, incorporating the origin of the right SCA. Intervention: An endovascular double-balloon trapping technique was used. Using bilateral groin access and bilateral vertebral artery guide catheters, a 4 × 20 mm HyperGlide balloon (ev3 Neurovascular, Irvine, CA) was placed across the neck of the aneurysm, and a 4 × 7 mm HyperForm balloon (ev3 Endovascular Inc., Plymouth, MN) was placed within the aneurysm. The aneurysm was catheterized with an Echelon 14 microcatheter (ev3 Endovascular Inc.). The inflated HyperGlide balloon was used to protect the parent basilar artery and “trap” the smaller HyperForm balloon within the aneurysm. The HyperForm balloon was inflated within the aneurysm and gently retracted to protect the origin of the SCA at the aneurysm neck. The aneurysm was coiled with the balloons inflated. A 4.5 × 20 mm Neuroform stent (Boston Scientific, Natick, MA) was deployed across the aneurysm neck. Final procedural angiography showed near complete occlusion of the aneurysm and preservation of flow in the SCA. Follow-up angiography at 8 months showed progressive thrombosis with complete occlusion of the aneurysm, preserved patency of the SCA, and anatomic reconstruction of the native artery. The patient remained neurologically normal at the time of the follow-up evaluation. Conclusion: Double-balloon trapping is a novel endovascular technique that can be used to treat wide-necked aneurysms and maintain patency of side branches incorporated into the aneurysm neck.

LVIS Blue as a low porosity stent and coil adjuvant

2018 ◽  
Vol 10 (7) ◽  
pp. 682-686 ◽  
Author(s):  
Matthew J Koch ◽  
Christopher J Stapleton ◽  
Scott B Raymond ◽  
Susan Williams ◽  
Thabele M Leslie-Mazwi ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Posterior Inferior Cerebellar Artery ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Aneurysm Neck ◽  
Proximal Internal Carotid Artery ◽  
Cerebellar Artery

IntroductionThe LVIS Blue is an FDA-approved stent with 28% metallic coverage that is indicated for use in conjunction with coil embolization for the treatment of intracranial aneurysms. Given a porosity similar to approved flow diverters and higher than currently available intracranial stents, we sought to evaluate the effectiveness of this device for the treatment of intracranial aneurysms.MethodsWe performed an observational single-center study to evaluate initial occlusion and occlusion at 6-month follow-up for patients treated with the LVIS Blue in conjunction with coil embolization at our institution using the modified Raymond–Roy classification (mRRC), where mRRC 1 indicates complete embolization, mRRC 2 persistent opacification of the aneurysm neck, mRRC 3a filling of the aneurysm dome within coil interstices, and mRRC 3b filling of the aneurysm dome.ResultsSixteen aneurysms were treated with the LVIS Blue device in conjunction with coil embolization with 6-month angiographic follow-up. Aneurysms were treated throughout the intracranial circulation: five proximal internal carotid artery (ICA) (ophthalmic or communicating segments), two superior cerebellar artery, two ICA terminus, two anterior communicating artery, two distal middle cerebral artery, one posterior inferior cerebellar artery, and two basilar tip aneurysms. Post-procedurally, there was one mRRC 1 closure, five mRRC 2 closures, and 10 mRRC 3a or 3b occlusion. At follow-up, all the mRRC 1 and mRRC 3a closures, 85% of the mRRC 3b closures and 75% of the mRRC 2 closures were stable or improved to an mRRC 1 or 2 at follow-up.ConclusionsThe LVIS Blue represents a safe option as a coil adjunct for endovascular embolization within both the proximal and distal anterior and posterior circulation.

scholarly journals Flow diversion and microvascular plug occlusion for the treatment of a complex unruptured basilar/superior cerebellar artery aneurysm: case report

2019 ◽  
Vol 130 (6) ◽  
pp. 1978-1983 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Howard A. Riina ◽  
Omar Tanweer ◽  
Peyman Shirani ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Case Report ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Endovascular Approach ◽  
Aneurysm Occlusion ◽  
The Right

The authors present the unusual case of a complex unruptured basilar artery terminus (BAT) aneurysm in a 42-year-old symptomatic female patient presenting with symptoms of mass effect. Due to the fusiform incorporation of both the BAT and left superior cerebellar artery (SCA) origin, simple surgical or endovascular treatment options were not feasible in this case. A 2-staged (combined deconstructive/reconstructive) procedure was successfully performed: first occluding the left SCA with a Pipeline embolization device (PED) coupled to a microvascular plug (MVP) in the absence of antiplatelet coverage, followed by reconstruction of the BAT by deploying a second PED from the right SCA into the basilar trunk. Six-month follow-up angiography confirmed uneventful aneurysm occlusion. The patient recovered well from her neurological symptoms. This case report illustrates the successful use of a combined staged deconstructive/reconstructive endovascular approach utilizing 2 endoluminal tools, PED and MVP, to reconstruct the BAT and occlude a complex aneurysm.

Aneurysms with persistent patency after treatment with the Pipeline Embolization Device

2016 ◽  
Vol 126 (6) ◽  
pp. 1894-1898 ◽  
Author(s):  
Peter Kan ◽  
Visish M. Srinivasan ◽  
Nnenna Mbabuike ◽  
Rabih G. Tawk ◽  
Vin Shen Ban ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Pipeline Embolization Device ◽  
Cerebellar Artery ◽  
Middle Cerebral Artery Aneurysms ◽  
Flow Diverters

The Pipeline Embolization Device (PED) was approved for the treatment of intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery. However, since its approval, its use for treatment of intracranial aneurysms in other locations and non-sidewall aneurysms has grown tremendously. The authors report on a cohort of 15 patients with 16 cerebral aneurysms that incorporated an end vessel with no significant distal collaterals, which were treated with the PED. The cohort includes 7 posterior communicating artery aneurysms, 5 ophthalmic artery aneurysms, 1 superior cerebellar artery aneurysm, 1 anterior inferior cerebellar artery aneurysm, and 2 middle cerebral artery aneurysms. None of the aneurysms achieved significant occlusion at the last follow-up evaluation (mean 24 months). Based on these observations, the authors do not recommend the use of flow diverters for the treatment of this subset of cerebral aneurysms.

scholarly journals The Medina Embolic Device: Karolinska experience

2017 ◽  
Vol 24 (1) ◽  
pp. 4-13 ◽  
Author(s):  
P Bhogal ◽  
PA Brouwer ◽  
L Yeo ◽  
M Svensson ◽  
M Söderman
Keyword(s):  
Internal Carotid ◽  
Clinical Status ◽  
Superior Cerebellar Artery ◽  
Anterior Communicating Artery ◽  
Single Centre ◽  
Complete Occlusion ◽  
Neck Size ◽  
Cerebellar Artery ◽  
Single Centre Experience

Background The aim of this study was to report our single centre experience with the Medina Embolic Device (MED). Methods We performed a retrospective analysis of prospectively collected data to identify all patients treated with the MED. A total of 14 aneurysms (non-consecutive), in 13 patients, were treated including one ruptured and one partially thrombosed aneurysm. Fundus diameter was ≥5 mm in all cases. We evaluated the angiographic appearances, the clinical status, complications, and the need for adjunctive devices or repeat treatments. Results Aneurysm location was cavernous internal carotid artery (ICA; n = 1), supraclinoid ICA ( n = 1), terminal ICA ( n = 2), anterior communicating artery (AComA; n = 4), A2–3 ( n = 1), M1–2 junction ( n = 1), posterior communicating artery (PComA; n = 1), superior cerebellar artery (SCA; n = 1), and basilar tip ( n = 2). The average aneurysm fundus size was 8.6 mm (range 7–10 mm) and average neck size 3.75 mm (range 1.9–6.9 mm). Immediate angiographic results were modified Raymond–Roy occlusion classification (mRRC) I n = 2, mRRC II n = 1, mRRC IIIa n = 2, mRRC IIIb n = 2, the remaining 7 aneurysms showed complete opacification. At follow-up angiography (mean 5 months) mRRC I n = 5, mRRC II n = 5, mRRC IIIa n = 3, and persistent filling was seen in 1 aneurysm. Overall, four patients had repeat treatment and one is pending further treatment. Of the aneurysms treated with more than one MED, 75% showed complete occlusion at 6-month follow up whereas only one aneurysm treated with a single device showed complete occlusion. Overall, three patients had temporary complications and there were no deaths. Conclusions The MED is an intra-saccular flow-diverting device with satisfactory angiographic results and an acceptable safety profile. Use of a single MED cannot be recommended and further longer term studies are needed prior to widespread clinical use.

scholarly journals Treatment of Unruptured Vertebral Artery Aneurysm Involving Posterior Inferior Cerebellar Artery With Pipeline Embolization Device

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.

scholarly journals Fusiform superior cerebellar artery aneurysm treated with flow diversion: A case report

2020 ◽  
Vol 11 ◽  
pp. 330
Author(s):  
Yafell Serulle ◽  
Deepak Khatri ◽  
Jada Fletcher ◽  
Anna Pappas ◽  
Audrey Heidbreder ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Flow Diversion ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Parent Vessel ◽  
Pipeline Embolization Device ◽  
Head Ct ◽  
Cerebellar Artery ◽  
The Right

Background: Fusiform aneurysms of the distal superior cerebellar artery are rare and challenging to treat. Due to the rarity of these lesions, there is little consensus regarding their management. Treatment options have traditionally included parent artery sacrifice with either an endovascular approach or microsurgical clipping. Given the small diameter of the superior cerebellar artery, flow diversion has not been typically considered as a viable treatment option for these aneurysms. Case Description: A 67-year-old female presented complaining of severe sudden onset headache. Noncontrast head CT demonstrated no intracranial hemorrhage. Head CT angiogram demonstrated a 4.2 mm fusiform aneurysm in the distal right superior cerebellar artery. The patient underwent treatment with the Pipeline embolization device which was deployed in the right superior cerebellar artery covering the aneurysm. Six-month posttreatment follow-up angiogram demonstrated resolution of the aneurysm with patency of the parent vessel. Conclusion: To the best of our knowledge, this is the first report of a distal superior cerebellar artery aneurysm treated with the Pipeline embolization device. The use of a Pipeline stent to create flow diversion should be considered in a case of a fusiform aneurysm of the right superior cerebellar artery. Treatment with flow diversion may allow for the treatment of the aneurysm while preserving patency of the parent vessel.

scholarly journals Subarachnoid hemorrhage due to ruptured dissecting duplicated superior cerebellar artery aneurysm treated by endovascular embolization: a case report

Nosotchu ◽  
2013 ◽  
Vol 35 (3) ◽  
pp. 209-212
Author(s):  
Keisuke Enoki ◽  
Katsumi Matsumoto ◽  
Koichiro Tsuruzono ◽  
Manabu Sasaki ◽  
Yasunori Yoshimura ◽  
...  
Keyword(s):  
Case Report ◽  
Subarachnoid Hemorrhage ◽  
Artery Aneurysm ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery

scholarly journals Double-Balloon Remodeling for Coil Embolization of a Primitive Trigeminal Artery Variant Aneurysm

2014 ◽  
Vol 20 (3) ◽  
pp. 295-300 ◽  
Author(s):  
Tomoji Takigawa ◽  
Kensuke Suzuki ◽  
Yoshiki Sugiura ◽  
Ryotaro Suzuki ◽  
Issei Takano ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Trigeminal Artery ◽  
Occlusion Balloon ◽  
Double Balloon ◽  
Persistent Primitive Trigeminal Artery ◽  
Cerebellar Artery ◽  
Primitive Trigeminal Artery ◽  
The Right

Here we describe the case of a patient with a wide-necked unruptured aneurysm arising at origin of a persistent primitive trigeminal artery (PTA) variant from the right internal carotid artery (ICA), supplying the territory of the right superior cerebellar artery and the anterior inferior cerebellar artery. To preserve the ICA and the PTA variant, coil embolization of the aneurysm was performed using a double-balloon remodeling technique (HyperForm™ and Hyper-Glide™ Occlusion Balloon Systems; ev3 Endovascular Inc., Irvine, CA, USA). The association of a PTA variant with an aneurysm is very rare. To our knowledge, this is the first description of the use of coil embolization using double-balloon remodeling to treat a PTA variant aneurysm. This technique permits complete embolization and reduces the risk of cerebral and cerebellar ischemia.

scholarly journals Two Distally Located Right SCA Aneurysms: Endovascular Treatment by Parent Artery Occlusion with GDC Coils and N-BCA Injection

2003 ◽  
Vol 9 (2) ◽  
pp. 193-198 ◽  
Author(s):  
M. Szajner ◽  
K. Obszaska ◽  
A. Nestorowicz ◽  
M. Szczerbo-Trojanowska
Keyword(s):  
Artery Occlusion ◽  
Endovascular Embolization ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Peripheral Aneurysms ◽  
Embolic Materials ◽  
The Right ◽  
Wide Neck

Peripheral aneurysms of the superior cerebellar artery are considered difficult to treat surgically and endovascularly because of their inaccessibility. Parent artery occlusion is therefore frequently the preferred method. Embolic materials previously reported in this situation are either GDC coils or a polymerizing agent (n-BCA). We report a patient with two distally located, wide-neck aneurysms of the right superior cerebellar artery who presented with hemorrhage and was treated by endovascular embolization of the parent artery using a combination of GDC coils and n-BCA.

Contralateral vertebral approach for stenting and coil embolization of a large, thrombosed vertebral–posterior inferior cerebellar artery aneurysm

2007 ◽  
Vol 107 (6) ◽  
pp. 1214-1216 ◽  
Author(s):  
Robert D. Ecker ◽  
Ricardo A. Hanel ◽  
Elad I. Levy ◽  
L. Nelson Hopkins
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Ipsilateral Side ◽  
Aneurysm Neck ◽  
Cerebellar Artery

✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.

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