Fenestra Obscura: Flow Diverter Reconstruction of a Complex Vertebrobasilar Aneurysm Through an Obscured Fenestration Limb: Technical Case Report

2015 ◽  
Vol 12 (1) ◽  
pp. E95-E100 ◽  
Author(s):  
Gabor Toth ◽  
Ferdinand Hui ◽  
Mark Bain
Keyword(s):  
Basilar Artery ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Vascular Lesions ◽  
Close Proximity ◽  
Vertebrobasilar Junction ◽  
Artery Reconstruction ◽  
Endovascular Technology ◽  
Flow Diverter Device

Abstract BACKGROUND AND IMPORTANCE Basilar fenestration aneurysms are rare, challenging intracranial vascular lesions with atypical anatomy. The posterior circulation represents a difficult therapeutic dilemma because of the close proximity of crucial life-sustaining brainstem structures. The use of flow diverter technology has been very limited in posterior circulation vessels. CLINICAL PRESENTATION We present the case of a 49-year-old female patient, who was diagnosed with a symptomatic large vertebrobasilar junction aneurysm, which was initially thought to be a proximal basilar dilatation. The aneurysm was later verified to arise from the proximal end of a basilar fenestration, distended by the aneurysm fundus. The small-caliber fenestration limbs were the only connection to the distal basilar artery, but were stretched laterally and concealed by the aneurysm fundus. This complex lesion was successfully treated by flow diverter deployment through one of the fenestration limbs, followed by coiling of the aneurysm fundus, and sacrificing the contralateral vertebral artery. A 6-month follow-up angiogram showed remodeling of the basilar artery and complete occlusion of the aneurysm with good clinical outcome. Careful diagnostic workup, multidisciplinary discussions, and the innovative use of versatile endovascular technology were crucial to achieve an optimal result in this case. CONCLUSION This is the first report of a successful basilar artery reconstruction for the treatment of a large atypical vertebrobasilar junction fenestration aneurysm by deployment of a flow diverter device directly in a small, obscured fenestration limb.

scholarly journals Two-stage reconstructive overlapping stent LEO+ and SILK for treatment of intracranial circumferential fusiform aneurysms in the posterior circulation

2016 ◽  
Vol 22 (5) ◽  
pp. 516-523 ◽  
Author(s):  
Guilherme Cabral de Andrade ◽  
Helvercio P Alves ◽  
Valter Clímaco ◽  
Eduardo Pereira ◽  
Alexandre Lesczynsky ◽  
...  
Keyword(s):  
Vascular Reconstruction ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
The Self ◽  
Reconstruction Technique ◽  
Fusiform Aneurysm ◽  
Arterial Reconstruction ◽  
The Brain ◽  
Flow Diverter Device

Intracranial circumferential fusiform aneurysms of the posterior circulation involving arterial branches or perforating vessels are difficult to treat. This article shows an endovascular reconstruction technique not yet described, using a telescoping self-expandable stent (LEO+) and flow-diverter device (SILK) at different surgical times. Two patients with circumferential fusiform aneurysm, one being an aneurysm of the segments P2 and P3 of the posterior cerebral artery, diagnosed after a headache, and the other a partially thrombosed aneurysm of the lower basilar artery, diagnosed following ischemia of the brain stem. Endovascular treatment was performed by means of a vascular reconstruction technique that used at different surgical times: overlapping; a telescoped self-expandable stent, LEO+; and a flow-diverter device, SILK. Angiographic control was carried out at 6 and 12 months, to evaluate arterial patency, flow maintenance in the arterial branches and perforating vessels, and thrombosis of the aneurysm. The combined use at different surgical times of the self-expandable stent and flow-diverter device was technically successful in both patients. There were no complications during the procedure, nor in the long-term follow-up with full arterial vascular reconstruction, maintenance of cerebral perfusion and complete aneurysm occlusion at the 6- and 12-month angiographic follow-up. There was no aneurysm recanalization nor intra-stent stenosis. Circumferential fusiform aneurysm of the posterior circulation involving arterial branches or perforating vessels to the brain stem may be treated with this arterial reconstruction technique at different surgical times, using the self-expandable stent called LEO+ and the flow-diverter device SILK, minimizing the risk of complications and failure of the endovascular technique, with the potential for arterial reconstruction with thrombosis of the aneurysmatic sac, as well as flow maintenance in the eloquent arteries, in this type of cerebral aneurysm.

149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Daga ◽  
M T Ahmad ◽  
M Taneja
Keyword(s):  
Treatment Option ◽  
Current Literature ◽  
Basilar Artery ◽  
Cerebral Angiography ◽  
Posterior Circulation ◽  
Anterior Circulation ◽  
Acute Setting ◽  
Post Procedure ◽  
Basilar Artery Stenosis

Abstract The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.

Abstract 120: Surpass Flow Diverter for Endovascular Treatment of Intracranial Aneurysms - A Multicenter Preliminary Clinical and Angiographic Experience in 161 Patients with 186 Aneurysms

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ajay K Wakhloo ◽  
Pedro Lylyk ◽  
Joost de Vries ◽  
Matthew J Gounis ◽  
Alexandra Biondi ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Experimental Studies ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Neck Size ◽  
Wide Range ◽  
New Generation

Objective: Validated through experimental studies a new generation of flow diverters (Surpass™ FD) was evaluated for treatment of intracranial aneurysms (IA). We present our multicenter preliminary clinical and angiographic experience. METHODS: To achieve the calculated flow disruption between the parent artery and aneurysm for thrombosis, single FDs were placed endovascularly in parent arteries. Implants measured 2.5-5.3mm in diameter with a length of 10-80mm. Patients were enrolled harboring a wide range large and giant wide-neck, fusiform and multiple small and blister-type aneurysm. Clinical and angiographic follow-up were performed at 1-3, 6, and 12 months. RESULTS: A total of 186 consecutive IA in 161 patients (mean age 57.1 years) were treated at 33 centers. Fifty-three aneurysms were smaller than 5 mm, 64 were 5-9.9mm in diameter, 47 were 10-20mm in diameter, and 22 were larger than 20mm (10.4±0.7mm, neck size 6.0±0.5mm [mean±SEM]) . The aneurysms originated in 63.4% from the internal carotid artery; 22% and 14.5% of the lesions were located in the anterior circulation distal to Circle of Willis and posterior circulation respectively. Technical success was achieved in 182 aneurysms (98%); average number of devices used per aneurysm was 1.05. Permanent morbidity and mortality during the follow-up period of mean 8.4months (range 1-24 months) including periprocedural complications for patients with aneurysms of the anterior circulation were encountered in 5 (3.7%) and 2 (1.5 %) patients respectively and 1 (3.7%) and 4 (14.8%) respectively for patients with aneurysms of the posterior circulation location. One-hundred-ten patients (70.5%) harboring 127 (70.2%) were available for clinical and angiographic follow-up and showed a complete or near complete aneurysm occlusion in 63 (81.8%) of the ICA. Aneurysms of the ICA≥10mm that were completely covered by FD and not previously stent-treated with a minimum of 6 months follow-up available in 16 patients showed a complete obliteration in 81.3% (n=13) and >90% occlusion in remaining 3 patients. CONCLUSION: Preliminary data demonstrate high safety and efficacy of a new generation of FD for a wide range of IA of the anterior and posterior circulation with a single implant.

scholarly journals Permanent Deployment of the Solitaire FR™ Device in the Basilar Artery in an Acute Stroke Scenario

2017 ◽  
Vol 7 (1-2) ◽  
pp. 6-11
Author(s):  
Miguel S. Litao ◽  
Erez Nossek ◽  
Keith DeSousa ◽  
Albert Favate ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Basilar Artery ◽  
Effective Means ◽  
Posterior Circulation ◽  
National Institutes Of Health ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Vessel Patency ◽  
Solitaire Fr

Background: Scarce reports exist of permanent deployment of Solitaire FR™ devices for arterial steno-occlusive disease as it is primarily indicated for temporary deployment for thrombectomy in large-vessel, anterior-circulation ischemic strokes. Even more scarce are reports describing permanent deployment of the Solitaire device for posterior circulation strokes. Summary: We present 2 cases where the Solitaire device was electrolytically detached to re-establish flow in an occluded or stenotic basilar artery in acutely symptomatic patients. In both cases, a 4 × 15 mm Solitaire device was positioned across the stenotic or occluded portion of the basilar artery and electrolytically detached to maintain vessel patency. Both cases had good clinical outcomes with a National Institutes of Health Stroke Scale (NIHSS) score of 1 (from 24) on 90-day follow-up and an NIHSS score of 2 (from 7) on 30-day follow-up. Key Messages: Permanent deployment of the Solitaire device may potentially be a safe and effective means of maintaining vessel patency in an occluded or stenotic basilar artery.

Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review

2020 ◽  
Vol 12 (7) ◽  
pp. 688-694
Author(s):  
Valerio Da Ros ◽  
Francesco Diana ◽  
Federico Sabuzi ◽  
Emanuele Malatesta ◽  
Antioco Sanna ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Treatment Options ◽  
Flow Diverter ◽  
Posterior Circulation ◽  
Complication Rates ◽  
Lower Complication ◽  
Long Term Follow Up ◽  
Ischemic Complication

BackgroundThe management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed.MethodsWe retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed.ResultsSeven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt–Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3–72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up.ConclusionsThe best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.

Factors associated with in-stent stenosis after cerebral aneurysm embolization using a Pipeline embolization device

2021 ◽  
pp. 159101992110663
Author(s):  
Gabriel Flores-Milan ◽  
Elliot Pressman ◽  
Ivo Peto ◽  
Zeguang Ren ◽  
Waldo R. Guerrero ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Pipeline Embolization Device ◽  
Flow Diverter Stent ◽  
Aneurysm Embolization ◽  
History Of ◽  
Vertebrobasilar Junction ◽  
Digital Subtraction Angiogram ◽  
Stent Stenosis ◽  
Statin Use

Background Flow-diverting (FD) stents, with or without coiling, are a mainstay in endovascular treatment of intracranial aneurysms (IAs). One observed complication from flow diverter stent (FDS) insertion has been in-stent stenosis. Though previously studied in the short-term period, the long-term history of this complication has yet to be described. Methods We performed a retrospective cohort study of consecutive IAs treated with Pipeline Embolization Device (PED), with or without coiling, at our centre between September 2014 and December 2018 that had at least one digital subtraction angiogram (DSA) during follow-up. In-stent stenosis was measured from DSA images, and associated patient and procedural characteristics were analysed. Results 94 patients treated with PED for IA were identified. On initial DSA during follow-up, 52 patients (55.3%) had in-stent stenosis within the PED. Of these 52 patients, 17 had a second DSA during follow-up. In this 2nd DSA, improvement and/or stable in-stent stenosis was seen 16 patients (94.1%). One patient in this group had worsening in-stent stenosis had a vertebrobasilar junction FD stent. Of the patients without in-stent stenosis on initial DSA, 15 had a second DSA during follow-up. Only one of these patients (6.7%) had new appearance of in-stent stenosis (measuring 5%). Multivariate analysis found statin use to be predictive of in-stent stenosis (p = 0.020, Odds ratio = 0.279 and 95% confidence interval = 0.095–0.821). Conclusions In-stent stenosis after FDS placement was seen in 53.2% of cases, which had between 1–50% of stenosis. 82.4% had resolution/improvement of their stenosis. Statin use was protective of in-stent stenosis.

scholarly journals Successful Treatment of Giant Intracranial Aneurysm Using Flow-Diverter Device: First Experience in Nepal

2020 ◽  
Vol 18 (3) ◽  
pp. 563-565
Author(s):  
Subash Phuyal ◽  
Pooja Agrawal ◽  
Ritesh Lamsal ◽  
Nirmal Prasad Neupane ◽  
Gopal Sedain
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Giant Aneurysm ◽  
Flow Diverter ◽  
Vascular Lesions ◽  
Successful Management ◽  
Flow Diverter Devices ◽  
First Time ◽  
Flow Diverter Device

Giant intracranial aneurysms are defined as aneurysms that measure over 25 mm in the greatest dimension. They are rare vascular lesions that preferentially involve regions with high-velocity blood flow, such as the cavernous and supraclinoid segments of the internal carotid artery, the middle cerebral artery, the vertebrobasilar region, and the basilar apex. The treatment of giant aneurysms is challenging and associated with high rates of morbidity and mortality. Flow-diverter devices have revolutionized their treatment in recent times. We report the successful management of two patients with giant cavernous internal carotid artery aneurysms using flow-diverter devices for the first time in Nepal. Keywords: Endovascular; flow-diverter devices; giant aneurysm

scholarly journals Patency of Posterior Circulation Branches Covered by Flow Diverter Device: A Hemodynamic Study

2019 ◽  
Vol 10 ◽  
Author(s):  
Xinzhi Wu ◽  
Zhongbin Tian ◽  
Jian Liu ◽  
Yisen Zhang ◽  
Wenqiang Li ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Posterior Circulation ◽  
Hemodynamic Study ◽  
Flow Diverter Device

Brain Stem Auditory Evoked Potentials in Posterior Circulation Surgery

Neurosurgery ◽  
1983 ◽  
Vol 12 (5) ◽  
pp. 496-502 ◽  
Author(s):  
John R. Little ◽  
Ronald P. Lesser ◽  
Hans Lueders ◽  
Anthony J. Furlan
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Basilar Artery ◽  
Auditory Evoked Potentials ◽  
Artery Aneurysm ◽  
Neurological Status ◽  
Posterior Circulation ◽  
Artery Stenosis ◽  
Vascular Lesions ◽  
Neurological Findings

Abstract The objectives of this study were to evaluate the use of brain stem auditory evoked potentials (BAEPs) in 10 adult patients with vascular disorders of the posterior circulation that were treated surgically and to compare the BAEPs with the neurological findings. The vascular lesions included basilar artery stenosis in 3 patients. vertebral artery stenosis in 1 patient, brain stem/cerebellar arteriovenous malformation in 2 patients. and basilar artery aneurysm in 4 patients. Measurement of BAEPs were carried out during operation in all cases. Eight patients had BAEPs measured before operation. and 9 patients had BAEPs measured after operation. Repeat postoperative studies were performed in patients with changes in neurological status. In general, BAEP abnormalities correlated with the neurological findings before and after operation. Six patients had normal intraoperative studies. None of them had clinical findings of pontomesencephalic dysfunction after operation. Three patients with significant BAEP abnormalities during operation had neurological findings of pontomedullary ischemia after operation. Transient BAEP changes in 1 patient were thought to be the result of brain stem retraction. The BAEPs were lost in 3 patients who died. The use of BAEP measurement did not lengthen the operative procedures. However, the technique used in this study required 4 to 8 minutes for the accumulation and interpretation of each average, thereby delaying feedback to the surgeon. The results of this study suggest a potential role for BAEP monitoring in identifying brain stem injury during posterior circulation surgery.

Sign in / Sign up

Export Citation Format

Share Document