Transcirculation Endovascular Treatment of Complex Cerebral Aneurysms: Technical Considerations and Preliminary Results

Neurosurgery ◽  
2011 ◽  
Vol 68 (3) ◽  
pp. 820-830 ◽  
Author(s):  
Felipe C Albuquerque ◽  
L Fernando Gonzalez ◽  
Yin C Hu ◽  
C Benjamin Newman ◽  
Cameron G McDougall
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Cerebral Aneurysms ◽  
Posterior Circulation ◽  
Alternative Pathways ◽  
Complex Aneurysms ◽  
Cerebellar Artery ◽  
Kissing Balloon Technique ◽  
Posterior Circulation Aneurysms ◽  
History Of

Abstract BACKGROUND: Unfavorable anatomy can preclude embolization of intracranial aneurysms. Transcirculation techniques, in which a catheter is navigated from one side of the brain to the other or from the anterior to the posterior circulation, are alternative pathways for primary or balloon- or stent-assisted coiling. OBJECTIVE: We report the largest experience in coil embolization of aneurysms using transcirculation techniques. METHODS: We reviewed our endovascular database from 2006 to 2009 and identified 18 patients who had aneurysms treated with transcirculation techniques. RESULTS: Eight patients had anterior and 10 had posterior circulation aneurysms. Overall, 8 patients were treated with stent-assisted coiling and 9 with balloon-assisted coiling, including 1 patient treated with a “kissing balloon” technique. Of the 9 patients treated with balloon-assistance, 1 also was stented at the conclusion of aneurysm coiling. One patient with a left fourth vertebral artery (V4) aneurysm was treated with coiling alone via a bilateral vertebral artery (VA) approach. In 14 patients, the anterior communicating and posterior communicating arteries were used as conduits. In 4 patients, both VAs were traversed to treat 2 V4 aneurysms and 2 posterior inferior cerebellar artery aneurysms. One patient died as a result of treatment and was the only permanent complication (5.6%). Complete or near-complete (>95%) embolization was achieved in all patients. CONCLUSION: Transcirculation techniques are effective pathways for embolization of complex aneurysms. Although technically challenging, these techniques are associated with an acceptably low rate of complications when compared to the natural history of the treated lesion.

scholarly journals Anatomical features of the vertebral artery for transbrachial direct cannulation of a guiding catheter to perform coil embolization of cerebral aneurysms in the posterior cerebral circulation

2015 ◽  
Vol 21 (3) ◽  
pp. 381-386 ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Yuichi Miyazaki ◽  
Yuhei Tanno ◽  
Shigen Kasakura ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Cerebral Circulation ◽  
Cerebral Aneurysms ◽  
Posterior Circulation ◽  
Anatomical Features ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysms ◽  
Posterior Cerebral Circulation ◽  
Guiding Catheter

Background Transbrachial approach is an alternative technique for coil embolization of posterior circulation aneurysms. The purpose of our study was to investigate the anatomical features of the vertebral artery (VA) for transbrachial direct VA cannulation of a guiding catheter (GC) to perform coil embolization of posterior circulation aneurysms. Methods Included in retrospective analysis were patients who underwent transbrachial coil embolization of cerebral aneurysms in the posterior cerebral circulation by direct VA cannulation of a GC from 2007 to 2013. Investigated were patient characteristics, preoperative sizes of aneurysms, aneurysms location, the angle formed by the target VA and the subclavian artery (AVS), and the VA diameter at the level of the fourth cervical vertebral body (VAD) in the side of the transbrachial access route. Results Thirty-one patients with 32 aneurysms met our criteria. The locations of aneurysms were the VA ( n = 16), basilar artery (BA) tip ( n = 10), BA trunk ( n = 3), BA superior cerebellar artery ( n = 1), BA anterior inferior cerebellar artery ( n = 1), and VA posterior inferior cerebellar artery ( n = 1). The right brachial artery was punctured in 27 cases with 28 aneurysms as transbrachial direct cannulation of a GC, and left was in 4 cases with 4 aneurysms. The average AVS, ranging from 45° to 95°, was 77°, and the average VAD, ranging from 3.18 to 4.45 mm, was 3.97 mm. Conclusion For transbrachial direct cannulation of a GC, it seems required that the AVS is about 45° or more and the VAD is about 3.18 mm or more.

scholarly journals Coiling Using Dual Microcatheter Technique—A Novel Approach

2022 ◽  
Author(s):  
Arvind Kumar ◽  
Swarup Sohan Gandhi ◽  
Ashok Gandhi ◽  
Trilochan Srivastav ◽  
Devendra Purohit
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Left Vertebral Artery ◽  
Aneurysm Neck ◽  
Novel Technique ◽  
Novel Approach ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysms ◽  
Flow Through

AbstractPosterior circulation aneurysms are difficult to treat, and if an incorporated artery is arising from the neck of aneurysm, management becomes much more challenging. Here, we are describing a novel technique used to treat a patient with a large, wide-necked left vertebral artery (VA)-posterior inferior cerebellar artery (PICA) junctional aneurysm. PICA seems to be arising from the aneurysm neck, but the aneurysm neck was not very clearly defined. So, we placed a second microcatheter into PICA, which not only allowed the coils to be placed in the aneurysm, without disrupting the flow through PICA but also helpful in assessing the aneurysmal occlusion. This technique allowed coils to be placed successfully without compromising flow through PICA.

scholarly journals Posterior Circulation Aneurysms: A Critical Appraisal of a Surgical Series in Endovascular Era

2021 ◽  
pp. 39-45
Author(s):  
Sabino Luzzi ◽  
Mattia Del Maestro ◽  
Renato Galzio
Keyword(s):  
Vertebral Artery ◽  
Critical Appraisal ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Cerebellar Artery ◽  
Average Patient ◽  
Posterior Circulation Aneurysms ◽  
The Mean

AbstractThe advent of the endovascular era has apparently decreased the role of microneurosurgery for many of the posterior circulation aneurysms. This study consists of a critical appraisal of a retrospective surgical series regarding posterior circulation aneurysms, targeted to define whether microneurosurgery still has a role for some of these. In 28 years, 157 aneurysms were surgically treated, 98 of which ruptured. The Average patient age was 56.7 ± 14.2 years, while in hemorrhagic cases, the mean Hunt-Hess score was 2.17 ± 0.8. Basilar tip, vertebral artery and proximal posterior inferior cerebellar artery were the most frequently involved sites. The treatment consisted of 128 clippings, 19 trappings, 7 wrappings, and 3 bypasses. A total exclusion was achieved in 88.5% of the aneurysms. An average follow-up of 67.1 ± 61.3 months proved no recurrences. The best results were observed in patients <65 years old who harbored small-to-regular aneurysms of the basilar tip, distal cerebellar arteries, or vertebral artery.Clipping proved to be a definitive and durable treatment for a large part of posterior circulation aneurysms, whereas bypass allows for treating aneurysms not amenable for coiling, stenting, or clipping. The present study confirms that microneurosurgery continues to have a paramount role within neurovascular pathology.

Delayed Endovascular Revascularization in a Patient With Progressive Neurological Deterioration From Bilateral Intracranial Vertebral Artery Occlusions: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. E251-E256 ◽  
Author(s):  
Christopher S Ogilvy ◽  
Alexander A Khalessi ◽  
Erik F Hauck ◽  
Larry R Shannon ◽  
L Nelson Hopkins ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Arterial Occlusion ◽  
Posterior Circulation ◽  
Vertebrobasilar Insufficiency ◽  
Endovascular Revascularization ◽  
Left Posterior ◽  
Cerebellar Artery ◽  
History Of ◽  
Cranial Neuropathies

Abstract BACKGROUND AND IMPORTANCE: This article describes delayed endovascular revascularization in a patient with clinical and radiographic evidence of posterior circulation hemodynamic failure in the setting of intracranial occlusive lesions. CLINICAL PRESENTATION: A 48-year-old man presented with a 6-week history of progressive headache, nausea, and ataxia. Bilateral intracranial vertebral artery occlusions and a left posterior inferior cerebellar artery stroke were diagnosed, and the patient began warfarin therapy. Despite these measures, the patient developed dense lower cranial neuropathies, including severe dysarthria, decreased left-sided hearing acuity, and left facial droop. He presented at this point for endovascular evaluation. The patient underwent successful revascularization with intravascular Wingspan stents (Boston Scientific, Natick, Massachusetts) in a delayed fashion (approximately 6 weeks after his initial stroke presentation). His neurological syndrome stabilized and began to improve slowly. CONCLUSION: Patients with arterial occlusion should be evaluated acutely for potential revascularization. In the posterior circulation, clinical progression may supplant physiological imaging in the assessment of hemodynamic collapse. A subpopulation of patients will present with progressive deficits distinct from extracranial manifestations of vertebrobasilar insufficiency; these patients should be considered for delayed revascularization.

scholarly journals Surgical Treatment of Posterior Circulation Aneurysms – Anatomical Study and Surgical Technique

2018 ◽  
Vol 37 (01) ◽  
pp. 27-37
Author(s):  
Vitor Yamaki ◽  
Eric Paschoal ◽  
Manoel Teixeira ◽  
Eberval Figueiredo
Keyword(s):  
Surgical Treatment ◽  
Posterior Inferior Cerebellar Artery ◽  
Cranial Nerves ◽  
Posterior Circulation ◽  
Surgical Approaches ◽  
Superior Cerebellar Artery ◽  
Anterior Circulation ◽  
Cerebellar Artery ◽  
Risk Of Rupture ◽  
Posterior Circulation Aneurysms

AbstractPosterior circulation aneurysms represent 10–15% of intracranial aneurysms. The diagnosis is usually secondary to subarachnoid hemorrhage due to its initial asymptomatic presentation and higher risk of rupture compared with aneurysms in the anterior circulation. The surgical treatment of posterior circulation aneurysms is complex and challenging for neurosurgeons because of the particular anatomy of the posterior circulation with its close relation to the brainstem and cranial nerves and also because of the depth and narrowness of the surgical approach. Aneurysms from different locations have specific anatomical relationships and surgical approaches for better visualization and dissection. Therefore, a detailed anatomy knowledge of the posterior circulation is mandatory for an individualized preoperative planning and good neurological and angiographic outcomes. We selected the main aneurysm sites on the posterior circulation, such as: posterior inferior cerebellar artery, basilar trunk, basilar bifurcation, posterior cerebral artery (PCA) and superior cerebellar artery for a detailed description of the relevant anatomy related to aneurysm, and the main surgical approaches for its surgical treatment. Furthermore, we performed a literature review with the most recent outcomes regarding to the surgical treatment of posterior circulation aneurysms.

Embolization of Posterior Circulation Aneurysms with Detachable Coils

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 127-130 ◽  
Author(s):  
K. Kazekawa ◽  
T. Fukushima ◽  
M. Tomonaga ◽  
T. Kawano ◽  
T. Kawaguchi ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Vertebrobasilar Junction

We evaluated the usefulness of endovascular treatment of posterior circulation aneurysms with GDCs and IDCs, Five cases were treated with IDCs, and 15 cases were treated with GDCs. In this study, 8 aneurysms were identified at the basilar bifurcation, 3 at the P1 segment of the pasterior cerebral artery, 1 at the origin of the superior cerebellar artery, 2 at the vertebrobasilar junction, 1 at the origin of the posterior inferior cerebellar artery, 1 at the distal anterior inferior cerebellar artery, and 4 dissecting aneurysms at the vertebral artery. Thirteen of the aneurysms were small (< 12 mm), 5 were large (13–24 mm), and 2 were giant (> 25 mm). Of the 20 patients, 14 patients returned to their previous occupation. Patients with permanent deficits included 2 patients with infarction caused by thromboembolic complications during the embolization procedure, and 2 with infarction caused by vasospasm. There were 2 deaths. The outcomes of the patients seemed favorable. However, long-term follow-up is necessary to determine the usefulness of detachable coils.

Pipeline embolization device for the treatment of vertebral artery aneurysms: the fate of covered branch vessels

2015 ◽  
Vol 8 (10) ◽  
pp. 1041-1047 ◽  
Author(s):  
Marcus D Mazur ◽  
Craig Kilburg ◽  
Victor Wang ◽  
Philipp Taussky
Keyword(s):  
Vertebral Artery ◽  
Vessel Wall ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
Cerebellar Artery ◽  
Flow Through ◽  
Flow Diverting Stent

IntroductionPreliminary studies suggest that flow-diverting stents may be suitable for the treatment of aneurysms of the posterior circulation. The safety and efficacy of using flow-diverting stents for vertebral artery (VA) aneurysms is not well defined.ObjectiveTo examine the fate of covering the posterior inferior cerebellar artery (PICA) in patients undergoing placement of a flow-diverting stent for VA aneurysm.MethodsConsecutive patients who underwent placement of a Pipeline Embolization Device (PED) for treatment of an aneurysm of the V4 segment of the VA between April 2012 and June 2015 at our institution were retrospectively evaluated. Angiograms were reviewed to determine the patency of the PICA when the vessel origin was covered by the PED.Results11 patients with VA aneurysms who underwent treatment with the PED were identified. In each case the device covered the origin of the PICA. Follow-up angiography in eight patients demonstrated thrombosis of the aneurysm with patency of the PICA.ConclusionsFlow-diverting stents can be used for the treatment of VA aneurysms. When appropriately sized to the vessel wall and positioned in the VA, the device may cover the origin of the PICA without impairing flow through the branching artery.

scholarly journals Posterior circulation aneurysms: A 10-year institutional analysis

2012 ◽  
Vol 01 (02) ◽  
pp. 119-123
Author(s):  
Saurabh Sharma ◽  
Ansari Abuzer ◽  
Ashish Suri ◽  
Shailesh Gaikwad ◽  
N.K. Mishra ◽  
...  
Keyword(s):  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Poor Grade ◽  
Cranial Nerve Palsies ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysms ◽  
Grade Ii ◽  
Multimodality Approach

Abstract Aneurysms are uncommon and challenging to manage. A retrospective study was designed to report 53 patients who are treated from June 2002 to June 2011. The mean age at presentation was 46.34 ± 13.67 years (males, 26). Clinical features included subarachnoid hemorrhage (median Hunt and Hess Grade II, n = 42), cranial nerve palsies (9), hydrocephalus (5), and incidentally diagnosed (5). Locations included superior cerebellar artery (3), posterior cerebral artery (2), basilar trunk (4), vertebral (8), anterior inferior cerebellar artery (AICA) (5), posterior inferior cerebellar artery (PICA) (13), vertebrobasilar junction (6), and basilar top (13). Management included both endovascular intervention (26) and surgery (19), and both (2). Five patients presented as poor grade and underwent only extraventricular drain placement while one patient had thrombosed aneurysm and was managed conservatively. Mortality was 26.4% (n = 14) and morbidity included vasospasm (10), meningitis (2), pseudomeningocele (2), pneumonitis (2), and myocardial infarction (1). Posterior circulation aneurysms are highly challenging. They require the multimodality approach, and decision regarding surgery or embolization has to be individualized.

scholarly journals Surgical Management of Ruptured Posterior Circulation Aneurysms – A Single Center Experience

2017 ◽  
Vol 36 (01) ◽  
pp. 14-20 ◽  
Author(s):  
João Silva ◽  
Joana Machado ◽  
Ana Machado ◽  
Célia Pinheiro ◽  
Joaquim Rei ◽  
...  
Keyword(s):  
Medical Records ◽  
Posterior Inferior Cerebellar Artery ◽  
Posterior Circulation ◽  
Single Center ◽  
Ruptured Aneurysms ◽  
Single Center Experience ◽  
Cerebellar Artery ◽  
Posterior Circulation Aneurysm ◽  
Posterior Circulation Aneurysms ◽  
Early Surgical Treatment

Objective The treatment of ruptured aneurysms of the posterior circulation is a controversy in neurosurgery. The aim of this work is to describe the experience and results of the early surgical treatment of this pathology at Centro Hospitalar do Porto. Method We retrospectively analyzed the medical records of all patients aged over 18 who, in the period between 1999–2013, were admitted to our center with the diagnosis of ruptured saccular posterior circulation aneurysm. The patients were clinically staged at admission using the Hunt & Hess (H&H) scale. The modified Glasgow Outcome Scale (mGOS) was used to assess the outcome at discharge and after 6 months. Results Between 1999–2013, 59 patients underwent surgery for ruptured posterior circulation aneurysms. Eighty percent of the patients were female, and their average age was 58.7 years. Posterior-inferior cerebellar artery aneurysms accounted for 49.2% of surgeries, while basilar aneurysms accounted for 28.8%. Upon admission, 86.4% of patients were classified as H&H1–3, and 13.6% as H&H4–5. The outcomes at discharge and at 6 months were as follows: at discharge, mGOS1 in 5.1%, mGOS2–3 in 18.6%, and mGOS4–5 in 76.3%; at 6 months, mGOS1 in 10.2%, mGOS2–3 in 10.2%, and mGOS4–5 in 79.6%. There was a statistically significant correlation between basilar aneurysms and worse outcomes (p = 0.011). No correlation was found between the values of the H&H scale upon admission and outcome. Conclusions The functional outcome of our group of patients is mainly in line with what is described in other series from the literature. However, there is a trend toward lower mortality but higher morbidity rates.

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