Endovascular Treatment of Posterior Circulation Fusiform Aneurysms: Single-Center Experience in 31 Patients

Neurosurgery ◽  
2011 ◽  
Vol 69 (2) ◽  
pp. 274-283 ◽  
Author(s):  
Guy Raphaeli ◽  
Laurent Collignon ◽  
Olivier De Witte ◽  
Boris Lubicz
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Excellent Outcome ◽  
Parent Artery Occlusion ◽  
Asymptomatic Patients ◽  
Cranial Nerve Palsies

Abstract BACKGROUND: Posterior circulation fusiform aneurysms are rare but difficult to treat. OBJECTIVE: To report our experience with endovascular treatment of posterior circulation fusiform aneurysms. METHODS: A retrospective review of our prospectively maintained database identified all posterior circulation fusiform aneurysms treated by endovascular approach over a 6-year period. Clinical charts, procedural data, and angiographic results were reviewed. RESULTS: From March 2004 to March 2010, 31 patients were identified: 11 asymptomatic patients, 9 who presented with a subarachnoid hemorrhage, 6 with a stroke, and 5 with a mass effect. All but 1 patient (97%), who died before being treated, were successfully treated by parent artery occlusion (n = 10), stenting plus coiling (n = 10), or stenting alone with conventional or flow-diverting stents (n = 10). Twenty-two patients showed a good or an excellent outcome (73%); 3 had a fair or a poor outcome (10%); and 5 patients died (17%). These 8 patients initially presented with severe subarachnoid hemorrhage or mass effect. Procedure-related morbidity includes only one patient who kept a worsening of cranial nerve palsies. There was no definitive procedure-related morbidity or mortality. Immediate aneurysm occlusion was incomplete in 20 cases (67%) and complete in 10 cases (33%). Mean follow-up of 20 months in 23 patients showed 12 further thromboses, 9 stable results, and 2 flow reductions. Final results included 19 complete occlusions (83%) and 4 incomplete occlusions (17%). CONCLUSION: Posterior circulation fusiform aneurysms may be treated by different endovascular approaches with satisfying clinical and anatomical results in most cases. However, patients who present with severe subarachnoid hemorrhage or mass effect still have a poor prognosis.

Endovascular treatment of anterior inferior cerebellar artery trunk aneurysms

2021 ◽  
pp. 159101992110490
Author(s):  
Kun Hou ◽  
Kan Xu ◽  
Jinlu Yu
Keyword(s):  
Endovascular Treatment ◽  
Collateral Circulation ◽  
Artery Occlusion ◽  
Anterior Inferior Cerebellar Artery ◽  
Parent Artery ◽  
Anatomical Location ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Reasonable Choice ◽  
Perforating Arteries

Background The anterior inferior cerebellar artery (AICA) is a very slender and anatomically variable artery that gives off many important perforating arteries that feed the brainstem and nerve-related arteries that feed the inner ear and labyrinth. AICA trunk aneurysms are rare entities that are also difficult to manage. At present, endovascular treatment (EVT) is the preferred choice; however, the understanding of EVT for AICA trunk aneurysms is limited. Methods In this article, we present a literature review on EVT for AICA trunk aneurysms. To promote understanding, we would also provide some illustrative educational cases of our institute. Results Aneurysms along the AICA trunk can occur alone (isolated AICA aneurysm) or secondary to cerebrovascular shunts (flow-related AICA aneurysm). According to their anatomical location, they can also be divided into proximal and distal types. At present, EVT is the mainstream treatment, mainly including selective coiling with parent artery preservation and parent artery occlusion. Both coils and liquid embolization materials can be used. Conclusions For AICA trunk aneurysms, EVT is a reasonable choice and should be based on the specific anatomical location, pathology, and collateral circulation. However, there is still controversy as to the specific type of treatment that should be chosen.

Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 930-938 ◽  
Author(s):  
Isao Naito ◽  
Tomoyuki Iwai ◽  
Tomio Sasaki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Ischemic Insult ◽  
Double Lumen ◽  
String Sign ◽  
Parent Artery Occlusion ◽  
Aneurysmal Dilation

Abstract OBJECTIVE The clinical and angiographic follow-up results for intracranial vertebral artery (VA) dissections that initially presented without subarachnoid hemorrhage (SAH) were retrospectively investigated, to clarify their management. METHODS Twenty-one patients with VA dissections that initially presented without SAH were studied. Initial angiography revealed aneurysmal dilation in 11 cases (typical pearl-and-string sign in 8 cases, aneurysmal dilation only in 2, and aneurysmal dilation with double-lumen sign in 1), occlusion in 7, double-lumen sign in 2, and string-like stenosis in 1. Nine patients (six with pearl-and-string sign, one with occlusion with aneurysmal dilations, and two with double-lumen sign), including three patients who experienced subsequent SAH, underwent endovascular proximal parent artery occlusion. The other 12 patients were treated conservatively. All patients were monitored with magnetic resonance angiography or digital subtraction angiography. RESULTS Three patients experienced subsequent SAH, 1 day (two patients) or 51 months after onset. Follow-up angiographic assessments of the 20 patients demonstrated complete resolution in five cases, reduction of aneurysmal dilation in one case, and partial recanalization in one case. However, enlargement or formation of an aneurysmal dilation was recognized in four cases and progression of dissection was observed in one case. Eighteen patients experienced good recoveries, and three patients demonstrated moderate disabilities as a result of the initial ischemic insult. CONCLUSION The risk of bleeding from unruptured VA dissections is higher than previously considered. Therefore, endovascular treatment should be considered for patients with VA dissections with relatively large or growing aneurysmal dilations.

scholarly journals Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

2013 ◽  
Vol 19 (2) ◽  
pp. 222-227 ◽  
Author(s):  
S.H. Shin ◽  
I.S. Choi ◽  
K. Thomas ◽  
C.A. David
Keyword(s):  
Pediatric Patient ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Endovascular Management ◽  
Excellent Outcome ◽  
Parent Artery Occlusion

Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

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.

scholarly journals Current Strategies in the Treatment of Intracranial Large and Giant Aneurysms

2021 ◽  
pp. 19-26
Author(s):  
Matthias Gmeiner ◽  
Andreas Gruber
Keyword(s):  
Treatment Strategies ◽  
High Volume ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Active Management ◽  
Definitive Treatment ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Parent Artery Occlusion ◽  
Large And Giant Aneurysms

AbstractIntroduction: Very large and giant aneurysms are among the most challenging cerebrovascular pathologies in neurosurgery.Methods: The aim of this paper is to review the current literature on the management of very large and giant aneurysms and to describe representative cases illustrating possible treatment strategies.Results: In view of the poor natural history, active management using multiprofessional individualized approaches is required to achieve aneurysm occlusion, relief of mass effect, and obliteration of the embolic source. Both reconstructive (clipping, coiling, stent-assisted coiling, flow diversion [FD]) and deconstructive techniques (parent artery occlusion [PAO], PAO in conjunction with bypass surgery, and strategies of flow modification) are available to achieve definitive treatment with acceptable morbidity.Conclusions: Patients harboring such lesions should be managed at high-volume cerebrovascular centers by multidisciplinary teams trained in all techniques of open and endovascular neurosurgery.

Abstract 1122‐000071: Large and Giant Intracranial Aneurysms, Clinico‐Radiological Outcome and Predictors with Flow Diverter Stent

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Islam El Malky ◽  
Ayman Zakaria ◽  
Essam Abdelhameed ◽  
Hazem Abdelkhalek
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Complex Aneurysms ◽  
Parent Artery Occlusion ◽  
Large And Giant Aneurysms ◽  
Flow Diverters

Introduction : Endovascular treatment for large and giant aneurysms has included either a reconstructive approach or a deconstructive approach by parent artery occlusion. 1,2 Stent‐assisted coiling and balloon‐assisted coiling were alternative techniques developed to deal with such complex aneurysms, but studies have shown less expected efficacy. This study aims to assess the safety and efficacy of the flow diverter stents for treating large and giant intracranial aneurysms and to examine possible predictors for radiological and clinical outcomes such as location and presence of branching artery, bifurcation, and adjuvant coiling. Methods : This study had been conducted on 65 consecutive patients with 65 large and giant aneurysms (size ≥ 10 mm) treated with flow diverters; Periprocedural complications were reported in all patients and clinical outcomes. Follow‐up angiography was done for 60 patients (92.3%) at 12 months. Results : The study included 65 patients who harbored 65 aneurysms. The median age was 55.5 years (IQR: 44.25 ‐ 62.75 years), the female represented 70.8 % of all patients. The clinical presentation had been reported (Headache, cranial nerve palsy, motor deficit, seizures, and visual field defect in 40 patients (61.5%), nine patients (13.8%), seven patients (10.8%), five patients (7.7%), and four patients (6.2%) respectively. The vascular risk factors had been reviewed (HTN, DM, smoking, and Hyperlipidemia in 25 patients (9.2%), Six patients (9.2%), sixteen (24.6%), and 10 patients (15.4%) respectively). The median size of aneurysms was 16.4 mm (IQR: 12.50 ‐ 23.85 mm) and the median neck width was 7.15 mm (IQR: 5.85‐10.24 mm). Fourteen aneurysms (21.4 %) had previous treatment, eleven aneurysms (16.9%) were treated by coils only, one case (1.5%) by assisted procedure, one case (1.5%) by previous FDS, and parent artery occlusion in one case (1.5%). Complete occlusion in 50 from 60 aneurysms (83.4%), neck remnant in 8 aneurysms (13.3%), and sac remnant in two aneurysms (3.3%). Periprocedural problems were encountered in 14 patients (21.5%) with morbidity in six patients (9.2%) and mortality in one patient (1.5%). Univariate and multivariate logistic regression analysis was used to discover possible predictors of combined mortality and morbidity and occlusion in Table (1). Conclusions : From this study, it could be concluded that Endovascular treatment of the large and giant aneurysms with flow diverters represents a safe method for treating this kind of complex intracranial aneurysms. Complex aneurysms with branching artery and bifurcation were associated with aneurysm persistence and complications respectively while the location of the aneurysm was the only predictor for clinical outcome.

Medical management in the endovascular treatment of carotid-cavernous aneurysms

1996 ◽  
Vol 84 (5) ◽  
pp. 755-761 ◽  
Author(s):  
Richard S. Polin ◽  
Mark E. Shaffrey ◽  
Mary E. Jensen ◽  
Lisa Braden ◽  
Robert D. G. Ferguson ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Heparin Therapy ◽  
Artery Occlusion ◽  
Carotid Occlusion ◽  
Neurological Deficits ◽  
Fistula Formation ◽  
Parent Artery ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
The University

✓ Carotid-cavernous aneurysms account for between 1.9% and 9.0% of intracranial aneurysms. Entirely intercavernous aneurysms are believed to have a relatively benign course, with cranial nerve findings or headache being the usual initial symptomatology; however, subarachnoid hemorrhage or carotid-cavernous fistula formation can result from rupture. Over the past 15 years endovascular parent artery occlusion has essentially replaced surgical carotid occlusion as the treatment of choice. The authors describe a series of 39 consecutive patients at the University of Virginia Health Sciences Center who underwent endovascular treatment of a carotid-cavernous aneurysm. Aggressive invasive hemodynamic monitoring and maintenance of a state of normo- to mild hypervolemia in the asymptomatic patient was used throughout the periprocedural period. Rapid institution of hypervolemic—hypertensive therapy can reverse early neurological deficits related to hypoperfusion in these patients. Only one individual managed with this protocol developed neurological deficits not reversible with hypertensive-hypervolemic therapy. Heparin therapy was administered for 48 hours after occlusion, with patients receiving subsequent aspirin therapy for 6 months to combat distal embolism secondary to thrombosis. Long-term complications were not seen in patients receiving aneurysm trapping; however, two individuals with proximal carotid occlusion developed late optic neuropathy and one had recurrent transient ischemic attacks that ceased with supraclinoidal carotid clipping.

Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992

1997 ◽  
Vol 87 (2) ◽  
pp. 141-162 ◽  
Author(s):  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Anterior Circulation ◽  
Content Type ◽  
Parent Artery Occlusion ◽  
Collateral Vessels ◽  
Proximal Occlusion

✓ The paucity of information about giant fusiform intracranial aneurysms prompted this review of 120 surgically treated patients. Twenty-five aneurysms were located in the anterior and 95 in the posterior circulation. Six patients suffered from atherosclerosis and only three others had a known arteriopathy. The remaining 111 patients presented with aneurysms resulting from an unknown arterial disorder; these patients were much younger than those harboring atherosclerotic aneurysms. Mass effect occurred in only 50% of cases and hemorrhage in 20%. Eight aneurysms caused transient ischemic attacks. Hunterian proximal occlusion or trapping were dominant among the treatment methods. In contrast to the management of giant saccular aneurysms, the usual thrombotic occlusion of a giant fusiform aneurysm after proximal parent artery occlusion requires the presence of two collateral circulations to prevent infarction, one for the end vessels and another for the perforating vessels that arise from the aneurysm. Although there was some reliance on the circle of Willis and on collateral vessels manufactured at surgery, the extent of natural leptomeningeal and perforating collateral, thalamic, lenticulostriate, and brainstem vessels was astonishing and formerly unknown to the authors. Good outcome occurred in 76% of patients with aneurysms in the anterior circulation; two of the six cases with poor results included patients who were already hemiplegic. Ninety percent of patients with posterior cerebral aneurysms fared well. Only 67% of patients with basilar or vertebral aneurysms had good outcomes, although more (17%) of these patients were in poor condition preoperatively because of brainstem compression.

Stent-Assisted Parent Artery Occlusion of Giant Cerebrovascular Aneurysms to Avoid Mass Effect

2009 ◽  
Vol 19 (4) ◽  
pp. 370-374 ◽  
Author(s):  
Syed I. Hussain ◽  
John R. Lynch ◽  
Thomas Wolfe ◽  
Brian-Fred Fitzsimmons ◽  
Osama O. Zaidat
Keyword(s):  
Mass Effect ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion

scholarly journals Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma

2022 ◽  
Vol 12 ◽  
Author(s):  
Kun Huo ◽  
Xianli Lv ◽  
Jinlu Yu
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Good Prognosis ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
The Status ◽  
Prime Objective

The posterior cerebral artery (PCA) is an important artery that can be divided into four segments (P1-4): segments P1-2 are proximal segments, and segments P3-4 are distal segments. Various aneurysms can occur along the PCA trunk. True saccular aneurysms are rare, and most PCA trunk aneurysms are dissecting. Sometimes, the PCA trunk can give rise to flow-related aneurysms in association with high-flow arteriovenous shunt diseases or moyamoya disease and internal carotid artery occlusion. Some PCA trunk aneurysms require treatment, especially ruptured or large/giant aneurysms. Recently, endovascular treatment (EVT) has become the mainstream treatment for PCA trunk aneurysms, and it mainly involves reconstructive or deconstructive techniques. Traditional EVT includes selective coiling with/without stent or balloon assistance and parent artery occlusion (PAO). For proximal aneurysms, the PCA should be preserved. For distal aneurysms, PAO can be performed. However, during EVT, preservation of the PCA must naturally be the prime objective. Recently, flow-diverting stents have been used and are a revolutionary treatment for unruptured dissecting aneurysms of the PCA trunk. Despite the associated complications, EVT remains an effective method for treating PCA trunk aneurysms and can result in a good prognosis.

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