Aggravation of Brainstem Symptoms Caused by a Large Superior Cerebellar Artery Aneurysm after Embolization by Guglielmi Detachable Coils —Case Report—

P98 Purpose: Thrombo-embolic complications associated with the endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils (GDC) generally occur at the time of the procedure or soon after. The purpose of this report is to determine the frequency of late thrombo-embolic events after GDC. Methods: The records of 189 patients who underwent GDC repair of one or more intracranial aneurysms at our institution were reviewed. The occurence of an ischemic event referrable to a coiled aneurysm was determined by clinical, angiographic, and imaging data. Events occuring within 2 days of the endovascular procedure were considered peri-procedural. Kaplan-Meier analysis of ischemic events over time was performed. Results: Two patients suffered documented thrombo-embolic events. One patient presented 5 weeks after coiling with a transient ischemic attack. Angiography demonstrated thrombus on the surface of the coils at the neck of a large ophthalmic artery aneurysm. The second patient presented with a posterior circulation stroke 4 weeks after coiling of a large superior cerebellar artery aneurysm. Angiography showed no significant proximal disease, with thrombus beginning at the neck of the treated aneurysm and extending out both P1 segments. No intra-procedural problems during the initial coiling had occured with either patient. There was no evidence for protrusion of coils into the parent artery in either patient. Both patients had been receiving daily aspirin (325 mg). One additional patient reporting symptoms suggesting possible ischemics event was evaluated and diagnosed as having atypical migraines. The frequency of a clinical thromboembolic event during the first year after coiling (excluding procedural complications) was 1.1%. Conclusions: Thrombo-embolic events may occur as late as 5 weeks after endovascular treatment of aneurysms with GDC.

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Application of flow coils to occlude distal vertebrobasilar aneurysms

Endovascular Neuroradiology ◽

10.26683/2304-9359-2020-2(32)-58-66 ◽

2020 ◽

Vol 32 (2) ◽

pp. 58-66

Author(s):

D.V. Shchehlov ◽

O.E. Svyrydiuk ◽

I.M. Bortnik ◽

O.A. Pastushyn ◽

Ya.E. Kudelskyi ◽

...

Keyword(s):

Cerebral Angiography ◽

Clinical Status ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Superior Cerebellar Artery ◽

Coordination Disorders ◽

Cerebellar Artery ◽

Detachable Coils ◽

Scientific Practical

Objective ‒ to improve the quality of treatment and endovascular occlusion techniques in case of distal vertebrobasilar (VB) aneurysms with implementation of flow coils usage.Materials and methods. Retrospective analysis of 4 patients (3 women and 1 man, mean age 53.5 years) with VB aneurysms in a 2-year period treated in Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine. Pretreatment clinical status was recorded from the patient files, any new neurologic symptoms after the treatment were recorded. Clinical outcome of the patients was established from the patient files. We describe the case of distal superior cerebellar artery aneurysm, 3 cases of posterior inferior cerebellar artery neurysms treated successfully with flow coils with 3-month follow-up at least. All patients underwent cerebral angiography with transfemoral access. Subsequently, coiling of the most distal to the aneurysm segment of the artery was performed.Results. All patients presented with subarachnoid hemorrhage with vestibulo-atactic disorder, diplopia in the case of an aneurysm of the superior cerebellar artery. Endovascular deconstructive occlusion of the aneurysm was performed, according to the data of cerebral angiography, anatomy of the involved artery. In postprocedure Reversible neurological decline in one patient after performing deconstructive occlusion was observed, the symptom completely recovered within 2 weeks of the post-procedural period. Three patients noted the regression of static-coordination disorders in the first 5 days after surgery. No cases of extravasation during coiling and recanalization of the artery during the control examination were observed.Conclusions. Aneurysms of posterior inferior cerebellar artery and superior cerebellar artery are rare. Technical availability to reach the distal to the aneurysm segment of the artery is the key of successful procedure. In comparison with general microcatheters used to insert detachable coils, A microcatheter that is congruent to flow coils is a better navigated in a flow and has lower risk of damaging the artery wall because its physical properties. When the favorable positioning of the tip of the microcatheter is achieved, the flow coils effectively and in a controlled manner occlude the eligible segment of the artery.

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Ruptured Distal Superior Cerebellar Artery Aneurysm After Gamma Knife Radiosurgery for Trigeminal Neuralgia: A Case Report and Review of the Literature

World Neurosurgery ◽

10.1016/j.wneu.2019.10.136 ◽

2020 ◽

Vol 135 ◽

pp. 2-6 ◽

Cited By ~ 1

Author(s):

Lisette Dominguez ◽

Brian Saway ◽

Michael J. Benko ◽

Evin Guilliams ◽

Eric A. Marvin ◽

...

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Artery Aneurysm ◽

Superior Cerebellar Artery ◽

Review Of The Literature ◽

Cerebellar Artery

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Endovascular Treatment of a Distal Aneurysm of the Superior Cerebellar Artery by Intra-Aneurysmal Injection of Glue

Interventional Neuroradiology ◽

10.1177/159101990100700411 ◽

2001 ◽

Vol 7 (4) ◽

pp. 343-348 ◽

Cited By ~ 7

Author(s):

M. Leonardi ◽

L. Simonetti ◽

A. Andreoli

Keyword(s):

Poor Prognosis ◽

Superior Cerebellar Artery ◽

Parent Artery ◽

High Morbidity ◽

Guglielmi Detachable Coils ◽

Parent Vessel ◽

Total Occlusion ◽

Cerebellar Artery ◽

Detachable Coils ◽

Distal Location

Aneurysms in the distal cerebellar arteries are rare events. They are associated with a poor prognosis, as surgery or embolisation with Guglielmi detachable coils (GDCs) is very difficult. The ability to treat them surgically depends on the location of the aneurysm, but surgery is considered difficult and is associated with a high morbidity/mortality rate. Embolisation with GDCs may be difficult or impossible because of the distal location of the aneurysm or the unfavourable ratio between the size of the aneurysm and the size of the parent vessel. We report our experience in one case treated with intra-aneurysmal injection of glue. The aneurysm, located in the distal right superior cerebellar artery, was catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysmal sac. The treatment resulted in total occlusion of the aneurysm with preservation of the parent artery.

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

Journal of Neurosurgery ◽

10.3171/2018.1.jns172465 ◽

2019 ◽

Vol 130 (6) ◽

pp. 1978-1983 ◽

Cited By ~ 1

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.

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