Ruptured Vertebral Artery Dissecting Aneurysm Associated with Parent Artery Occlusion: Report of 2 Cases

We herein report a case of a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery that was treated using the stent-jack technique. After parent artery occlusion of the distal vertebral artery, stenting of the posterior inferior cerebellar artery was performed. Further coiling was needed because distal vertebral artery recanalization occurred due to transformation of the coil mass. The stent-jack technique for a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery is effective; however, careful attention to recanalization after stenting is needed due to transformation of the coil mass.

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Ruptured Vertebral Artery Dissecting Aneurysm Associated With Parent Artery Occlusion-Case Report-

Neurologia medico-chirurgica ◽

10.2176/nmc.43.298 ◽

2003 ◽

Vol 43 (6) ◽

pp. 298-300 ◽

Cited By ~ 4

Author(s):

Kyoji SAKAI ◽

Masahiro KAMEDA ◽

Takaho TANIMOTO ◽

Kaoru TERASAKA ◽

Hiroshi SUGATANI ◽

...

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Vertebral Artery Dissecting Aneurysm

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Treatment of Intracranial Aneurysm with Bare Stent Only

Interventional Neuroradiology ◽

10.1177/15910199080140s213 ◽

2008 ◽

Vol 14 (2_suppl) ◽

pp. 75-78 ◽

Cited By ~ 3

Author(s):

Michael Mu Huo Teng ◽

Chao-Bao Luo ◽

Feng-Chi Chang ◽

Harsan Harsan

Keyword(s):

Intracranial Aneurysm ◽

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Fusiform Aneurysm ◽

Surgical Clipping ◽

Parent Artery Occlusion ◽

Typical Treatment ◽

Dissecting Aneurysms

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.

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Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage

Neurosurgery ◽

10.1097/00006123-200210000-00013 ◽

2002 ◽

Vol 51 (4) ◽

pp. 930-938 ◽

Cited By ~ 26

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.

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Endovascular treatment of posterior cerebral artery aneurysms: a single center's experience of 55 cases

Journal of Neurosurgery ◽

10.3171/2016.1.jns152447 ◽

2017 ◽

Vol 126 (4) ◽

pp. 1094-1105 ◽

Cited By ~ 6

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.

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Treatment of vertebral artery aneurysms with transposition of the posterior inferior cerebellar artery to the vertebral artery combined with parent artery occlusion

Journal of Neurosurgery ◽

10.3171/jns.2006.105.5.781 ◽

2006 ◽

Vol 105 (5) ◽

pp. 781-784 ◽

Cited By ~ 11

Author(s):

Kuniaki Ogasawara ◽

Yoshitaka Kubo ◽

Nobuhiko Tomitsuka ◽

Masayuki Sasoh ◽

Yasunari Otawara ◽

...

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Occlusion ◽

The Other ◽

Parent Artery ◽

Pica Pica ◽

Suboccipital Craniectomy ◽

Parent Artery Occlusion ◽

Cerebellar Artery ◽

Good Patency

✓ The authors describe transposition of the posterior inferior cerebellar artery (PICA) to the vertebral artery (VA) combined with parent artery occlusion for the treatment of VA aneurysms in cases in which a clip could not be applied because of the origin of the ipsilateral PICA. The aneurysm is trapped through a lower lateral suboccipital craniectomy. The PICA is then cut just distal to the aneurysm, and the PICA and VA proximal to the aneurysm are anastomosed in an end-to-end or end-to-side fashion. The surgical procedure was successfully performed in two patients, each of whom had hypoplastic occipital arteries (OAs). The PICA contralateral to the lesion was hypoplastic in one patient and distant to the ipsilateral PICA in the other patient. Mild transient dysphagia developed postoperatively in one patient due to glossopharyngeal and vagus nerve palsy, and the other patient had an uneventful postoperative course. In both patients, postoperative cerebral angiography demonstrated good patency of the transposed PICA. These results show that transposition of the PICA to the VA is a useful procedure for the reconstruction of the PICA when parent artery occlusion is necessary to exclude a VA aneurysm involving the origin of the PICA and when OA–PICA anastomosis or PICA–PICA anastomosis cannot be performed.

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Radical treatment of ruptured dissecting aneurysm on the P1 segment with monotherapy using multiple LVIS stents

BMJ Case Reports ◽

10.1136/bcr-2021-244950 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244950

Author(s):

Natsuhi Sasaki ◽

Hirotoshi Imamura ◽

Masashi Shigeyasu ◽

Nobuyuki Sakai

Keyword(s):

Artery Occlusion ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Collateral Flow ◽

Radical Treatment ◽

Parent Artery Occlusion ◽

Low Profile ◽

Critical Regions ◽

The Sacrifice ◽

Dissecting Aneurysms

The standard endovascular treatment for ruptured dissecting aneurysm is a parent artery occlusion. However, this treatment is unsuitable when the artery of the lesion gives off perforating vessels that supply blood to critical regions or when the collateral flow cannot be expected due to the sacrifice of the parent artery. Here, we present an infrequent case of ruptured dissecting aneurysm on P1 segment of the posterior cerebral artery. The aneurysm had little sac for coiling and the artery of the lesion had some perforator branches; thus, we selected the monotherapy with three overlapping low-profile visualised intraluminal support stents as radical treatment, which resulted in prompt obliteration of the aneurysm. The patient was fully recovered at 3 months after the procedure. Previous studies have reported the effectiveness of multiple stents alone for dissecting aneurysms, whereas this case showed that overlapping stents may also be effective on the P1 segment.

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Antegrade recanalization of parent artery in internal trapping of vertebral artery dissecting aneurysm: a case report

Surgical Neurology ◽

10.1016/j.surneu.2006.07.023 ◽

2007 ◽

Vol 68 (1) ◽

pp. 108-111 ◽

Cited By ~ 12

Author(s):

Seung Kug Baik ◽

Yong Sun Kim ◽

Hui Jung Lee ◽

Jaechan Park ◽

Duk Sik Kang

Keyword(s):

Case Report ◽

Vertebral Artery ◽

Dissecting Aneurysm ◽

Parent Artery ◽

Vertebral Artery Dissecting Aneurysm

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Combined microsurgical PICA-PICA bypass and endovascular parent artery occlusion for a ruptured dissecting vertebral artery aneurysm

Neurosurgical FOCUS ◽

10.3171/2015.v1.focus14526 ◽

2015 ◽

Vol 38 (videosuppl1) ◽

pp. Video3 ◽

Cited By ~ 6

Author(s):

Robert M. Starke ◽

Dale Ding ◽

Christopher R. Durst ◽

R. Webster Crowley ◽

Kenneth C. Liu

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

Distal Portion ◽

Artery Occlusion ◽

Parent Artery ◽

Treatment Technique ◽

Pica Pica ◽

Parent Artery Occlusion ◽

The Right

Dissecting vertebral artery (VA) aneurysms are difficult to obliterate when the parent artery cannot be safely occluded. In this video, we demonstrate a combined microsurgical and endovascular treatment technique for a ruptured, dissecting VA aneurysm incorporating the origin of the posterior inferior cerebellar artery (PICA). We first performed a PICA-PICA side-to-side bypass to preserve flow through the right PICA. An endovascular approach was then utilized to embolize the proximal portion of the aneurysm from the right VA and the distal portion of the aneurysm from the left VA.The video can be found here: http://youtu.be/dkkKsX2BiJI.

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Stent-assisted coil embolization of unruptured vertebral artery dissecting aneurysms with the low-profile visualized intraluminal support stent, with five techniques: Technical note and case report

Surgical Neurology International ◽

10.25259/sni-293-2019 ◽

2019 ◽

Vol 10 ◽

pp. 105

Author(s):

Ryosuke Maeoka ◽

Ichiro Nakagawa ◽

Koji Omoto ◽

Takeshi Wada ◽

Kimihiko Kichikawa ◽

...

Keyword(s):

Vertebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

Dissecting Aneurysm ◽

Parent Artery ◽

High Morbidity ◽

Low Profile ◽

Ischemic Complications ◽

Wall Apposition ◽

Vertebral Artery Dissecting Aneurysm

Background: Intracranial vertebral artery dissecting aneurysm (VADA) is rare and shows high morbidity and mortality rates when the aneurysm ruptures. Endovascular treatment for VADA is one of the optimal treatments, but the dominant side VA and its branches or perforators need to be preserved. We report a novel and successful stent-assisted coil embolization technique using the low-profile visualized intraluminal support (LVIS) stent, with five technical notes in three consecutive cases of unruptured vertebral artery dissecting aneurysm (VADA). Case Description: We report three consecutive cases of unruptured VADA which involved a posterior inferior cerebellar artery (PICA), an anterior spinal artery, and perforators. Stent-assisted coil embolization with the LVIS stent was performed in all patients. The stent was carefully placed to obtain parent artery wall apposition at distal portion and with moderate pushing at aneurysm portion. The LVIS stent was placed with tailor-made wall apposition at perforating arterial side in the barrel view, and coil embolization was performed avoiding doughnut-like stent form to prevent perforator infarcts. All cases showed complete occlusion of the aneurysms with preservation of both parent artery and its branches and perforators patency. In three cases, clinical presentations were improved without ischemic complications. The median follow-up period was 1 year. At present, no recurrence and no complication have been observed. Conclusion: We demonstrate the coil embolization of VADA using LVIS stent with five techniques. Our techniques for the treatment of VADA using LVIS stent are safe and can minimize ischemic complications by creating suitable wall apposition to the orifices of branches or perforators.

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