Treatment of Ruptured Posterior Inferior Cerebellar Artery (PICA)-Involved Vertebral Artery Dissecting Aneurysms and an Association Between the Vascular Territory of the PICA and the Changes in Aneurysmal Morphology after Endovascular Proximal Occlusion

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

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Treatment of Dissecting Vertebral Aneurysm

Interventional Neuroradiology ◽

10.1177/15910199010070s123 ◽

2001 ◽

Vol 7 (1_suppl) ◽

pp. 155-160 ◽

Cited By ~ 1

Author(s):

Y. Kai ◽

J. Hamada ◽

M. Morioka ◽

T. Todaka ◽

T. Mizuno ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Posterior Inferior Cerebellar Artery ◽

Dissecting Aneurysm ◽

The Other ◽

Cerebellar Artery ◽

Retrograde Filling ◽

Angiographic Evidence ◽

Vertebral Aneurysm ◽

Proximal Occlusion ◽

Dissecting Aneurysms

We report 17 patients with dissecting aneurysm of the vertebral artery (VA) who were treated by direct surgery (n=8) or interventional surgery (n=9). Eight patients presented with subarachnoid hemorrhage (SAH) and nine with ischemia. Ten patients were treated by trapping of the aneurysm that was occlusion of the VA on both sides of aneurysm (direct surgery, n=2; interventional surgery, n=8). The other seven patients were treated by ligation of the VA proximal to the aneurysm (direct surgery, n=6; interventional surgery, n=1). Two patients underwent transposition of the posterior inferior cerebellar artery (PICA). In 15 patients, there were no major complications. Two patients who had been treated by proximal occlusion of the VA developed rebleeding and ischemia due to persistent retrograde filling of the dissecting site. We suggest that angiographic evidence of retrograde filling of the dissecting site should have been considered as an indication for trapping. Trapping of VA dissecting aneurysms is easier and safer by interventional surgery than by direct surgery.

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Long-term outcomes of trapping vertebral artery-posterior inferior cerebellar artery dissecting aneurysms after revascularization

Neurology India ◽

10.4103/0028-3886.128247 ◽

2014 ◽

Vol 62 (1) ◽

pp. 15 ◽

Cited By ~ 4

Author(s):

Zhiwei Tang ◽

Chongqian Wang ◽

Jinkun Wang ◽

Bo Wang ◽

Xiang-En Shi

Keyword(s):

Vertebral Artery ◽

Posterior Inferior Cerebellar Artery ◽

Long Term Outcomes ◽

Cerebellar Artery ◽

Dissecting Aneurysms

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Successful Treatment of Ruptured Dissecting Vertebral Artery Aneurysms through Proximal Occlusion of the Vertebral Artery along with Reconstruction of the Posterior Inferior Cerebellar Artery: Two Case Reports

Surgery for Cerebral Stroke ◽

10.2335/scs.49.401 ◽

2021 ◽

Vol 49 (5) ◽

pp. 401-407

Author(s):

Michio NAKAMURA ◽

Tadashi MIYAZAKI ◽

Yoshihiko FUSE ◽

Akihiko ADACHI ◽

Tomoko YONEYAMA-SARNECKY ◽

...

Keyword(s):

Vertebral Artery ◽

Successful Treatment ◽

Case Reports ◽

Posterior Inferior Cerebellar Artery ◽

Cerebellar Artery ◽

Proximal Occlusion

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Application of covered stent grafts for intracranial vertebral artery dissecting aneurysms

Journal of Neurosurgery ◽

10.3171/2008.3.17470 ◽

2009 ◽

Vol 110 (3) ◽

pp. 418-426 ◽

Cited By ~ 18

Author(s):

Min He ◽

Heng Zhang ◽

Ding Lei ◽

Bo-Yong Mao ◽

Chao You ◽

...

Keyword(s):

Vertebral Artery ◽

Stent Graft ◽

Posterior Inferior Cerebellar Artery ◽

Covered Stent ◽

Stent Grafts ◽

Graft Placement ◽

Cerebellar Artery ◽

Covered Stent Graft ◽

Dissecting Aneurysms

Object Utilization of covered stent grafts in treating neurovascular disorders has been reported, but their efficacy and safety in vertebral artery (VA) dissecting aneurysms needs further investigation. Methods Six cases are presented involving VA dissecting aneurysms that were treated by positioning a covered stent graft. Two aneurysms were located distal to the posterior inferior cerebellar artery, and 4 were located proximal to the posterior inferior cerebellar artery. Aspirin as well as ticlopidine or clopidogrel were administered after the procedure to prevent stent-related thrombosis. All patients were followed up both angiographically and clinically. Results Five of the 6 patients underwent successful placement of a covered stent graft. The covered stent could not reach the level of the aneurysm in 1 patient with serious vasospasm who died secondary to severe subarachnoid hemorrhage that occurred 3 days later. Patient follow-up ranged from 6 to 14 months (mean 10.4 months), and demonstrated complete stabilization of the obliterated aneurysms, and no obvious intimal hyperplasia. No procedure-related complications such as stenosis or embolization occurred in the 5 patients with successful stent graft placement. Conclusions Although long-term follow-up studies using a greater number of patients is required for further validation of this technique, this preliminary assessment shows that covered stent graft placement is an efficient, safe, and microinvasive technique, and is a promising tool in treating intracranial VA dissecting aneurysms.

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