Endovascular obliteration of an intracranial pseudoaneurysm: the utility of Onyx

2009 ◽  
Vol 4 (5) ◽  
pp. 445-448 ◽  
Author(s):  
Ricky Medel ◽  
R. Webster Crowley ◽  
D. Kojo Hamilton ◽  
Aaron S. Dumont
Keyword(s):  
Pediatric Patient ◽  
Coil Embolization ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Potential Treatment ◽  
Parent Artery Occlusion ◽  
Endovascular Methods ◽  
Iatrogenic Pseudoaneurysm

Pseudoaneurysms are rare lesions with a multitude of causes, including infectious, traumatic, and iatrogenic origins. In addition, there are a number of potential treatment options, all of which require consideration to determine the most appropriate management. Historically, surgical intervention has been the method of choice, but because the histopathological features of these lesions make them largely unsuitable for clipping, trapping or excision is often required. More recently endovascular methods have been used, including coil embolization, stent reconstruction, or parent artery occlusion. Although these methods are often successful, situations arise in which they are not technically feasible. The authors describe such a case in a pediatric patient with an iatrogenic pseudoaneurysm. Onyx was used to embolize the lesion and the results were excellent.

scholarly journals Blister Aneurysm of Middle Cerebral Artery Division: Stent-Assisted Coiling Using Shelfing Technique

2019 ◽  
Vol 03 (02) ◽  
pp. 126-129
Author(s):  
Shrikant Londhe ◽  
Vipul Gupta ◽  
Rajsrnivias Parthasarathy ◽  
Hilal Ahmad Ganie ◽  
Nishchint Jain
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Options ◽  
Side Wall ◽  
Flow Diverter ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Surgical Options ◽  
Endovascular Methods

AbstractBlister aneurysms pose significant diagnostic and therapeutic challenge to neurointerventionists as well as neurosurgeons. Fragile nature of these aneurysms with involvement of the adjacent parent artery makes surgical options more difficult and complicated. Various endovascular treatment options such as overlapping stent, parent artery occlusion, and flow diverter placement are available in the present era. Though side wall aneurysms can be managed with flow diverter placement, bifurcation aneurysms are difficult to treat with these devices due to possibility of compromised flow in covered branch arteries. Blister aneurysms of the middle cerebral artery (MCA) are rare, and their treatment can be challenging when they are treated by endovascular methods with either overlapping stent or flow diverter placement. The authors report a case of ruptured MCA trifurcation blister aneurysm treated with shelfing technique using braided stent monotherapy along with coil embolization. The patient had good clinical outcome (modified Rankin’s scale 1 [mRS-1]) at discharge and complete aneurysm occlusion on follow-up angiogram after 6 months.

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 Intracranial Artery Dissection: Clinical and Angiographic Follow-Up

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Reza Mohammadian ◽  
Ali Akbar Taheraghdam ◽  
Ehsan Sharifipour ◽  
Reza Mansourizadeh ◽  
Ali Pashapour ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Treatment Options ◽  
Artery Dissection ◽  
Parent Artery ◽  
Intracranial Artery ◽  
Anterior Circulation ◽  
Stent Occlusion ◽  
Parent Artery Occlusion ◽  
Endovascular Approach

Background. Intracranial artery dissections are rare and many controversies exist about treatment options. The aim of this study was to evaluate the efficacy and safety of the endovascular approach in patients with an intracranial dissection presenting with different symptoms.Methods. We prospectively evaluated the clinical features and treatment outcomes of 30 patients who had angiographically confirmed nontraumatic intracranial dissections over 4 years. Patients were followed up for 17 months, and their final outcomes were assessed by the modified Rankin Score (mRS) and angiography.Results. Sixteen (53.3%) patients had a dissection of the anterior circulation, whereas 14 (46.7%) had a posterior circulation dissection. Overall, 83.3% of the patients suffered a subarachnoid hemorrhage (SAH). Grade IV Hunt and Hess score was seen in 32% of the SAH presenting cases. Parent artery occlusion (PAO) with coil embolization was used in 70% of the cases. The prevalence of overall procedural complications was 23.3%, and all were completely resolved at the end of follow-up. No evidence of in-stent occlusion/stenosis or rebleeding was observed in our cases during follow-up. Angiography results improved more frequently in the PAO with coil embolization group (100%) than in the stent-only-treated group (88.9%) (P=0.310) and the unruptured dissection group (5/5, 100%) in comparison with the group that presented with SAH (95.8%) (P=0.833).Conclusion. Favorable outcomes were achieved following an endovascular approach for symptomatic ruptured or unruptured dissecting aneurysms. However, the long-term efficacy and durability of these procedures remain to be determined in a larger series.

scholarly journals Hemifacial spasm caused by vertebral artery aneurysm treated by endovascular coil embolization

2020 ◽  
Vol 11 ◽  
pp. 431
Author(s):  
Yu Iida ◽  
Kentaro Mori ◽  
Yosuke Kawahara ◽  
Issei Fukui ◽  
Katsuya Abe ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
Parent Artery Occlusion ◽  
Endovascular Coil Embolization

Background: Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. Case Description: A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. Conclusion: Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

Endovascular treatment of mycotic pseudoaneurysms

VASA ◽  
2010 ◽  
Vol 39 (3) ◽  
pp. 256-261 ◽  
Author(s):  
Vávrova ◽  
Jonszta ◽  
Czerný ◽  
Hrbac ◽  
Lipina ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Pediatric Patients ◽  
Artery Occlusion ◽  
Morbidity And Mortality ◽  
Parent Artery ◽  
High Morbidity ◽  
Prolonged Administration ◽  
Parent Artery Occlusion ◽  
Lower Morbidity

The surgical correction of ruptured intracranial infectious pseudoaneurysms is associated with high morbidity and mortality. An endovascular therapeutic approach has been introduced recently. This treatment is, compared to surgical intervention, less invasive, faster, more effective and safer, thus making it a gentler option, particularly for pediatric patients. Lower morbidity and mortality have been achieved thanks to the combination of prolonged administration of antibiotics, coil embolization, and parent artery occlusion. Two pediatric cases of bleeding mycotic pseudoaneurysm treated successfully with fibered coil embolization and long-term antibiotics are dealt with in this manuscript.

Hemifacial Spasm Due to Contralateral Aneurysmal Compression of the Facial Nerve Successfully Treated With Endovascular Coil Embolization: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. E768-E772 ◽  
Author(s):  
Ichiro Nakagawa ◽  
Katsutoshi Takayama ◽  
Shinichiro Kurokawa ◽  
Takeshi Wada ◽  
Hiroyuki Nakagawa ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Coil Embolization ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Root Exit Zone ◽  
Parent Artery Occlusion ◽  
Facial Spasm ◽  
Endovascular Coil Embolization

Abstract BACKGROUND AND IMPORTANCE: Hemifacial spasm is usually caused by compression of the facial nerve at the root exit zone (REZ), whereas fusiform aneurysmal compression is extremely rare. The authors describe symptomatic hemifacial spasm caused by a contralateral fusiform aneurysm of the vertebral artery (VA) that was treated by endovascular coil embolization. CLINICAL PRESENTATION: A 55-year-old woman developed left hemifacial spasm that had gradually worsened over a period of 2 years before admission to our hospital. Cerebral angiography showed an elongated right VA fusiform aneurysm near the VA union that inclined toward the left side. The cause of the facial spasm was considered to be compression of the left facial nerve REZ by the aneurysm. Endovascular parent artery embolization including the aneurysm was performed. The hemifacial spasm disappeared within 3 months. CONCLUSION: Hemifacial spasm caused by contralateral VA fusiform aneurysm can be treated by intravascular parent artery occlusion with coil embolization.

“Clip Anchor-Assisted Coil Embolization” for Endovascular Parent Artery Occlusion of Intracranial Traumatic Aneurysm

2019 ◽  
Vol 28 (11) ◽  
pp. 104374
Author(s):  
Hitoshi Fukuda ◽  
Toshio Yanagawa ◽  
Fumihiko Horikawa ◽  
Norio Nakajima ◽  
Masashi Kitagawa ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Traumatic Aneurysm ◽  
Parent Artery Occlusion

Treatment of Hemorrhagic Intracranial Dissections

Neurosurgery ◽  
2003 ◽  
Vol 53 (2) ◽  
pp. 289-301 ◽  
Author(s):  
René Anxionnat ◽  
João Ferreira de Melo Neto ◽  
Serge Bracard ◽  
Jean Christophe Lacour ◽  
Catherine Pinelli ◽  
...  
Keyword(s):  
Treatment Options ◽  
Clinical Status ◽  
Current Method ◽  
Artery Occlusion ◽  
Balloon Occlusion ◽  
Acute Stage ◽  
Parent Artery ◽  
Parent Vessel ◽  
Parent Artery Occlusion ◽  
Ischemic Complications

Abstract OBJECTIVE To analyze the treatment options in hemorrhagic intracranial dissections. METHODS This study involved a retrospective review of 27 patients with 29 dissections treated during a 16-year period, mainly by endovascular treatment (EVT). RESULTS EVT was performed in the acute stage in 12 of the 29 dissections, and occlusion was performed using coils at the dissection site in six dissections and with proximal balloon occlusion in six dissections. Wrapping was performed in one case. In the remaining 16 dissections, which were not treated, mainly for anatomic reasons, three patients died, one from rebleeding. Angiographic follow-up performed in the 13 surviving patients demonstrated an initially misdiagnosed lesion in one and worsening lesions in five that led to delayed EVT in five and surgical clipping in one. One of these dissections, which was located on a dominant vertebral artery, was treated after subsequent rupture using a stent and coils to preserve the patency of the parent vessel. Four ischemic complications related to EVT resulted in a moderate disability in two patients. No rebleeding occurred after EVT, but one patient died because of a poor initial clinical status; the other patients improved. In the 10 patients treated conservatively, four died, three from a poor initial clinical status and one from rebleeding, and six patients had a good clinical outcome. Of the 27 patients, three had rebleeding and one died as a result of that rebleeding. Seventeen patients (63%) had a good recovery, six (22%) had a moderate disability, and four (15%) died. CONCLUSION EVT provides effective protection against rebleeding. When possible, occlusion with coils at the dissection site is the current method of choice. Another option is parent artery occlusion with balloons, and the use of a stent may preserve vessel permeability in specific cases.

scholarly journals Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization

2014 ◽  
Vol 5 (5) ◽  
pp. 143 ◽  
Author(s):  
Ichiro Nakagawa ◽  
Yasuo Hironaka ◽  
Kimihiko Kichikawa ◽  
Hun-Soo Park ◽  
Takeshi Wada ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion
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