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

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video3 ◽  
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.

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

2006 ◽  
Vol 105 (5) ◽  
pp. 781-784 ◽  
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.

scholarly journals Treatment of Unruptured Vertebral Artery Aneurysm Involving Posterior Inferior Cerebellar Artery With Pipeline Embolization Device

2021 ◽  
Vol 12 ◽  
Author(s):  
Weiqi Fu ◽  
Huijian Ge ◽  
Gang Luo ◽  
Xiangyu Meng ◽  
Jiejun Wang ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Pipeline Embolization Device ◽  
Complete Occlusion ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery

Background: Treatment of unruptured vertebral artery aneurysm involving posterior inferior cerebellar artery (PICA) is challenging. The experience of pipeline embolization device (PED) therapy for these lesions is still limited.Objective: To evaluate the safety and efficacy of the PED for unruptured vertebral artery aneurysm involving PICA.Methods: Thirty-two patients with unruptured vertebral artery aneurysm involving PICA underwent treatment with PED were retrospectively identified. Procedure-related complications, PICA patency, clinical, and angiographic outcomes were analyzed.Results: Thirty-two aneurysms were successfully treated without any procedure-related complications. Images were available in 30 patients (93.8%) during a period of 3–26 months follow-up (average 8.4 months), which confirmed complete occlusion in 17 patients (56.5%), near-complete occlusion in 9 patients (30%), and incomplete occlusion in one patient (3.3%). Parent artery occlusion (PAO) was occurred in 3 patients (10%). Twenty-eight of 30 PICA remained patent. The two occlusions of PICA were secondary to PAO. At a mean of 20.7 months (range 7–50 months) clinical follow-up, all the patients achieved a favorable outcome without any new neurological deficit.Conclusion: PED seems to be a safe and effective alternative endovascular option for patients with unruptured vertebral artery aneurysm involving PICA.

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.

scholarly journals Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery

2020 ◽  
Vol 15 (2) ◽  
pp. 84-88
Author(s):  
Toshitsugu Terakado ◽  
Yasunobu Nakai ◽  
Go Ikeda ◽  
Kazuaki Tsukada ◽  
Sho Hanai ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Careful Attention ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Vertebral Artery Stenting

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.

scholarly journals Trapping and Thrombectomy of Giant Thrombosed Vertebral Artery Aneurysm via Bilateral Subocciptal Approach – Technical Note

2020 ◽  
Vol 2 (2) ◽  
pp. 66-70
Author(s):  
Pritam Gurung ◽  
Yoshihiro Kuga ◽  
Yuji Kodama ◽  
Katsushi Taomoto ◽  
Hideyuki Ohnishi
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Distal Portion ◽  
Technical Note ◽  
Neurological Deficits ◽  
Occipital Artery ◽  
Parent Artery ◽  
The Right ◽  
Suboccipital Approach

Background: Giant aneurysms arising from the vertebral artery (VA) are rare; they represent 4% to 6% of all intracranial giant aneurysm. The natural history of thrombosed aneurysms is extremely poor. Most such lesions progressively enlarge and result in irreversible progression of neurological deficits and fatal sequelae through resultant compression of the brainstem. We present the clinical experience of giant thrombosed vertebral artery aneurysm successfully treated via a bilateral suboccipital approach. A 62 –year-old woman presented with slight dysarthria and ataxia for one year. Neurological examination showed right lateral gaze nystagmus, bilateral absent corneal reflex, absent gag reflex, bilateral dysdiadochokinesia, poor right finger nose test, and slightly poor tandem gait. MRI showed a 27 mm giant thrombosed left VA aneurysm with brain stem compression. We performed trapping of the aneurysm and thrombectomy through a bilateral suboccipital approach. First, the distal portion was clipped from the left side. Next, the proximal portion was approached from the right side. Thrombectomy was performed and after shrinkage of the aneurysm, the clips were applied involving some part of the aneurysm just distal to PICA. Conclusion: The optimum treatment for aneurysm of this type is thought to be complete obliteration of the parent artery with trapping and thrombectomy to decompress the brainstem. Sometimes if PICA could not be preserved Occipital artery (OA)-PICA bypass should be considered.

scholarly journals A Case of Vertebral Artery Aneurysm Causing Hemifacial Spasm Rapidly Improved after Parent Artery Occlusion

2019 ◽  
Vol 13 (7) ◽  
pp. 288-292 ◽  
Author(s):  
Miyahito Kugai ◽  
Takehiro Suyama ◽  
Toshihiko Inui ◽  
Keisho Yamazato ◽  
Masahiko Kitano ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion

scholarly journals Re-growth of a Thrombosed Vertebral Artery Aneurysm after Endovascular Parent Artery Occlusion : A Case Report

1998 ◽  
Vol 7 (11) ◽  
pp. 711-715 ◽  
Author(s):  
Masahiro Kawanishi ◽  
kunio Yamamura ◽  
Hiroshi Kajikawa ◽  
Eiichi Nomura ◽  
Akira Sugie ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Parent Artery Occlusion

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

scholarly journals Endovascular Treatment of Giant P1/P2 Aneurysm by Direct Puncture of the Vertebral Artery

2003 ◽  
Vol 9 (4) ◽  
pp. 359-365 ◽  
Author(s):  
M. Szajner ◽  
K. Obsza_Ska ◽  
A. Nestorowicz ◽  
M. Szczerbo-Trojanowska ◽  
T. Trojanowski
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Endovascular Embolization ◽  
Seldinger Technique ◽  
Parent Artery ◽  
Direct Puncture ◽  
Femoral Approach ◽  
Parent Artery Occlusion ◽  
Transbrachial Approach ◽  
The Right

Vascular access is usually achieved through a femoral arterial puncture using a modified Seldinger technique. However, selective catheterization of the great cerebral vessels by femoral approach fails completely when the vessel is tortuous or atheromatous. In case of posterior vascular circulation aneurysms, transbrachial approach or direct puncture of the vertebral artery (VA) is an alternative. The aneurysms of the posterior cerebral artery (PCA) are reported to be rare. Due to unfavorable anatomic location, the PCA aneurysms are difficult to reach during surgical procedure. Endovascular embolization is at present considered to be more effective and safer treatment of the PCA aneurysms arising from different segments, offering a viable alternative to the surgical approach. We report the case of the giant left PCA aneurysm, located at the junction of P1/P2 segments, successfully treated by parent artery occlusion achieved after the direct puncture of the right VA which was used because both VAs were tortuous, irregular and their ostia were not accessible by femoral approach. According to different authors, parent artery occlusion appears to be safe in the treatment of P2 segment aneurysms, whatever the location of the occlusion. In our case we decided to perform this kind of treatment believing it was the only possible one.

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