Transluminal angioplasty for atherosclerotic disease of the vertebral and basilar arteries

1993 ◽  
Vol 78 (2) ◽  
pp. 192-198 ◽  
Author(s):  
Randall T. Higashida ◽  
Fong Y. Tsai ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Tony Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Cerebral Circulation ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Atherosclerotic Stenosis ◽  
Basilar Arteries ◽  
Posterior Cerebral Circulation ◽  
Fine Print

✓ Transluminal angioplasty for hemodynamically significant stenosis (> 70%) involving the posterior cerebral circulation is now being performed by the authors in selected cases. A total of 42 lesions affecting the vertebral or basilar artery have been successfully treated by percutaneous transluminal angioplasty techniques in 41 patients. The lesions involved the proximal vertebral artery in 34 cases, the distal vertebral artery in five, and the basilar artery in three. Patients were examined clinically at 1 to 3 and 6 to 12 months after angioplasty. Three (7.1%) permanent complications occurred, consisting of stroke in two cases and vessel rupture in one. There were four (9.5%) transient complications (< 30 minutes): two cases of vessel spasm and two of cerebral ischemia. Clinical follow-up examination demonstrated improvement of symptoms in 39 cases (92.9%). Radiographic follow-up studies demonstrated three cases (7.1 %) of restenosis involving the proximal vertebral artery; two were treated by repeat angioplasty without complication, and the third is being followed clinically while the patient remains asymptomatic. In patients with significant atherosclerotic stenosis involving the vertebral or basilar artery territories, transluminal angioplasty may be of significant benefit in alleviating symptoms and improving blood flow to the posterior cerebral circulation.

A fatal, chronically growing basilar artery: a new type of dissecting aneurysm

1996 ◽  
Vol 84 (6) ◽  
pp. 962-971 ◽  
Author(s):  
Tohru Mizutani
Keyword(s):  
Mr Imaging ◽  
Basilar Artery ◽  
Dissecting Aneurysm ◽  
Neurological Deficits ◽  
Vertebrobasilar Insufficiency ◽  
Content Type ◽  
Asymptomatic Patients ◽  
Basilar Arteries ◽  
Fine Print

✓ A long-term follow-up study (minimum duration 2 years) was made of 13 patients with tortuous dilated basilar arteries. Of these, five patients had symptoms related to the presence of such arteries. Symptoms present at a very early stage included vertebrobasilar insufficiency in two patients, brainstem infarction in two patients, and left hemifacial spasm in one patient. Initial magnetic resonance (MR) imaging in serial slices of basilar arteries obtained from the five symptomatic patients showed an intimal flap or a subadventitial hematoma, both of which are characteristic of a dissecting aneurysm. In contrast, the basilar arteries in the eight asymptomatic patients did not show particular findings and they remained clinically and radiologically silent during the follow-up period. All of the lesions in the five symptomatic patients gradually grew to fantastic sizes, with progressive deterioration of the related clinical symptoms. Dilation of the basilar artery was consistent with hemorrhage into the “pseudolumen” within the laminated thrombus, which was confirmed by MR imaging studies. Of the five symptomatic patients studied, two died of fatal subarachnoid hemorrhage (SAH) and two of brainstem compression; the fifth patient remains alive without neurological deficits. In the three patients who underwent autopsy, a definite macroscopic double lumen was observed in both the proximal and distal ends of the aneurysms within the layer of the thickening intima. Microscopically, multiple mural dissections, fragmentation of internal elastic lamina (IEL), and degeneration of media were diffusely observed in the remarkably extended wall of the aneurysms. The substantial mechanism of pathogenesis and enlargement in the symptomatic, highly tortuous dilated artery might initially be macroscopic dissection within a thickening intima and subsequent repetitive hemorrhaging within a laminated thrombus in the pseudolumen combined with microscopic multiple mural dissections on the basis of a weakened IEL. The authors note and caution that symptomatic, tortuous dilated basilar arteries cannot be overlooked because they include a group of malignant arteries that may grow rapidly, resulting in a fatal course.

Percutaneous transluminal angioplasty in the treatment of atherosclerotic disease of the anterior cerebral circulation and hemodynamic evaluation

1995 ◽  
Vol 82 (6) ◽  
pp. 953-960 ◽  
Author(s):  
Hajime Touho
Keyword(s):  
Cerebral Circulation ◽  
Percutaneous Transluminal Angioplasty ◽  
Cerebral Perfusion ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Vasodilatory Response ◽  
Percutaneous Transluminal ◽  
Stenotic Lesions ◽  
Fine Print

✓ Nineteen patients between 56 and 76 years of age with clinically symptomatic atherosclerotic stenotic lesions at or distal to the C-5 segment in the carotid arterial system underwent percutaneous transluminal angioplasty (PTA). The 19 patients had a total of 19 stenotic lesions, including two lesions in the C-5 segment, three in the C-4 segment, and three in the C-2 segment of the carotid artery, six in the M1 segment and three in the M2 segment of the middle cerebral artery, and two in the A2 segment of the anterior cerebral artery. Both prior to and more than 6 months after PTA, angiograms were performed and cerebral perfusion was measured using 99mTc-hexamethyl-propyleneamine-oxime single-photon emission computerized tomography, before and after the administration of 10 mg/kg acetazolamide. Percutaneous transluminal angioplasty could be performed in 13 (68.4%) of the 19 patients. The mean degree of stenosis (± standard deviation) was 83.1% ± 8.6% before PTA, but only 35.8% ± 17.3% on the follow-up angiograms. Restenosis was detected in follow-up angiograms in five (38.5%) of the 13 patients. Seven of the 13 patients exhibited improvement in their neurological condition after PTA and had shown subnormal cerebral perfusion and subnormal vasodilatory response to administration of acetazolamide prior to undergoing PTA. On the other hand, the remaining six patients exhibited no improvement in neurological condition after PTA, and four of these patients (66.7%) had shown normal perfusion and five (83.3%) had shown normal vasodilatory response to administration of acetazolamide prior to undergoing PTA. These findings suggest that PTA may be indicated for patients with atherosclerotic stenotic lesions in the anterior cerebral circulation who have subnormal cerebral perfusion and low vasodilatory response to administration of acetazolamide.

Vertebral artery stenting following percutaneous transluminal angioplasty

1996 ◽  
Vol 84 (5) ◽  
pp. 883-887 ◽  
Author(s):  
Gayle S. Storey ◽  
Michael P. Marks ◽  
Michael Dake ◽  
Alexander M. Norbash ◽  
Gary K. Steinberg
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Transluminal Angioplasty ◽  
Posterior Circulation ◽  
Atherosclerotic Vascular Disease ◽  
Anterior Circulation ◽  
Content Type ◽  
Vertebral Arteries ◽  
Atherosclerotic Stenosis

✓ The authors report initial results and follow up using stent placement to treat atherosclerotic stenosis in vertebral arteries. Three patients with severe atherosclerotic vascular disease underwent vertebral artery stent placement using a balloon expandable stent. Medical therapy (aspirin and warfarin) and conventional percutaneous angioplasty failed to resolve the disease and the patients developed symptomatic restenosis within 3 months of angioplasty. Two patients had symptoms of anterior circulation ischemia with carotid artery occlusions and reduced supply to the anterior circulation from the stenosed vertebral arteries. One patient had recurrent posterior circulation symptoms. Stents were successfully placed in all three, resulting in immediate reversal of stenosis and resolution of symptoms. Clinical follow-up study (mean 9 months) has shown no recurrent symptoms in the patient with posterior circulation symptoms, but the two patients with anterior circulation ischemia did develop recurrent symptoms. Angiographic follow up in these two patients at 3 months and 1 year, however, demonstrated continued patency of vertebral artery lumina. They underwent extracranial—intracranial bypass surgery to relieve their symptoms. This experience suggests stents can be placed without complication in the proximal vertebral arteries and may have an adjunctive role in the treatment of atherosclerotic cerebrovascular disease following unsuccessful angioplasty.

Combined endovascular treatment of dissecting vertebral artery aneurysms by using stents and coils

2001 ◽  
Vol 94 (3) ◽  
pp. 427-432 ◽  
Author(s):  
Pedro Lylyk ◽  
José E. Cohen ◽  
Rosana Ceratto ◽  
Angel Ferrario ◽  
Carlos Miranda
Keyword(s):  
Vertebral Artery ◽  
Neurological Complication ◽  
Safe Alternative ◽  
Endovascular Stents ◽  
Content Type ◽  
Aneurysm Occlusion ◽  
Intravascular Stent ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. With the recent development and refinement of endovascular stents, the significant potential for these devices in the treatment of wide-necked dissecting and fusiform aneurysms has become apparent. In this article the authors report on the use of stents and coils to treat dissecting and fusiform vertebral artery (VA) aneurysms. Methods. Eight consecutive patients harboring eight dissecting aneurysms and one fusiform aneurysm of the VA were succesfully treated using a procedure in which the authors inserted an intravascular stent and secondary endosaccular coils when needed. In all but one patient complete aneurysm occlusion was achieved, and in all cases there was no neurological complication. Follow-up angiography examinations were performed in all patients (mean duration of follow-up angiography review 13.1 months, range 3–42 months). The patients remained stable throughout the clinical follow-up period (mean 14.1 months, range 4–42 months). No rebleeding was recorded. Conclusions. At present this combined approach represents a reliable and safe alternative for the treatment of VA dissecting aneurysms, especially in patients who cannot tolerate occlusion tests.

Antegrade recanalization of a completely embolized vertebral artery after endovascular treatment of a ruptured intracranial dissecting aneurysm

2005 ◽  
Vol 102 (1) ◽  
pp. 161-166 ◽  
Author(s):  
Motoshi Sawada ◽  
Yasuhiko Kaku ◽  
Shinichi Yoshimura ◽  
Masahiro Kawaguchi ◽  
Takashi Matsuhisa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Cerebral Aneurysms ◽  
Systemic Circulation ◽  
Parent Artery ◽  
Content Type ◽  
Endovascular Occlusion ◽  
Aneurysmal Dilation ◽  
Dissecting Aneurysms ◽  
Fine Print

✓ Occlusion of the parent artery is a traditional method of treatment of unclippable cerebral aneurysms. Surgical or endovascular occlusion of the parent artery proximal to the aneurysm has been recommended for the treatment of dissecting aneurysms located in the vertebrobasilar circulation. Nevertheless, occlusion of the parent artery may not result in permanent exclusion of the aneurysm from the systemic circulation because, occasionally, postoperative rebleeding occurs after proximal occlusion. Alternatively, endovascular occlusion of the affected site, including the aneurysmal dilation, and parent artery, is a safe and reliable treatment for dissecting aneurysms. The authors present two rare cases of ruptured vertebral artery (VA) dissecting aneurysms that were treated by endovascular occlusion of the affected site including the aneurysm and parent artery by using Guglielmi detachable coils. In both cases the VA recanalized in an antegrade fashion during the follow-up period. Based on these unique cases, the authors suggest that a careful angiographic follow up of dissecting aneurysms is required, even in patients successfully treated with endovascular occlusion of the affected artery and aneurysm.

Enlargement of basilar artery aneurysms following balloon occlusion — “water-hammer effect”

1991 ◽  
Vol 75 (6) ◽  
pp. 963-968 ◽  
Author(s):  
Eddie S. K. Kwan ◽  
Carl B. Heilman ◽  
William A. Shucart ◽  
Richard P. Klucznik
Keyword(s):  
Basilar Artery ◽  
Water Hammer ◽  
Balloon Occlusion ◽  
Successful Therapy ◽  
Content Type ◽  
Aneurysm Neck ◽  
Water Hammer Effect ◽  
Fine Print

✓ Two patients with distal basilar aneurysms were treated with intra-aneurysmal balloon occlusion. After apparently successful therapy, follow-up angiograms demonstrated aneurysm enlargement with balloon migration distally in the sac. Geometric mismatch between the base of the balloons and the aneurysm neck together with transmitted pulsation through the 2-hydroxyl-ethylmethacrylate (HEMA)-filled balloon directly contributed to aneurysm enlargement. In this report, the authors discuss the problems of progressive aneurysm enlargement due to a “water-hammer effect” and the possibility of hemorrhage following subtotal occlusion.

Microvascular anatomy of foramen caecum medullae oblongatae

1991 ◽  
Vol 75 (2) ◽  
pp. 299-304 ◽  
Author(s):  
Asim Mahmood ◽  
Manuel Dujovny ◽  
Maximo Torche ◽  
Ljubisa Dragovic ◽  
James I. Ausman
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Foramen Magnum ◽  
Left Vertebral Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Outer Diameter ◽  
Vertebrobasilar Insufficiency ◽  
High Concentration ◽  
Content Type ◽  
Fine Print

✓ The foramen caecum (FC) is a triangular-shaped fossa situated in the midline on the base of the brain stem, at the pontomedullary junction. Although this area is known to have a very high concentration of brainstem perforating vessels, its microvascular anatomy has not been studied in detail. The purpose of this study was to detail the microvasculature of this territory. Twenty unfixed brains were injected with silicone rubber solution and dissected under a microscope equipped with a camera. The origin, course, outer diameter, and branching pattern of the perforators were examined. The total number of perforators found in the 20 brains was 287, with an average (± standard deviation) of 14.35 ± 1.24 perforators per brain (range seven to 28). Their origin was as follows: right vertebral artery in 52 perforators (18.11%); left vertebral artery in 35 (12.19%); basilar artery below the anterior inferior cerebellar artery (AICA) in 139 (48.43%); basilar artery above the AICA in 46 (16.02%); AICA in 10 (3.48%); and anterior spinal artery in five (1.74%). Most of the perforators arose as sub-branches of larger trunks; their average outer diameter was 0.16 ± 0.006 mm while that of trunks was 0.35 ± 0.02 mm. These anatomical data are important for those wishing 1) to study the pathophysiology of vascular insults to this area caused by atheromas, thrombi, and emboli; 2) to plan vertebrobasilar aneurysm surgery; 3) to plan surgery for vertebrobasilar insufficiency; and 4) to study foramen magnum neoplasms.

Ligation of the vertebral (unilateral or bilateral) or basilar artery in the treatment of large intracranial aneurysms

1975 ◽  
Vol 43 (3) ◽  
pp. 255-274 ◽  
Author(s):  
Charles G. Drake
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Collateral Flow ◽  
Patient Death ◽  
Artery Ligation ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
Complete Thrombosis ◽  
Fine Print

✓ The author reports the use of vertebral artery ligation, unilateral and bilateral, for the treatment of large vertebral-basilar aneurysms in 14 patients with one delayed death. Extracranial ligation was carried out unilaterally with a Selverstone clamp in three patients. In two, where the aneurysm filled only from one vertebral artery, there was extensive thrombosis within the sac and dramatic clinical improvement after decompression. Extracranial ligation was done bilaterally in three patients, temporarily in two. A 14-year-old boy is well after 5 years but the bilateral vertebrobasilar aneurysm did not undergo extensive thrombosis until both vertebral arteries were occluded at their intracranial entrance above collateral flow. In two others, the clamp had to be reopened on the second artery. In one patient, death from delayed thrombosis of a huge aneurysm and pontine infarction might have been prevented with anticoagulants. In the other, the aneurysm ruptured again fatally 18 months later. Unilateral intracranial occlusion of a vertebral artery was done in eight cases, with no morbidity and complete or nearly complete thrombosis in all but one aneurysm. Seven patients had excellent or good results while one showed little recovery from an existing medullary syndrome. Occlusion of the basilar artery was done in seven cases. In five it was used deliberately as the only treatment, but in two it was forced when an aneurysm burst during dissection. Only two of the patients in the first group and one of the second group have made complete recoveries. The results of vertebral artery occlusion are encouraging and the technique deserves further consideration. Extensive collateral circulation enhances the safety of cervical vertebral artery occlusion but can be of a degree to make the occlusion ineffective. For intracranial occlusion knowledge of the size and distribution of each vertebral artery is essential. Occlusion of the basilar artery is dangerous, although it seems to be effective in producing extensive thrombosis in the aneurysm. It should probably be done under anesthesia only when the artery fills spontaneously from the carotid circulation. Otherwise, even when reasonable posterior communicating arteries are demonstrated, it is best to test occlusion under local anesthesia.

Successful surgical treatment of giant aneurysm of the basilar artery

1978 ◽  
Vol 49 (1) ◽  
pp. 124-128 ◽  
Author(s):  
Chhabi Bhushan ◽  
Fred J. Hodges ◽  
John Posey
Keyword(s):  
Surgical Treatment ◽  
Vertebral Artery ◽  
Basilar Artery ◽  
Giant Aneurysm ◽  
Artery Ligation ◽  
Content Type ◽  
Fine Print

✓ The authors describe a case of giant aneurysm of the basilar artery successfully treated by bilateral vertebral artery ligation at the sulcus arteriosus of the atlas.

Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience

1999 ◽  
Vol 90 (5) ◽  
pp. 843-852 ◽  
Author(s):  
Gerhard Bavinzski ◽  
Monika Killer ◽  
Andreas Gruber ◽  
Andrea Reinprecht ◽  
Cordell E. Gross ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Thrombotic Complication ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Poor Grade ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Fine Print

Object. The authors retrospectively analyzed the results of their 6-year experience in the treatment of basilar artery (BA) bifurcation aneurysms by using Guglielmi detachable coils (GDCs).Methods. This analysis involved 45 BA tip aneurysms in 16 men and 29 women who ranged in age from 23 to 78 years (mean 50 years). Seventy-five percent of the aneurysms had ruptured and 25% remained unruptured. Of the group whose aneurysms hemorrhaged, 14 patients were Hunt and Hess Grade I or II and 20 were Hunt and Hess Grades III to V; 32 patients were treated within 2 weeks of their subarachnoid hemorrhage (SAH). Initially, treatment with GDCs was limited to poor-grade high-risk patients who refused surgery or patients in whom surgery proved unsuccessful. Later in the study, good-grade patients with narrow-necked aneurysms were also treated using GDCs.The length of clinical follow up ranged from 1 to 72 months (average 27.4 months) in the 37 surviving patients. In 33 of the 45 aneurysms treated with coil placement, good to excellent results were achieved. There were 12 poor results (27%) including one in a patient from the non-SAH group who suffered a thrombotic complication due to an underlying vasculitis. Eight deaths were recorded in this group of 45 patients. One of these deaths was caused by a complication related to anesthesia, one by unknown causes, and six resulted from complications of the disease. One patient rebled on the 2nd day after the endovascular procedure. The mortality and permanent morbidity rates directly related to the intervention were 2.2% and 4.4%, respectively.Angiographic studies obtained immediately postintervention demonstrated 99 to 100% occlusion in 30 (67%) of the aneurysms; nine (20%) were more than 90% occluded; and six (13%) were less than 90% occluded by the GDCs. Follow-up angiograms were obtained in 31 patients between 2 and 72 months after coil placement. Nineteen (61%) of the follow-up angiograms revealed stable results (that is, no change from initial treatment). Twelve of the 31 showed coil compaction, but only eight of these lesions could accept additional coils.In large aneurysms recanalization was seen in 57%, and some of the larger lesions required as many as four embolizations (mean 1.7) to achieve optimal occlusion. When small-necked aneurysms were analyzed as a subset, a stable angiographic result was seen in 92%.Conclusions. Use of GDCs led to excellent clinical and angiographic results in the majority of patients with BA tip aneurysms included in this limited follow-up study. Rebleeding was encountered in one of the 34 previously ruptured BA aneurysms treated with GDCs, and no hemorrhages have been documented in the 11 unruptured aneurysms treated with GDCs in this series. Long-term follow-up studies are necessary before it is possible to compare adequately the treatment of aneurysms with coil placement to the gold standard of aneurysm clipping.

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