Deliberate basilar or vertebral artery occlusion in the treatment of intracranial aneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 161-173 ◽  
Author(s):  
Gary K. Steinberg ◽  
Charles G. Drake ◽  
Sydney J. Peerless
Keyword(s):  
Clinical Outcome ◽  
Vertebral Artery ◽  
Brain Stem ◽  
Intracranial Aneurysms ◽  
Artery Occlusion ◽  
Neurological Deterioration ◽  
Content Type ◽  
Vertebrobasilar Junction ◽  
Aneurysm Thrombosis ◽  
Fine Print

✓ Deliberate occlusion of the basilar or vertebral arteries was performed in 201 patients with intracranial aneurysms, where the aneurysmal neck could not be clipped directly. The aneurysms arose from the basilar apex in 83 cases, the basilar trunk in 46, the vertebrobasilar junction in 35, and the vertebral artery in 37; 87% of the aneurysms were classified as giant lesions (> 2.5 cm). There were 85 upper basilar occlusions, 41 lower basilar occlusions, 29 bilateral vertebral occlusions, and 48 unilateral vertebral artery occlusions. The clinical follow-up period varied from 1 to 23 years, with a mean of 9.5 years. Overall long-term results were excellent in 68% of the patients, good in 5%, and poor in 3%; 24% died. Clinical outcome varied according to aneurysm site; excellent or good results were achieved in 64% of the patients with basilar apex, 76% with basilar trunk, 74% with vertebrobasilar junction, and 87% with vertebral artery aneurysms. Clinical outcome also varied depending on preoperative grade: 86% of the patients with an excellent presenting grade achieved excellent results. The size of the posterior communicating arteries was a good predictor of tolerance to basilar artery occlusion (p < 0.05). Successful aneurysm thrombosis was achieved in 78% of the patients. The neurological status in 26 patients (13%) deteriorated due to vertebrobasilar ischemia occurring within the 1st postoperative week, and thrombosis or embolism was implicated much more frequently than hemodynamic insufficiency. Subarachnoid hemorrhage (SAH) in 14 patients, vasospasm in five patients, and surgical trauma in seven patients accounted for additional morbidity in the 1st month following operation; however, many of these patients ultimately made an excellent recovery. Late vertebrobasilar ischemic complications or neurological deterioration from persistent mass effect occurred in 4% of patients with successful aneurysm thrombosis 6 weeks to 18 months after arterial ligation. Among the 43 patients with incompletely thrombosed aneurysms, 67% developed early or late neurological deterioration from SAH, progressive brain-stem compression, or brain-stem stroke, with 86% of the complications proving fatal.

Vertebrobasilar insufficiency secondary to vertebral artery occlusion from a fibrous band

1982 ◽  
Vol 56 (4) ◽  
pp. 581-583 ◽  
Author(s):  
Timothy Mapstone ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Vertebrobasilar Insufficiency ◽  
Fibrous Band ◽  
Content Type ◽  
Vertebral Artery Occlusion ◽  
The Right ◽  
Band Crossing ◽  
Fine Print

✓ A case is described in which vertebral artery occlusion, caused by a fibrous band, occurred whenever the patient turned his head to the right side, resulting in vertigo and syncope whenever the head was turned to the right. Release of a fibrous band crossing the vertebral artery 2 cm from its origin relieved the patient's vertebral artery constriction and symptoms.

Endovascular coil embolization of intracranial aneurysms: important factors related to rates and outcomes of incomplete occlusion

2005 ◽  
Vol 102 (4) ◽  
pp. 607-615 ◽  
Author(s):  
Max K. Kole ◽  
David M. Pelz ◽  
Paul Kalapos ◽  
Donald H. Lee ◽  
Irene B. Gulka ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Repeated Treatment ◽  
Negative Events ◽  
Content Type ◽  
Cox Regression Analysis ◽  
Endovascular Coil Embolization ◽  
Angiographic Result ◽  
Fine Print

Object. The authors report on important factors that influenced clinical and angiographically demonstrated outcomes in patients treated using coil embolization. Methods. This study included 160 consecutive patients who underwent endovascular coil embolization for treatment of intracranial aneurysms. Univariate and multivariate logistic regression analyses were performed to assess factors that influenced the immediate posttreatment angiographic result. Cox regression analysis was used to establish factors related to the occurrence of negative events as well as a curve indicating the time to a negative event. Negative events were defined as aneurysm remnant increase, repeated treatment, rebleeding, or death during periprocedural hospitalization. Seventy-three percent of the patients treated in this study were independent or demonstrated no deficit (Glasgow Outcome Scale [GOS] Score 4 or 5) at a mean follow up of 18.2 months. The annual delayed rebleeding rate was 0.45%. Fifty percent of patients (65 of 131) suffered a negative event within 13 ± 14 months (standard deviation). Statistically significant factors associated with the occurrence of negative events were rupture status (p = 0.0128) and immediate posttreatment angiographic result (p < 0.001). Overall clinical outcome assessed using the GOS was significantly related to the immediate posttreatment angiographic result (χ2 = 4.788, p = 0.029). The immediate posttreatment angiographic results were significantly influenced by catheter stability (p = 0.0012), aneurysm geometry (that is, simple or complex, p = 0.0053), and aneurysm neck diameter (p = 0.0205). Conclusions. A good or excellent clinical outcome can be obtained in most patients treated using endovascular coil embolization of intracranial aneurysms. Note, however, that a significant number of patients treated using traditional platinum coils will harbor unstable aneurysm remnants or require repeated treatment.

Pseudoaneurysm of the extracranial vertebral artery

1987 ◽  
Vol 67 (6) ◽  
pp. 935-939 ◽  
Author(s):  
Karl Detwiler ◽  
John C. Godersky ◽  
Lindell Gentry
Keyword(s):  
Soft Tissue ◽  
Vertebral Artery ◽  
Intracranial Aneurysms ◽  
Balloon Occlusion ◽  
Artery Pseudoaneurysm ◽  
Content Type ◽  
Unusual Association ◽  
Associated Symptoms ◽  
Extracranial Vertebral Artery ◽  
Fine Print

✓ The unusual association of a giant extracranial vertebral artery pseudoaneurysm, intracranial aneurysms, and extracranial carotid occlusion in a woman with neurofibromatosis is presented. Pain as a result of expansion of the mass in the soft tissue of the neck led to her seeking evaluation. Herniation of the mass intraspinally between the occiput and C-1 resulted in myelopathy. Following balloon occlusion of the vertebral artery, the mass and associated symptoms resolved without the need for direct resection. The salient features of these unusually associated problems are discussed.

Percutaneous intracranial stent placement for aneurysms

2003 ◽  
Vol 99 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Patrick P. Han ◽  
Felipe C. Albuquerque ◽  
Francisco A. Ponce ◽  
Christopher I. Mackay ◽  
Joseph M. Zabramski ◽  
...  
Keyword(s):  
Stent Placement ◽  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Content Type ◽  
Intracranial Stent ◽  
Parent Vessel Occlusion ◽  
Vertebrobasilar Junction ◽  
Fine Print

Object. Intracranial stent placement combined with coil embolization is an emerging procedure for the treatment of intracranial aneurysms. The authors report their results using intracranial stents for the treatment of intracranial aneurysms. Methods. A prospectively maintained database was reviewed to identify all patients with intracranial aneurysms that were treated with intracranial stents. Ten lesions, including eight broad-based aneurysms and two dissecting aneurysms, were treated in 10 patients. Four lesions were located in the cavernous segment of the internal carotid artery, two at the vertebrobasilar junction, two at the basilar trunk, one at the basilar apex, and one in the intracranial vertebral artery. Attempts were made to place stents in 13 patients, but in three the stents could not be delivered. Altogether, intracranial stents were placed in 10 patients for 10 lesions. Results that were determined to be satisfactory angiographically were achieved in all 10 lesions. Two patients suffered permanent neurological deterioration related to stent placement. In two patients, the aneurysm recurred after stent-assisted coil embolization. In one case of recurrence a second attempt at coil embolization was successful, whereas in the second case of recurrence parent vessel occlusion was required and well tolerated. Conclusions. Intracranial stents can be a useful addition to coil embolization by providing mechanical, hemodynamic, and visual benefits in the treatment of complex, broad-based aneurysms.

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.

Posttraumatic bilateral vertebral artery occlusion

1981 ◽  
Vol 54 (6) ◽  
pp. 814-817 ◽  
Author(s):  
Eric G. Six ◽  
W. Lynn Stringer ◽  
A. Ron Cowley ◽  
Courtland H. Davis
Keyword(s):  
Vertebral Artery ◽  
Artery Occlusion ◽  
Posterior Fixation ◽  
Kirschner Wires ◽  
Content Type ◽  
Vertebral Arteries ◽  
Vertebral Artery Occlusion ◽  
Neurologically Normal ◽  
Collateral Vessels ◽  
Fine Print

✓ A case of bilateral vertebral artery occlusion following trauma in a 25-year-old woman is presented. The patient had minimal subluxation of C-2 on C-3 without neurological deficit. Her neck was immobilized for 16 days, and then a posterior fixation of C-1 through C-4 was performed with Kirschner wires and methyl methacrylate. Occlusion of the vertebral arteries has persisted, but collateral vessels are adequate and the patient has remained neurologically normal.

Subarachnoid hemorrhage caused by a fungal aneurysm of the vertebral artery as a complication of intracranial aneurysm clipping

1990 ◽  
Vol 73 (6) ◽  
pp. 962-964 ◽  
Author(s):  
Wolfgang Peter Piotrowski ◽  
Peter Pilz ◽  
I-Hsing Chuang
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysm ◽  
Fungal Infection ◽  
Vertebral Artery ◽  
Immunosuppressive Therapy ◽  
Intracranial Aneurysms ◽  
Content Type ◽  
Aneurysm Clipping ◽  
Long Period ◽  
Fine Print

✓ Intracranial aneurysms are an uncommon manifestation of fungal infection. A case is described in which the formation of an aneurysm followed an intracranial intraoperative Aspergillus infection attributable to a long period of preoperative antibiotic medication and immunosuppressive therapy with steroids.

Stereotaxic thrombosis of inaccessible intracranial aneurysms

1977 ◽  
Vol 47 (6) ◽  
pp. 833-839 ◽  
Author(s):  
Randall W. Smith ◽  
John F. Alksne
Keyword(s):  
Brain Stem ◽  
Cavernous Sinus ◽  
Intracranial Aneurysms ◽  
Sphenoid Sinus ◽  
Ophthalmic Artery ◽  
Sella Turcica ◽  
Content Type ◽  
The Brain ◽  
Stereotaxic Technique ◽  
Fine Print

✓ Some intracranial aneurysms that might be considered inoperable by open craniotomy are readily treatable by stereotaxic thrombosis. This is possible because the stereotaxic technique requires only that some point on the fundus of the aneurysm can be punctured with a needle. Illustrative cases are given describing the successful treatment of aneurysms arising at the origin of the ophthalmic artery, within the cavernous sinus, within the sella turcica, and from the vertebrobasilar and the posterior inferior cerebellar arteries ventral to the brain stem. The aneurysms within the sella or cavernous sinus can be approached through the sphenoid sinus, and the aneurysms ventral to the brain stem can be approached through the clivus without opening the dura.

Posterior inferior to posterior inferior cerebellar artery anastomosis combined with trapping for vertebral artery aneurysm

1990 ◽  
Vol 73 (3) ◽  
pp. 462-465 ◽  
Author(s):  
James I. Ausman ◽  
Fernando G. Diaz ◽  
Sean Mullan ◽  
Randy Gehring ◽  
Balaji Sadasivan ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Artery Ligation ◽  
Content Type ◽  
Cerebellar Artery ◽  
Vertebrobasilar Junction ◽  
Vertebral Aneurysm ◽  
The Right ◽  
Fine Print

✓ A case is presented in which a giant intracranial vertebral artery aneurysm gave rise to an associated ipsilateral posterior inferior cerebellar artery (PICA) from its waist. Proximal vertebral artery ligation at C-1 was achieved. The aneurysm filled from the opposite vertebrobasilar junction. Direct intracranial trapping of the right vertebral aneurysm was followed by successful anastomosis of the proximally sectioned right PICA to the adjacent left PICA in an end-to-end fashion.

Rotational vertebral artery occlusion from occipital bone anomaly: a rare cause of embolic stroke

2002 ◽  
Vol 97 (6) ◽  
pp. 1456-1459 ◽  
Author(s):  
Teiji Tominaga ◽  
Toshiyuki Takahashi ◽  
Hiroaki Shimizu ◽  
Takashi Yoshimoto
Keyword(s):  
Vertebral Artery ◽  
Three Dimensional ◽  
Craniovertebral Junction ◽  
Artery Occlusion ◽  
Occipital Bone ◽  
Atlantoaxial Instability ◽  
Posterior Arch ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ Vertebral artery (VA) occlusion by rotation of the head is uncommon, but can result from mechanical compression of the artery, trauma, or atlantoaxial instability. Occipital bone anomalies rarely cause rotational VA occlusion, and patients with nontraumatic intermittent occlusion of the VA usually present with compromised vertebrobasilar flow. A 34-year-old man suffered three embolic strokes in the vertebrobasilar system within 2 months. Magnetic resonance imaging demonstrated multiple infarcts in the vertebrobasilar territory. Angiography performed immediately after the third attack displayed an embolus in the right posterior cerebral artery. Radiographic and three-dimensional computerized tomography bone images exhibited an anomalous osseous process of the occipital bone projecting to the posterior arch of the atlas. Dynamic angiography indicated complete occlusion of the left VA between the osseous process and the posterior arch while the patient's head was turned to the right. Surgical decompression of the VA resulted in complete resolution of rotational occlusion of the artery. An occipital bone anomaly can cause rotational VA occlusion at the craniovertebral junction in patients who present with repeated embolic strokes resulting from injury to the arterial wall.

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