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.

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.

Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse—sigmoid sinus

2002 ◽  
Vol 96 (5) ◽  
pp. 823-829 ◽  
Author(s):  
David Hung-chi Pan ◽  
Wen-yuh Chung ◽  
Wan-yuo Guo ◽  
Hsiu-mei Wu ◽  
Kang-du Liu ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Neurological Complication ◽  
Endovascular Embolization ◽  
Sigmoid Sinus ◽  
Type I ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Fine Print

Object. The aim of this study was to assess the efficacy and safety of radiosurgery for the treatment of dural arteriovenous fistulas (DAVFs) located in the region of the transverse—sigmoid sinus. Methods. A series of 20 patients with DAVFs located in the transverse—sigmoid sinus, who were treated with gamma knife surgery between June 1995 and June 2000, was evaluated. According to the Cognard classification, the DAVF was Type I in four patients, Type IIa in seven, Type IIb in two, and combined Type IIa+b in seven. Nine patients had previously been treated with surgery and/or embolization, whereas 11 patients underwent radiosurgery alone. Radiosurgery was performed using multiple-isocenter irradiation of the delineated DAVF nidus. The target volume ranged from 1.7 to 40.7 cm3. The margin dose delivered to the nidus ranged from 16.5 to 19 Gy at a 50 to 70% isodose level. Nineteen patients were available for follow-up review, the duration of which ranged from 6 to 58 months (median 19 months). Of the 19 patients, 14 (74%) were cured of their symptoms. At follow up, magnetic resonance imaging and/or angiography demonstrated complete obliteration of the DAVF in 11 patients (58%), subtotal obliteration (95% reduction of the nidus) in three (16%), and partial obliteration in another five (26%). There was no neurological complication related to the treatment. One patient experienced a recurrence of the DAVF 18 months after angiographic confirmation of total obliteration, and underwent a second course of radiosurgery. Conclusions. Stereotactic radiosurgery provides a safe and effective option for the treatment of DAVFs involving the transverse and sigmoid sinuses. For some aggressive DAVFs with extensive retrograde cortical venous drainage, however, a combination of endovascular embolization and surgery may be necessary.

Endovascular treatment of basilar tip aneurysms using electrolytically detachable coils

1996 ◽  
Vol 84 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Cameron G. McDougall ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
Donald W. Larsen ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Content Type ◽  
Initial Treatment Period ◽  
Long Term Follow Up ◽  
Detachable Coils ◽  
Aneurysm Occlusion ◽  
Permanent Morbidity ◽  
Fine Print

✓ Preliminary experience using electrolytically detachable coils to treat basilar tip aneurysms in 33 patients is described. The most frequent presentation was subarachnoid hemorrhage (SAH) in 23 patients. All patients were referred after neurosurgical assessment and exclusion as candidates for surgical clipping of their aneurysms. At the time of initial treatment complete aneurysm occlusion was achieved in seven (21.2%) of 33 patients. In 17 of the patients (51.5%), greater than 90% but less than 100% aneurysm occlusion was achieved. Angiographic follow up (mean 11.7 months) was available in 19 patients. At follow-up angiography four (21%) of 19 aneurysms were 100% occluded and 12 (63.2%) of 19 were more than 90% but less than 100% occluded. The mean clinical follow-up time in treated patients surviving beyond the initial treatment period is 15 months. One patient suffered major permanent morbidity from thrombosis of the basilar tip region a few hours after coil placement. One patient treated following SAH experienced further hemorrhage 6 months later. No other patient suffered direct or indirect permanent morbidity as a consequence of this method of treatment. The authors believe that this technique is a reasonable alternative for patients who are not candidates for conventional surgical treatment or in whom such treatment has failed. This study's follow-up period is brief and greater experience with long-term follow-up study is mandatory.

Multimodal treatment of ruptured dissecting aneurysms of the vertebral artery during the acute stage

2003 ◽  
Vol 99 (6) ◽  
pp. 960-966 ◽  
Author(s):  
Jun-ichiro Hamada ◽  
Yutaka Kai ◽  
Motohiro Morioka ◽  
Shigetoshi Yano ◽  
Tatemi Todaka ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Acute Stage ◽  
The Other ◽  
Content Type ◽  
Lateral Medullary Syndrome ◽  
Detachable Coils ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. The goal of this study was to implement an algorithm for and assess the multimodal (endovascular and microsurgical) treatment of patients with ruptured dissecting aneurysms of the vertebral artery (VA) during the acute stage. Methods. During a 4-year period, the authors treated 19 ruptured dissecting aneurysms of the VA during the acute stage, within 3 days after the hemorrhage. Factors guiding management decisions were tolerance of the test occlusion and the site of the dissection. The algorithm takes into account these factors to select among treatment options, that is, trapping of the VA with Guglielmi Detachable Coils (GDCs); trapping of the VA and revascularization of the posterior inferior cerebellar artery (PICA); trapping of the VA and VA—posterior cerebral artery (PCA) anastomosis; and trapping of the VA, VA—PCA anastomosis, and revascularization of the PICA. Of the 15 aneurysms without PICA involvement, 14 were treated by trapping of the VA with GDCs and one by trapping of the VA and a VA—PCA bypass. The other four aneurysms with PICA involvement were treated by VA trapping and PICA revascularization. There was no episode of recurrent hemorrhage or ischemia during the posttreatment follow-up period. Although lateral medullary syndrome developed as a permanent complication in one patient, a good recovery was made by the other 18 patients by 6 months after the ictus. Conclusions. The factors that determine the appropriate treatment for ruptured dissecting aneurysms of the VA are tolerance of a test occlusion and the site of dissection. Favorable patient outcomes can be achieved when this algorithm is used.

Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding

1999 ◽  
Vol 90 (4) ◽  
pp. 656-663 ◽  
Author(s):  
James V. Byrne ◽  
Min-Joo Sohn ◽  
Andrew J. Molyneux
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Content Type ◽  
Aneurysm Embolization ◽  
Aneurysm Occlusion ◽  
The Stability ◽  
Ruptured Intracranial Aneurysms ◽  
Fine Print

Object. During a 5-year period 317 patients presenting with aneurysmal subarachnoid hemorrhage were successfully treated by coil embolization within 30 days of hemorrhage. The authors followed patients to assess the stability of aneurysm occlusion and its longer-term efficacy in protecting patients against rebleeding.Methods. Patients were followed for 6 to 65 months (median 22.3 months) by clinical review, angiography performed at 6 months posttreatment, and annual questionnaires. Stable angiographic occlusion was evident in 86.4% of small and 85.2% of large aneurysms with recurrent filling in 38 (14.7%) of 259 aneurysms. Rebleeding was caused by aneurysm recurrence in four patients (between 11 and 35 months posttreatment) and by rupture of a coincidental untreated aneurysm in one patient. Annual rebleeding rates were 0.8% in the 1st year, 0.6% in the 2nd year, and 2.4% in the 3rd year after aneurysm embolization, with no rebleeding in subsequent years. Rebleeding occurred in three (7.9%) of 38 recurrent aneurysms and in one (0.4%) of 221 aneurysms that appeared stable on angiography.Conclusions. Periodic follow-up angiography after coil embolization is recommended to identify aneurysm recurrence and those patients at a high risk of late rebleeding.

Nonsurgical treatment of unruptured intracranial vertebral artery dissection with serial follow-up angiography

1994 ◽  
Vol 80 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Chifumi Kitanaka ◽  
Jun-Ichi Tanaki ◽  
Masanori Kuwahara ◽  
Akira Teraoka ◽  
Tomio Sasaki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Bed Rest ◽  
Arterial Dissection ◽  
Artery Dissection ◽  
Aneurysmal Dilatation ◽  
Content Type ◽  
Brain Stem Ischemia ◽  
Fine Print

✓ The question of whether unruptured intracranial vertebral artery dissections should be treated surgically or nonsurgically still remains unresolved. In this study, six consecutive patients with intracranial vertebral artery dissection presenting with brain-stem ischemia without subarachnoid hemorrhage (SAH) were treated nonsurgically with control of blood pressure and bed rest, and five received follow-up review with serial angiography. No further progression of dissection or associated SAH occurred in any of the cases, and all patients returned to their previous lifestyles. In the serial angiograms in five patients, the findings continued to change during the first few months after onset. Four cases ultimately showed “angiographic cure,” while fusiform aneurysmal dilatation of the affected vessel persisted in one case. In one patient, arterial dissection was visualized on the second angiogram despite negative initial angiographic findings. These results indicate that intracranial vertebral artery dissection presenting without SAH can be treated nonsurgically, with careful angiographic follow-up monitoring. Persistent aneurysmal dilatation as a sequela of arterial dissection seemed to form a subgroup of fusiform aneurysms of the posterior circulation. These aneurysms may be prone to late bleeding and may require surgical treatment.

Effectiveness of microsurgery for intracranial aneurysms

1973 ◽  
Vol 39 (6) ◽  
pp. 690-693 ◽  
Author(s):  
Sidney A. Hollin ◽  
Robert E. Decker
Keyword(s):  
Intracranial Aneurysms ◽  
Aneurysm Surgery ◽  
Parent Vessel ◽  
Content Type ◽  
Complete Occlusion ◽  
Microsurgical Technique ◽  
Aneurysm Occlusion ◽  
High Degree ◽  
Fine Print

✓ The authors report postoperative angiographic results in a series of 50 patients who had undergone microsurgery for intracranial aneurysms. The aneurysmal body and fundus were obliterated in every case. The neck was visualized postoperatively in three cases, or 6%; in one of these, later follow-up angiography demonstrated subsequent total aneurysm occlusion. No postoperative rebleeding occurred. The incidence of postoperative occlusion of the parent vessel was small, with complete occlusion in only one case and partial branch occlusion in another. These results confirm the impression that a high degree of accuracy in clip placement is possible with microsurgical technique. Routine postoperative angiography does not appear to be necessary if the surgeon has become skilled in the use of the microscope for aneurysm surgery.

Extracranial vertebral artery stent placement: in-hospital and follow-up results

1999 ◽  
Vol 91 (4) ◽  
pp. 547-552 ◽  
Author(s):  
Hollace D. Chastain ◽  
Morgan S. Campbell ◽  
Sriram Iyer ◽  
Gary S. Roubin ◽  
Jiri Vitek ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Stent Placement ◽  
Elastic Recoil ◽  
Clinical Recurrence ◽  
Content Type ◽  
Luminal Narrowing ◽  
Prospective Comparison ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. The authors summarize their experience with stent deployment in the treatment of vertebrobasilar artery (VBA) insufficiency. This is an underdiagnosed condition, and the incidence of significant vertebral artery (VA) stenosis has been underappreciated. Medical therapy has been the mainstay of treatment because of the high rate of morbidity associated with surgical correction of VA stenosis. Recently, some authors have reported acceptable results with the use of percutaneous transluminal angioplasty, but this technique has significant weaknesses such as elastic recoil and problems in achieving safe treatment of dissections.Methods. The authors investigated the feasibility, safety, and outcome of VA stent placement in 50 patients in whom 55 vessels were treated using stents. Technical success was achieved in 54 (98%) of 55 vessels, with no procedure-related complications. However, one patient (2%) died of nonneurological causes, and one (2%) suffered a stroke that occurred within the 30-day postprocedural period and was related to a complicated coronary intervention. Clinical follow-up review performed at a mean of 25 ± 10 months revealed two patients (4%) with recurrence of VBA symptoms. Six-month angiographic follow up was completed in 90% of eligible patients, with a 10% incidence of restenosis as defined by greater than 50% luminal narrowing.Conclusions. Vertebral artery stent placement is feasible in patients who have significant VA stenosis, with predictably good angiographically demonstrated and clinical results. The 6-month angiographically confirmed restenosis rate appears to be low, as does the clinical recurrence rate. This technique solves the problems of elastic recoil and the treatment of angioplasty-induced dissections. Further prospective comparison with medical preventive strategies is warranted.

Dissecting aneurysm of the vertebral artery

1984 ◽  
Vol 61 (6) ◽  
pp. 1038-1046 ◽  
Author(s):  
Takeyoshi Shimoji ◽  
Kuniaki Bando ◽  
Keiji Nakajima ◽  
Kazufumi Ito
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Vertebral Artery ◽  
Arterial Wall ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Venous Phase ◽  
Dissecting Aneurysms ◽  
Angiographic Findings ◽  
Fine Print

✓ Seven cases of dissecting aneurysm of the vertebral artery, all appearing to be of fusiform type, are reported. Clinically, all seven cases initially showed symptoms of subarachnoid hemorrhage; however, three of these were associated with Wallenberg's syndrome. The characteristic angiographic findings in these cases were: 1) retention of contrast medium in the aneurysm; 2) the presence of a true (vertebral artery) and false (arterial wall) lumen in the late arterial and/or venous phase; and 3) irregular arterial narrowing proximal and/or distal to the aneurysm. Autopsy findings of one patient supported the angiographic findings. Recently, reports of fusiform aneurysms associated with subarachnoid hemorrhage have been increasing. As dissecting aneurysms are found in the fusiform group, it is very important to analyze serial angiograms in order to choose a method of surgical treatment.

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