Occult rupture of a giant vertebral artery aneurysm following proximal occlusion and intrasaccular thrombosis

2001 ◽  
Vol 95 (1) ◽  
pp. 132-137 ◽  
Author(s):  
David G. Piepgras ◽  
Vini G. Khurana ◽  
Douglas A. Nichols
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Parent Artery ◽  
Content Type ◽  
Giant Aneurysms ◽  
Proximal Occlusion ◽  
A Site ◽  
Fine Print

✓ The authors describe a unique clinicopathological phenomenon in a patient who presented with an unruptured giant vertebral artery aneurysm and who underwent endovascular proximal occlusion of the parent artery followed, several days later, by surgical trapping of the aneurysm after delayed subarachnoid hemorrhage (SAH). The intraoperative finding of a thrombus extruding from the wall of the aneurysm at a site remote from the origin of the SAH underscores the possibility that occult rupture of an aneurysmal sac can occur in patients with thrombosed giant aneurysms.

Giant aneurysms of the vertebral artery

1988 ◽  
Vol 68 (6) ◽  
pp. 960-966 ◽  
Author(s):  
Kenichiro Sugita ◽  
Shigeaki Kobayashi ◽  
Toshiki Takemae ◽  
Yuichiro Tanaka ◽  
Hiroshi Okudera ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Surgical Results ◽  
Two Stage ◽  
Content Type ◽  
Giant Aneurysms ◽  
Remarkable Improvement ◽  
Second Procedure ◽  
Proximal Occlusion ◽  
Distal Artery

✓ The authors report five cases of surgically treated giant vertebral artery aneurysm. Two giant serpentine aneurysms were managed with aneurysmectomy, a giant semifusiform aneurysm with trapping and partial aneurysmectomy, and the other two saccular giant aneurysms with clipping. Surgical results were satisfactory in all cases. In particular, the two patients who underwent complete aneurysmectomy showed remarkable improvement after the second procedure of a two-stage operation that consisted of initial proximal occlusion and secondary evacuation of clots in the aneurysm when advanced thrombosis was identified. Aneurysmectomy in a two-stage operation was the best treatment for these partially thrombosed giant aneurysms which completely concealed the distal artery under a tight thinned medulla.

Endovascular treatment of vertebral artery dissections and pseudoaneurysms

1993 ◽  
Vol 79 (2) ◽  
pp. 183-191 ◽  
Author(s):  
Van V. Halbach ◽  
Randall T. Higashida ◽  
Christopher F. Dowd ◽  
Kenneth W. Fraser ◽  
Tony P. Smith ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Transluminal Angioplasty ◽  
Artery Dissection ◽  
Parent Artery ◽  
Content Type ◽  
Balloon Test Occlusion ◽  
Endovascular Occlusion ◽  
Proximal Occlusion ◽  
Fine Print

✓ Sixteen patients with dissecting aneurysms or pseudoaneurysms of the vertebral artery, 12 involving the intradural vertebral artery and four occurring in the extradural segment, were treated by endovascular occlusion of the dissection site. Patients with vertebral fistulas were excluded from this study. The dissection was caused by trauma in three patients (two iatrogenic) and in the remaining 13 no obvious etiology was disclosed. Nine patients presented with subarachnoid hemorrhage (SAH), two of whom had severe cardiac disturbances secondary to the bleed. The nontraumatic dissections occurred in seven women and six men, with a mean age on discovery of 48 years. Fifteen patients were treated with endovascular occlusion of the parent artery at or just proximal to the dissection site. One patient had occlusion of a traumatic pseudoaneurysm with preservation of the parent artery. Four patients required transluminal angioplasty because of severe vasospasm produced by the presenting hemorrhage, and all benefited from this procedure with improved arterial flow documented by transcranial Doppler ultrasonography and arteriography. In 15 patients angiography disclosed complete cure of the dissection. One patient with a long dissection of extracranial origin extending intracranially had proximal occlusion of the dissection site. Follow-up angiography demonstrated healing of the vertebral artery dissection but persistent filling of the artery above the balloons, which underscores the need for embolic occlusion near the dissection site. No hemorrhages recurred. One patient had a second SAH at the time of therapy which was immediately controlled with balloons and coils. This patient and one other had minor neurological worsening resulting from the procedure (mild Wallenberg syndrome in one and minor ataxia in the second). Symptomatic vertebral artery dissections involving the intradural and extradural segments can be effectively managed by endovascular techniques. Balloon test occlusion and transluminal angioplasty can be useful adjuncts in the management of this disease.

Dissecting aneurysms of the vertebral artery: a management strategy

2002 ◽  
Vol 97 (2) ◽  
pp. 259-267 ◽  
Author(s):  
Koji Iihara ◽  
Nobuyuki Sakai ◽  
Kenichi Murao ◽  
Hideki Sakai ◽  
Toshio Higashi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Management Strategy ◽  
Morbidity Rate ◽  
Recurrent Bleeding ◽  
Occipital Artery ◽  
Parent Artery ◽  
Content Type ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. The authors present a retrospective analysis of their experience in the treatment of vertebral artery (VA) dissecting aneurysms and propose a management strategy for such aneurysms, with special emphasis on the most formidable VA dissecting aneurysms, which involve the origin of the posterior inferior cerebellar artery (PICA). Methods. Since 1998, 18 patients with VA dissecting aneurysms, 11 of whom presented with subarachnoid hemorrhage (SAH), have been treated by endovascular surgery at the authors' institution. Obliteration of the entire segment of the dissected site with coils (internal trapping) was performed for aneurysms without involvement of the origin of the PICA (12 cases; among these the treatment-related morbidity rate was 16.7%). The treatment strategy applied to PICA-involved VA dissecting aneurysms presenting with SAH (three cases) included proximal occlusion of the parent artery followed by internal trapping of the aneurysm (one case), proximal occlusion of the parent artery followed by occipital artery (OA)—PICA bypass (one case), and two-staged internal trapping of the aneurysm involving double PICAs (one case). For PICA-involved VA dissecting aneurysms that were not associated with SAH at presentation (three cases), OA—PICA bypass was performed and followed by internal trapping of the aneurysm (two cases). In the remaining case in which a fetal-type posterior communicating artery was present, internal trapping was performed following successful balloon test occlusion (BTO). Overall, there was no sign of infarction in the PICA territory, despite complete occlusion of aneurysms involving the PICA. There was no recurrent bleeding or ischemic symptoms during the follow-up periods. The overall treatment-related morbidity rate for the VA dissecting aneurysms involving the PICA was 16.7%. Conclusions. Dissecting VA aneurysms that do not involve the PICA can be safely treated by internal trapping. For those lesions that do involve the PICA, a decision-making algorithm is advocated to maximize the efficacy of the treatment as well as to minimize the risks of treatment-related morbidity based on BTO.

Selection and combination of various endovascular techniques in the treatment of giant aneurysms

1992 ◽  
Vol 77 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Waro Taki ◽  
Shogo Nishi ◽  
Kohsuke Yamashita ◽  
Akiyo Sadatoh ◽  
Ichiro Nakahara ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
The Other ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Detachable Balloon ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Complete Occlusion ◽  
Giant Aneurysms ◽  
Fine Print

✓ Between April, 1989, and January, 1991, a total of 19 cases of giant aneurysm were treated by the endovascular approach. The patients included seven males and 12 females aged 15 to 72 years. Detachable balloons, occlusion coils, and ethylene vinyl alcohol copolymer liquid were used as embolic materials. In seven cases, thrombosis of the aneurysmal sac and/or base was achieved while sparing the parent arterial flow; complete obliteration of the aneurysm was achieved in four of these. Of these four patients, the thrombotic material was a detachable balloon in two, a combination of a detachable balloon and coils in one, and occlusion liquid in one. In the other three cases, complete occlusion was not achieved; one aneurysm was occluded with a detachable balloon and two with coils. In 11 patients, the parent artery was occluded either by trapping or by proximal arterial occlusion, and all patients showed complete occlusion of the aneurysms. In one patient, a combined bypass procedure and parent artery occlusion was performed. Among the 19 cases in this series there were four transient ischemic attacks, one reversible ischemic neurological deficit, and one death due to aneurysmal rupture during the procedure. Two patients died in the follow-up period, one from pneumonia 2 months postoperatively and the other from acute cardiac failure 2 weeks following surgery. Both deaths were unrelated to the endovascular procedure. It is concluded that the endovascular treatment of giant aneurysms remains difficult because of the large and irregular shape of the aneurysmal base and thrombus in the aneurysmal sac. The proper selection and combination of the available endovascular techniques is therefore of critical importance.

Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage

2004 ◽  
Vol 100 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Jane Skjøth-Rasmussen ◽  
Mette Schulz ◽  
Soren Risom Kristensen ◽  
Per Bjerre
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cerebral Metabolism ◽  
Brain Infarction ◽  
Neurological Deficits ◽  
Parent Artery ◽  
Glycerol Concentration ◽  
Microdialysis Probe ◽  
Content Type ◽  
Fine Print

Object. In the treatment of patients with aneurysmal subarachnoid hemorrhage (SAH), early occlusion of the aneurysm is necessary as well as monitoring and treatment of complications following the primary bleeding episode. Monitoring with microdialysis has been studied for its ability to indicate and predict the occurrence of delayed ischemic neurological deficits (DINDs) in patients with SAH. Methods. In 42 patients with aneurysmal SAH microdialysis monitoring of metabolites was performed using a 0.3-µl/minute perfusion flow over several days, and the results were correlated to clinical events and to brain infarction observed on computerized tomography scans. The microdialysis probe was inserted into the territory of the parent artery of the aneurysm. The authors defined an ischemic pattern as increases in the lactate/glucose (L/G) and lactate/pyruvate (L/P) ratios that were greater than 20% followed by a 20% increase in glycerol concentration. This ischemic pattern was found in 17 of 18 patients who experienced a DIND and in three of 24 patients who did not experience a delayed clinical deterioration. The ischemic pattern preceded the occurrence of a DIND by a mean interval of 11 hours. Maximum L/G and L/P ratios did not correlate with the presence of DIND or outcome, and there was no association between the glycerol level and subsequent brain infarction. Conclusions. Microdialysis monitoring of the cerebral metabolism in patients with SAH may predict with high sensitivity and specificity the occurrence of a DIND. Whether an earlier diagnosis results in better treatment of DINDs and, therefore, in overall better outcomes remains to be proven, as it is linked to an efficacious treatment of cerebral vasospasm.

A newly designed puncture needle for suction decompression of giant aneurysms

1992 ◽  
Vol 76 (5) ◽  
pp. 880-882 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi ◽  
Kenji Wakui ◽  
Yoshiki Ichinose ◽  
Hiroshi Okudera
Keyword(s):  
Operating Room ◽  
Parent Artery ◽  
Intravenous Catheter ◽  
Suction System ◽  
Content Type ◽  
Giant Aneurysms ◽  
Puncture Needle ◽  
Fine Print

✓ A newly designed puncture needle for aspirating large or giant aneurysms is described. This puncture needle represents a modification of an intravenous catheter with an internal needle. It is designed to prevent blood from leaking when the internal needle is removed and has a lateral tube for aspiration. Following aneurysm puncture with the parent artery temporarily trapped, the catheter is positioned on the head frame with a brain spatula and a self-retaining retractor. Blood is suctioned through the lateral tube with a syringe or the suction system normally used in the operating room.

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.

Effect of early operation for ruptured aneurysms on prevention of delayed ischemic symptoms

1982 ◽  
Vol 57 (5) ◽  
pp. 622-628 ◽  
Author(s):  
Mamoru Taneda
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Reliable Method ◽  
Early Operation ◽  
Permanent Disability ◽  
Content Type ◽  
Giant Aneurysms ◽  
Ruptured Aneurysms ◽  
Blood Clots ◽  
Subarachnoid Blood ◽  
Fine Print

✓ The effect of removal of subarachnoid blood clots on the prevention of delayed ischemic deficit was evaluated in 239 consecutive patients with ruptured supratentorial non-giant aneurysms. All patients were hospitalized within 24 hours after subarachnoid hemorrhage (SAH) and were classified in Grades 1 to 4 according to the system of Hunt and Hess; classification was made immediately preoperatively in patients operated on within 48 hours after SAH, or 48 hours after SAH in patients for whom delayed operation was planned. Delayed ischemic deficit causing permanent disability or death occurred in 11 (25%) of 44 patients in whom surgery was planned to be delayed for 10 days or more, in 26 (27.7%) of 94 patients in whom the aneurysms were obliterated and blood clots adjacent to them were removed within 48 hours of SAH, and in 11 (10.9%) of 101 patients in whom the aneurysms were obliterated and extensive and aggressive removal of thick subarachnoid clots lying along the arteries (identified on computerized tomographic scan) was performed within 48 hours of SAH. Accordingly, early operation is an effective and reliable method to reduce the occurrence of severe delayed ischemic deficit only when subarachnoid blood clots are removed extensively and aggressively along the arteries within 48 hours of SAH.

Combined surgical and endovascular treatment of a giant vertebral artery aneurysm in a child

1994 ◽  
Vol 81 (2) ◽  
pp. 304-307 ◽  
Author(s):  
Mazen H. Khayata ◽  
Robert F. Spetzler ◽  
Jan J. A. Mooy ◽  
James M. Herman ◽  
Harold L. Rekate
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Mass Effect ◽  
Left Vertebral Artery ◽  
Parent Artery ◽  
Content Type ◽  
Cerebellar Artery ◽  
Coil Occlusion ◽  
Surgical Bypass

✓ The case is presented of a 5-year-old child who suffered a subarachnoid hemorrhage from a giant left vertebral artery-posterior inferior cerebellar artery (PICA) aneurysm. Initial treatment consisted of surgical occlusion of the parent vertebral artery combined with a PICA-to-PICA bypass. Because of persistent filling of the aneurysm, the left PICA was occluded at its takeoff from the aneurysm. Endovascular coil occlusion of the aneurysm and the distal left vertebral artery enabled complete elimination of the aneurysm. Follow-up magnetic resonance imaging and arteriography performed 6 months postoperatively showed persistent occlusion and elimination of the mass effect. Combined surgical bypass and endovascular occlusion of the parent artery may be a useful adjunct in the management of these aneurysms.

Endovascular treatment of ruptured dissecting aneurysms aimed at occlusion of the dissected site by using Guglielmi detachable coils

1999 ◽  
Vol 90 (5) ◽  
pp. 853-856 ◽  
Author(s):  
Ikuya Yamaura ◽  
Eiichi Tani ◽  
Masayuki Yokota ◽  
Atsuhisa Nakano ◽  
Masahiro Fukami ◽  
...  
Keyword(s):  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Retrograde Flow ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Endovascular Occlusion ◽  
Detachable Coils ◽  
Proximal Occlusion ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. Surgical or endovascular occlusion of the parent artery proximal to an aneurysm has been recommended for treatment of dissecting aneurysms of the intracranial posterior circulation. However, dissecting aneurysms may rupture even after proximal occlusion because distal progression of thrombus is necessary to occlude the dissecting aneurysm completely, and this may be delayed by the presence of retrograde flow. In this article the authors present their experience in treating six patients with ruptured dissecting aneurysms.Methods. The authors report on six patients with a ruptured dissecting aneurysm in the posterior fossa who were successfully treated by endovascular occlusion of the aneurysm by using Guglielmi detachable coils. The procedure was particularly aimed at occluding the dissected site.Conclusions. At the present time, endovascular occlusion of the dissected site is a safe, minimally invasive, and reliable treatment for dissecting aneurysms when a test occlusion is tolerated and adequate collateral circulation is present.

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