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.

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.

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.

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.

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.

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.

scholarly journals Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome

2017 ◽  
Vol 23 (3) ◽  
pp. 240-248 ◽  
Author(s):  
K Urasyanandana ◽  
P Withayasuk ◽  
D Songsaeng ◽  
T Aurboonyawat ◽  
E Chankaew ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Vertebral Artery ◽  
Intracranial Haemorrhage ◽  
Posterior Inferior Cerebellar Artery ◽  
Recurrent Bleeding ◽  
Parent Artery ◽  
Parent Vessel ◽  
Total Occlusion ◽  
First Choice ◽  
Dissecting Aneurysms

Objective Intracranial spontaneous vertebral artery dissecting aneurysms commonly occur in the third to fifth decades of life, and are mostly associated with hypertension. Patients present with intracranial haemorrhage or thromboembolic events. Patients who present with intracranial haemorrhage carry about a 70% risk of recurrent bleeding. Patients with a posterior-inferior cerebellar artery (PICA) or ipsilateral dominant vertebral artery involve selecting which parent vessel could not be sacrificed. Recent reconstructive techniques such as stent-assisted coiling embolisation and flow-diverting stents are effective treatments of choice. Methods Seventeen patients presented subarachnoid haemorrhage and nine patients with other symptoms. Sacrificing the parent vertebral artery was the first choice for surgical or endovascular methods. Endovascular reconstructive treatment by stent-assisted coiling embolisation was indicated in dissecting vertebral artery aneurysms with ipsilateral dominant vertebral artery or PICA involvement. Clinical outcomes were determined using the modified Rankin Score (mRS) at 90 days, with favourable outcomes defined as 0 to 2. Results Of the patients presenting with ruptured aneurysms, 11 (61.1%) had a good clinical outcome, with a mRS of 0–2. Favourable Hunt and Hess grading (65%), mild to moderate GCS (65%) and total occlusion of aneurysms after treatment (65%) were significantly good prognostic factors in patients with ruptured vertebral artery dissecting aneurysms. Conclusion Endovascular parent vessel sacrifice could be the first choice to treat a ruptured vertebral artery dissecting aneurysm. Stent-assisted coiling to preserve the patency of the parent artery and its branches is a promising treatment for vertebral artery dissections.

Thrombosis of difficult intracranial aneurysms by the endovascular placement of platinum-Dacron microcoils

1992 ◽  
Vol 77 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Neville W. Knuckey ◽  
Richard Haas ◽  
Ross Jenkins ◽  
Mel H. Epstein
Keyword(s):  
Cerebral Circulation ◽  
Treatment Modalities ◽  
Morbidity Rate ◽  
Parent Artery ◽  
Safe Procedure ◽  
Total Occlusion ◽  
Content Type ◽  
Aneurysm Thrombosis ◽  
Second Procedure ◽  
Fine Print

✓ Patients with symptomatic aneurysms that are not excluded from the cerebral circulation have a poor prognosis. Standard treatment is surgical exploration with direct clipping of the aneurysm. Because of their large size or relationship to the base of the skull, some aneurysms may not be suitable for direct surgical clipping and may require alternative treatment modalities. A prospective clinical and radiological study of seven patients treated with the endovascular placement of platinum-Dacron microcoils to exclude the aneurysm from the cerebral circulation is reported. The seven patients ranged in age from 37 to 63 years; four were women. At completion of the endovascular procedure, total occlusion of the aneurysm with preservation of the parent artery had been achieved in four patients and 90% occlusion of the aneurysm in two. In the seventh patient, occlusion of the internal carotid artery resulted in the patient's death. At the 6-month follow-up review, both patients with an aneurysm less than 20 mm in size had persistent aneurysm thrombosis; however, the two patients with giant aneurysms had partial recanalization. Both required repeat thrombosis of their aneurysm with the placement of additional microcoils, one at 6 weeks and one at 6 months. These two patients have persistent aneurysm thrombosis at 12 months following their second procedure. The patient mortality rate for this study was 14%, while the procedure mortality/morbidity rate was 9%. It is concluded that thrombotic aneurysm therapy of difficult aneurysms is a safe procedure and will have a place in the treatment of selected aneurysms.

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.

An angiographic study of meningiomas of the posterior fossa

1971 ◽  
Vol 35 (6) ◽  
pp. 731-741 ◽  
Author(s):  
Georges M. Salamon ◽  
André Combalbert ◽  
Charles Raybaud ◽  
Jorge Gonzalez
Keyword(s):  
Vertebral Artery ◽  
Posterior Fossa ◽  
Foramen Magnum ◽  
Posterior Cranial Fossa ◽  
Occipital Artery ◽  
Angiographic Study ◽  
Content Type ◽  
Meningeal Arteries ◽  
Cranial Fossa ◽  
Fine Print

✓ The meningeal vasculature of the posterior cranial fossa was studied on injected normal anatomical specimens and in angiograms of patients with posterior fossa meningiomas. The correlated results indicate that the dura anterior to the foramen magnum is supplied by meningeal vessels from the carotid siphon, the ascending pharyngeal and middle meningeal arteries. The dura posterior to the foramen magnum is supplied primarily by the occipital artery and secondarily by the vertebral artery.

Serial angiography and endovascular treatment of dissecting aneurysms of the anterior cerebral and vertebral arteries

1999 ◽  
Vol 91 (4) ◽  
pp. 682-686 ◽  
Author(s):  
Kenichi Amagasaki ◽  
Tsutomu Yagishita ◽  
Shinichi Yagi ◽  
Katsuhiro Kuroda ◽  
Kazuyuki Nishigaya ◽  
...  
Keyword(s):  
Endovascular Embolization ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Content Type ◽  
Chronic Stage ◽  
Disturbance Of Consciousness ◽  
Endovascular Coil Embolization ◽  
The Right ◽  
Dissecting Aneurysms ◽  
Fine Print

✓ This 47-year-old man was admitted to the hospital with disturbance of consciousness due to subarachnoid hemorrhage caused by a ruptured dissecting aneurysm of the left anterior cerebral artery (ACA). Conservative treatment resulted in improvement in the patient's consciousness; however, repeated rupture occurred during the chronic stage. Endovascular coil embolization of the parent artery was successful. Serial angiography demonstrated all stages in the development of the aneurysm. Follow-up angiography demonstrated an incidental dissecting aneurysm of the right vertebral artery. This aneurysm was also treated by endovascular embolization. No new neurological deficit appeared during or after the treatment.Multiple dissecting aneurysms are rare, especially those involving both supra- and infratentorial regions. A ruptured dissecting aneurysm of the ACA is also an uncommon vascular disorder. This case shows that rebleeding may occur, even during the chronic stage, and thus appropriate treatment for the prevention of subsequent bleeding is essential. Incidental dissecting aneurysms can be treated using the endovascular technique, but further study is necessary.

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