Endovascular management of dissecting vertebrobasilar artery aneurysms in patients presenting with acute subarachnoid hemorrhage

2005 ◽  
Vol 103 (4) ◽  
pp. 649-655 ◽  
Author(s):  
Ichiro Yuki ◽  
Yuichi Murayama ◽  
Fernando Viñuela
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Dissecting Aneurysm ◽  
Endovascular Techniques ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Vertebrobasilar Artery ◽  
Acute Subarachnoid Hemorrhage ◽  
Grade Ii ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. The authors report on a series of 29 patients presenting with acute subarachnoid hemorrhage (SAH) related to the rupture of a vertebrobasilar dissecting aneurysm. Special attention was focused on embolization techniques and immediate and midterm anatomical and clinical outcomes. Methods. Between March 1994 and January 2003, 29 patients presented with acute SAH caused by the rupture of a vertebrobasilar dissecting aneurysm. Eleven patients (37.9%) had Hunt and Hess Grade I SAH, four (13.8%) Grade II, six (20.7%) Grade III, five (17.2%) Grade IV, and three (10.3%) Grade V. Aneurysms were classified into five groups based on lesion location, and treatment courses were decided. All patients except two were treated by endovascular trapping of the aneurysm with concomitant occlusion of the involved vertebral artery (VA). No technical or clinical complication was observed in 28 patients (97%). Aneurysm perforation occurred during the procedure in one patient (3%). There was evidence of aneurysm recanalization in one patient. One patient with Hunt and Hess Grade IV SAH and two patients with Grade V SAH died. One patient died of respiratory infection 1 year after aneurysm trapping. One patient presented with a recurrent hemorrhage 1 month after treatment and died. Overall morbidity and mortality rates were 13.8 and 17.2%, respectively. Conclusions. Twenty-nine patients with acute SAH due to rupturing of vertebrobasilar dissecting aneurysms were treated using endovascular techniques. In most cases, endovascular trapping of the aneurysm and concomitant occlusion of the VA was technically and clinically successful.

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.

Subarachnoid hemorrhage caused by a dissecting aneurysm of the internal carotid artery

2002 ◽  
Vol 97 (3) ◽  
pp. 576-583 ◽  
Author(s):  
Hiroki Ohkuma ◽  
Takahiro Nakano ◽  
Hiroshi Manabe ◽  
Shigeharu Suzuki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Poor Prognosis ◽  
Internal Carotid ◽  
Postoperative Recurrence ◽  
Dissecting Aneurysm ◽  
Acute Stage ◽  
Intraoperative Bleeding ◽  
Content Type ◽  
Dissecting Aneurysms ◽  
Fine Print

Object. Subarachnoid hemorrhage (SAH) caused by the rupture of a dissecting aneurysm of the internal carotid artery (ICA) has been considered rare. Based on data from cooperatively collected cases, the clinical features of patients with dissecting aneurysms of the ICA who presented with SAH were examined. Methods. Data from 18 patients with dissecting aneurysms of the ICA who presented with SAH diagnosed on the basis of clinical signs, neuroradiological findings, and intraoperative findings from 41 institutions were collected during a 5-year period between 1995 and 1999. The authors found that 0.3% of all cases of SAH and 3.1% of cases of SAH of unverified cause were attributable to a dissecting aneurysm of the ICA. Eleven patients (61%) were middle-aged women, and eight patients (44%) had hypertension. Rebleeding before admission was demonstrated in 13 patients (72%), and intraoperative bleeding was exhibited in half of the patients who underwent surgery during the acute stage. Postoperative growth of an aneurysm bulge or recurrent SAH was seen in five of 10 patients who had undergone wrapping or clipping of the aneurysm bulge in the acute phase. Trapping with or without bypass, which resulted in no postoperative recurrence, was performed in three patients in the acute stage and in two patients in the chronic stage. Twelve patients (67%) had a poor prognosis, primarily attributed to intraoperative bleeding and postoperative recurrence. Conclusions. Generally, dissecting aneurysms of the ICA are not thought of as frequent causes of SAH. Nonetheless, the presence of these aneurysms should be considered when dealing with SAH because they have a susceptibility to bleeding that can lead to a poor prognosis. Careful surgical planning is necessary to decrease intraoperative bleeding and to avoid postoperative recurrence.

Chronic subdural hematoma presenting as spontaneous subarachnoid hemorrhage

1985 ◽  
Vol 63 (5) ◽  
pp. 691-692 ◽  
Author(s):  
Zbigniew Kotwica ◽  
Jerzy Brzeziński
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Clinical Findings ◽  
Content Type ◽  
Acute Subarachnoid Hemorrhage ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Fine Print

✓ Six cases of chronic subdural hematoma presenting with the clinical findings of acute subarachnoid hemorrhage are reported. No systemic or focal cause for the bleeding was found, and possible mechanisms are discussed.

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.

Failure of a Heifetz aneurysm clip

1982 ◽  
Vol 57 (2) ◽  
pp. 233-239 ◽  
Author(s):  
Ram Kossowsky ◽  
Manuel Dujovny ◽  
Nir Kossovsky ◽  
Yves Keravel
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Stress Corrosion ◽  
Fracture Mechanism ◽  
Intergranular Corrosion ◽  
Content Type ◽  
Aneurysm Clip ◽  
Stress Load ◽  
Highly Sensitive ◽  
Acute Subarachnoid Hemorrhage ◽  
Fine Print

✓ A 16-year-old girl died from an acute subarachnoid hemorrhage following the fracture of a blade of a Heifetz aneurysm clip. The clip was manufactured from 17-7PH steel, which on metallurgical testing was found to be highly sensitive to intergranular corrosion. The fracture mechanism was stress corrosion, brought on by the combination of a stress load, an electrolytic environment, and a susceptible steel.

Subarachnoid hemorrhage from intracranial dissecting aneurysm

1984 ◽  
Vol 60 (2) ◽  
pp. 325-334 ◽  
Author(s):  
Allan H. Friedman ◽  
Charles G. Drake
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Arterial Occlusion ◽  
Dissecting Aneurysm ◽  
Content Type ◽  
Vertebrobasilar Circulation ◽  
Intracranial Dissecting Aneurysm ◽  
Fine Print

✓ Rupture of an intracranial dissecting aneurysm is a rare but dangerous event. The authors' experience with 14 cases of these lesions on the vertebrobasilar circulation suggests that these aneurysms have typical angiographic silhouettes and that, at least in the vertebral artery, they are treatable by proximal arterial occlusion.

Surgical anatomy of the cerebral arteries in patients with subarachnoid hemorrhage: comparison of computerized tomography angiography and digital subtraction angiography

2001 ◽  
Vol 95 (2) ◽  
pp. 206-212 ◽  
Author(s):  
Birgitta K. Velthuis ◽  
Maarten S. van Leeuwen ◽  
Theodoor D. Witkamp ◽  
Lino M. P. Ramos ◽  
Jan Willem Berkelbach van der Sprenkel ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ct Angiography ◽  
Computerized Tomography ◽  
Cerebral Arteries ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Content Type ◽  
Computerized Tomography Angiography ◽  
Vertebrobasilar Artery ◽  
Fine Print

Object. The purpose of this study was to compare computerized tomography (CT) angiography and digital subtraction (DS) angiography studies in patients with subarachnoid hemorrhage (SAH) to assess their vascular anatomy relevant to cerebral aneurysm surgery. Methods. From a prospective series of 100 patients with SAH, the authors selected 73 patients whose CT angiography studies were of adequate quality and in whom DS angiography of both carotid arteries had been performed. Eleven patients with no DS angiographic studies of the vertebrobasilar artery were only evaluated for the anterior half of the circle of Willis. Anterior communicating arteries (ACoAs), both precommunicating anterior cerebral arteries (A1 segments), both posterior communicating arteries (PCoAs), and both precommunicating posterior cerebral arteries (P1 segments) were assessed on CT angiography and DS angiography by two independent observers. Conclusions. Computerized tomography angiography compares well with DS angiography for visualizing normal-sized arteries, and is superior for visualizing ACoAs and hypoplastic A1 and P1 segments. Important preoperative aspects such as dominant A1 segments and PCoAs are equally well seen using either modality. Neither method enabled the authors to visualize more than 50% of PCoAs. Use of CT angiography can provide the required preoperative anatomical information for aneurysm surgery in most patients with SAH.

Nizofenone administration in the acute stage following subarachnoid hemorrhage

1986 ◽  
Vol 64 (3) ◽  
pp. 420-426 ◽  
Author(s):  
Tomio Ohta ◽  
Haruhiko Kikuchi ◽  
Kazuo Hashi ◽  
Yoshio Kudo
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Placebo Treatment ◽  
Clinical Findings ◽  
Acute Stage ◽  
Test Drug ◽  
Double Blind ◽  
Content Type ◽  
Significant Difference ◽  
Grade Ii ◽  
Fine Print

✓ A multi-center controlled double-blind clinical study was carried out to evaluate the effects of nizofenone in patients with subarachnoid hemorrhage who were treated within 2 weeks of the ictus. The test drug was administered as an addition to conventional therapy, which was maintained during the study. Of 208 patients studied, 102 were treated with nizofenone and 106 with placebo. Treatment with nizofenone was significantly more effective (p < 0.05) than that with placebo based on functional recovery and other clinical findings. Although no significant difference was found in mortality rate between the nizofenone- and placebo-treated groups, a higher percentage of survivors in the former group exhibited a good outcome (p < 0.05). The effects of nizofenone administration were found to be especially notable in patients with delayed ischemic symptoms, moderately severe preoperative deficits (Hunt and Hess Grade II or III), and diffuse high-density areas in preand postoperative computerized tomography scans. No significant side effects were observed.

Harvey W. Cushing and cerebrovascular surgery: Part I, aneurysms

2004 ◽  
Vol 101 (3) ◽  
pp. 547-552 ◽  
Author(s):  
Aaron A. Cohen-Gadol ◽  
Dennis D. Spencer
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracranial Aneurysms ◽  
Surgical Techniques ◽  
Cerebral Aneurysms ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Cerebrovascular Surgery ◽  
Neurological Surgery ◽  
Modern Era ◽  
Fine Print

✓ The development of surgical techniques for the treatment of intracranial aneurysms has paralleled the evolution of the specialty of neurological surgery. During the Cushing era, intracranial aneurysms were considered inoperable and only ligation of the carotid artery was performed. Cushing understood the limitations of this approach and advised the need for a more thorough understanding of aneurysm pathology before further consideration could be given to the surgical treatment of cerebral aneurysms. Despite his focus on brain tumors, Cushing's contributions to the discipline of neurovascular surgery are of great importance. With the assistance of Sir Charles Symonds, Cushing described the syndrome of subarachnoid hemorrhage. He considered inserting muscle strips into cerebral aneurysms to promote aneurysm sac thrombosis and designed the “silver clip,” which was modified by McKenzie and later used by Dandy to clip the first intracranial aneurysm. Cushing was the first surgeon to wrap aneurysms in muscle fragments to prevent recurrent hemorrhage. He established the foundation on which pioneers such as Norman Dott and Walter Dandy launched the modern era of neurovascular surgery.

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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