Intravascular ultrasonography-guided stent angioplasty of an extracranial vertebral artery dissection

2008 ◽  
Vol 109 (6) ◽  
pp. 1113-1118 ◽  
Author(s):  
Won-Ki Yoon ◽  
Young-Woo Kim ◽  
Sang-Don Kim ◽  
Ik-Seong Park ◽  
Min-Woo Baik ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Intravascular Ultrasonography ◽  
Stent Angioplasty ◽  
Posterior Neck ◽  
Extracranial Vertebral Artery ◽  
The Right

The authors report on a case of intravascular ultrasonography (IVUS)-guided stent angioplasty for iatrogenic extracranial vertebral artery (VA) dissection in a 49-year-old man after coil embolization for an unruptured aneurysm of the right posterior inferior cerebellar artery. Insignificant dissections occurred during the procedure. Postoperatively, the patient experienced gradually worsening posterior neck pain and headache, and follow-up angiography 8 months after the coil embolization revealed expansion of the dissection. The patient underwent stent angioplasty with IVUS guidance and his symptoms improved. To the authors' knowledge, this is the first report of IVUS-guided stent angioplasty of an extracranial VA dissection. It was safe and feasible to treat extracranial VA dissections with stent placement under IVUS guidance. Intravascular environments are in real time with IVUS, and this technique is useful in the confirmation of a true lumen and evaluation of appropriate stent apposition. More clinical experience with this technique is necessary and mandatory, and devices with smaller diameters with improved trackability are essential for further introduction of IVUS into the field of endovascular neurosurgery.

Spinal Cord Infarction in the Region of the Posterior Spinal Artery After Embolization for Vertebral Artery Dissection

2018 ◽  
Vol 15 (6) ◽  
pp. 701-710 ◽  
Author(s):  
Wataro Tsuruta ◽  
Tetsuya Yamamoto ◽  
Go Ikeda ◽  
Masayuki Sato ◽  
Yoshiro Ito ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Univariate Analysis ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Endovascular Surgery ◽  
Artery Dissection ◽  
Spinal Cord Infarction ◽  
Posterior Spinal Artery

AbstractBACKGROUNDEndovascular surgery for vertebral artery dissections (VADs) carries the risk of spinal cord infarction (SCI). Although SCI in the region of the anterior spinal artery (ASA) has been reported, SCI in the region of the posterior spinal artery (PSA) is rare.OBJECTIVETo investigate PSA infarction after endovascular surgery for VAD.METHODSInfarction in the region of the PSA after endovascular surgery for VADs carried out in consecutive 21 cases was investigated. The variables of aneurysmal location, status, intra-aneurysmal thrombosis, antithrombotic therapy, and endovascular procedure were investigated in relation to the occurrence of spinal cord or brain stem infarction.RESULTSThirteen cases were unruptured aneurysms, and 8, ruptured aneurysms. The endovascular surgical method was internal trapping in 10 cases, stent-assisted coil embolization in 8 cases, and proximal occlusion (PO) in 3 cases. Periprocedural symptomatic infarction was detected in 4 of the 21 cases (19%): 3 SCIs and 1 lower medulla infarction, after 1 stent-assisted coil embolization and 3 PO. All 3 symptomatic SCIs were PSA infarction. On univariate analysis, the variables of posterior inferior cerebellar artery-involved-type, PO, and intraprocedural proximal flow arrest were significantly correlated with occurrence of PSA infarction.CONCLUSIONPSA infarction after endovascular surgery for VAD seems not to be a rare potential complication. Insufficiency of collateral blood flow and artery-to-artery embolism due to intraprocedural flow stagnation of the VA seem to be the possible mechanisms of PSA infarction in addition to previously reported mechanisms such as direct obliteration by the embolic materials and extended thrombosis of the VA stump.

Republished: Delayed subarachnoid hemorrhage 7 years after cerebellar infarction from traumatic vertebral artery dissection

2016 ◽  
Vol 9 (4) ◽  
pp. e9-e9
Author(s):  
Michael A Silva ◽  
Alfred P See ◽  
Priyank Khandelwal ◽  
Nirav J Patel ◽  
Mohammad Ali Aziz-Sultan
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Cerebellar Infarction ◽  
Radiographic Evidence ◽  
Vessel Injury ◽  
Cerebellar Artery ◽  
The Right

Vertebral artery dissection (VAD) is an important cause of ischemic stroke and subarachnoid hemorrhage (SAH). Dissections presenting with ischemia rarely cause SAH after more than a few hours, especially without radiographic evidence of pseudoaneurysm. We successfully treated a patient for persistent vessel injury presenting with SAH 7 years after presenting with extracranial subocclusive dissection of the right vertebral artery and an associated right posterior inferior cerebellar artery stroke. This is one of only three reported cases of delayed SAH occurring more than 2 weeks after an initial ischemic presentation of a VAD, and the only one without radiographic evidence of pseudoaneurysm at standard follow-up duration.

scholarly journals Endovascular Management of Complete Vertebral Artery Dissection Presenting with Subarachnoid Haemorrhage

1999 ◽  
Vol 5 (2) ◽  
pp. 161-166 ◽  
Author(s):  
R.K. Lenthall ◽  
B.D. White ◽  
N.S. McConachie
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Endovascular Techniques ◽  
First Case ◽  
Surgical Clip ◽  
Cerebellar Artery ◽  
The Right

Spontaneous vertebral artery (VA) dissection may involve the intradural segment of the VA and result in subarachnoid haemorrhage (SAH). These lesions are frequently associated with recurrent SAH, and have a high mortality. Prior to the development of endovascular techniques the majority of these lesions were treated surgically. In cases where the dissection involved the posterior inferior cerebellar artery (PICA) origin surgery was associated with significant complications including recurrent SAH from retrograde VA flow into the dissected segment above the surgical clip. We describe two cases of complete VA dissection in which the entire intradural VA was sacrificed to prevent recurrent SAH. The first case tolerated planned left PICA occlusion without developing a significant neurological deficit. The second case had infarcted the right PICA territory at presentation.

scholarly journals Threat of a Cycle Proof: Vertebral Artery Dissection Associated with Posterior Inferior Cerebellar Artery Infarction

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Francisco Monteiro ◽  
Pedro Oliveira ◽  
Artur Condé
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Imaging Studies ◽  
Cerebellar Artery ◽  
The Face ◽  
Extracranial Vertebral Artery ◽  
High Degree ◽  
Peripheral Vertigo

This paper presents a case of a perfectly healthy 36-year-old male, who went to the emergency department with a clinical picture of diffuse headache, dizziness, and asthenia with 3 days of evolution, after a long cycling race. He was admitted to the ENT Department with suspected diagnosis of peripheral vertigo. The patient developed hypoesthesia of the face, diplopia, right lateropulsion, and Romberg with preferential rightward fall, and imaging studies demonstrated an extracranial vertebral artery dissection concomitant with PICA territory infarction. This is a rare described case of a vertebral artery dissection concomitant with an infarction of the PICA territory. This case demonstrates the importance of maintaining a high degree of suspicion of stroke in patients with signs/symptoms of nystagmus/vertigo and the relevance of magnetic resonance imaging instead of tomography in the detection of these serious clinic conditions.

Extracranial vertebral artery dissection after trauma: A 5-year review

1997 ◽  
Vol 84 (1) ◽  
pp. 94-94 ◽  
Author(s):  
L. C. Thibodeaux ◽  
A. T. Hearn ◽  
J. L. Peschiera ◽  
R. M. Deshmukh ◽  
G. M. Kerlakian ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Vertebral Artery Dissection ◽  
Artery Dissection ◽  
Extracranial Vertebral Artery

scholarly journals Cerebellar infarction after sneezing

2020 ◽  
Vol 66 (10) ◽  
pp. 1351-1354
Author(s):  
Gustavo Bittencourt Camilo ◽  
Marco Antônio Riccio ◽  
Anna Luíza Machado Nogueira ◽  
Amanda Campos Querubino ◽  
Ana Luísa dos Santos Maciel ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Lumbar Disc ◽  
Vertebral Artery Dissection ◽  
Rare Condition ◽  
Artery Dissection ◽  
Cerebellar Infarction ◽  
Herniated Lumbar Disc ◽  
Angio Ct ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

SUMMARY Vertebral Artery Dissection (VAD) is a rare condition that can be caused by a wide amplitude of neck movement, which injures the vessel wall and can cause ischemia in the cerebellum. We present a 37-year-old man with herniated lumbar disc and allergic rhinosinusitis, which caused sneezing spells. After one of these bouts with a ricochet of the head, he presented C3 misalignment with local pain. Twenty-one days later, affected by a new crisis, he presented left temporal headache, nystagmus, and vertigo. After 3 days, Magnetic Resonance Imaging (MRI) identified 2 regions of cerebellar ischemia and filling failure of the right vertebral artery. After 2 days, Computed Angiotomography (CT Angiography) was performed and showed right VAD with a local thrombus, without aneurysmal signs. Transcranial Doppler did not indicate an increase in blood flow from this artery. The suggested treatment involved administration of anticoagulant Apixabana 5mg, 12/12h, for 3 months, until the condition was reevaluated with new Angio CT and MRI. It was recommended that the patient was released from work for 1 month and forbidden from doing intense physical exercises for 3 months; however, due to setbacks, these deadlines were extended until a new appointment, 4 months after the first visit. The new tests showed no changes, indicating that the condition was stable. This case aims to indicate the possible investigations of the diagnosis and therapeutic options of the rare association between VAD with cerebellar infarction in a well-documented case.

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