scholarly journals Possibility of Worsening Flow Diversion Effect Due to Morphological Changes of a Stented Artery With Multiple Overlapping Stents for Partially Thrombosed Vertebral Artery Aneurysms

2020 ◽  
Vol 11 ◽  
Author(s):  
Tomoaki Suzuki ◽  
Hitoshi Hasegawa ◽  
Kazuhiro Ando ◽  
Kouhei Shibuya ◽  
Haruhiko Takahashi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Morphological Changes ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Aneurysm Neck ◽  
Low Profile ◽  
Computational Fluid Dynamics Analysis ◽  
Recurrent Case ◽  
Negative Effect ◽  
Altered Blood

Background: Morphological changes of a stented artery can cause a flow diversion effect to reduce intra-aneurysmal flow; however, there is a potential for the negative effect of increased intra-aneurysmal flow. We present cases with multiple overlapping stents for a partially thrombosed vertebral artery aneurysm and characterize the hemodynamic properties of a recurrent case by focusing on the morphological changes of the stented artery.Methods: Between October 2017 and April 2019, four consecutive cases of symptomatic unruptured large and giant partially thrombosed vertebral artery aneurysms were treated with multiple overlapping low-profile visualized intraluminal support stents and no coils. Both angiographic and clinical outcomes were assessed. Computational fluid dynamics analysis was performed to clarify hemodynamic features. The degree of pressure elevation was calculated as the pressure difference (Pd). Wall shear stress (WSS) was also calculated.Results: In three of the four cases, successful flow reduction was achieved with no morphological change of the stented arteries. The patients' symptoms were gradually improved. The remaining case required additional stents after the initial treatment. In the recurrent case, Pd was noticeably elevated at the aneurysm neck after treatment, and WSS was generally increased in the area due to altered blood flow into the aneurysm dome caused by morphological changes of the stented artery.Conclusion: Overlapping stents can be used for the treatment of large and giant thrombosed vertebral artery aneurysms with flow diversion effect; however, morphological changes of the stented artery requires careful attention as it may lead to an increase in the intra-aneurysmal flow, causing negative outcomes.

scholarly journals Hemodynamic Effect of the Last Finishing Coils in Packing the Aneurysm Neck

2020 ◽  
Vol 11 ◽  
Author(s):  
Hailin Wan ◽  
Gang Lu ◽  
Lei Huang ◽  
Liang Ge ◽  
Yeqing Jiang ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Computational Study ◽  
Artery Aneurysm ◽  
Finite Element Method Simulation ◽  
Hemodynamic Effect ◽  
Aneurysm Neck ◽  
Low Profile ◽  
Hemodynamic Characteristics ◽  
Pre Treatment ◽  
Dynamics Models

Background: Using the finishing coils to densely pack the aneurysm neck is necessary. However, the exact hemodynamic effect of finishing coils in packing the aneurysm neck is unknown.Objective: To evaluate the hemodynamic characteristics of finishing coils to densely pack the aneurysm neck, using finite element method simulation.Methods: A computational study was performed based on a 44-year-old female patient with an unruptured wide-necked carotid-ophthalmic artery aneurysm treated with low-profile visualized intraluminal support stent-assisted coil embolization. Four computational fluid dynamics models including pre-treatment, post-stenting, common stent-assisted coil embolization (SACE), and common SACE with finishing coils were evaluated qualitatively and quantitatively.Results: Compared with the baseline of pretreatment model (100%), sac-averaged velocity in post-stenting, common SACE, and common SACE with finishing coil models decreased to 95.68%, 24.38%, and 13.20%, respectively; high flow volume (>0.1 m/s) around the aneurysm neck decreased to 92.19%, 9.59%, and 5.57%, respectively; and mean wall shear stress increased or decreased to 107%, 25.94%, and 23.89%, respectively.Conclusion: Finishing coils to densely pack the aneurysm neck can generate favorable hemodynamic modifications, which may decrease the recurrence.

Treatment of Extracranial Vertebral Artery Aneurysm with Flow Diversion

2020 ◽  
Vol 138 ◽  
pp. 328-331
Author(s):  
Han Wu ◽  
Mingyi Wang ◽  
Ke Li ◽  
Feng Wang
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Extracranial Vertebral Artery

scholarly journals Hemifacial spasm caused by vertebral artery aneurysm treated by endovascular coil embolization

2020 ◽  
Vol 11 ◽  
pp. 431
Author(s):  
Yu Iida ◽  
Kentaro Mori ◽  
Yosuke Kawahara ◽  
Issei Fukui ◽  
Katsuya Abe ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Aneurysm Neck ◽  
Parent Artery Occlusion ◽  
Endovascular Coil Embolization

Background: Hemifacial spasm (HFS) caused by vertebral artery (VA) aneurysms is rare. Several cases of HFS caused by VA aneurysms treated by endovascular parent artery occlusion (PAO) have been reported. Recently, we treated a rare case of HFS caused by a saccular VA aneurysm at the bifurcation of the posterior inferior cerebellar artery (PICA), which was successfully treated by endovascular coil embolization, preserving the parent artery, and PICA. We discuss endovascular treatment for HFS induced by VA aneurysms with a literature review. Case Description: A 59-year-old man presented with the left HFS persisting for 2 months. Magnetic resonance imaging revealed a left saccular VA-PICA aneurysm and demonstrated that a left facial nerve was compressed by the aneurysm at the root exit zone. Angiography revealed that the PICA was branching from the aneurysm neck. Endovascular coil embolization was performed using the balloon remodeling technique to preserve the left VA and PICA. HFS disappeared after treatment. Conclusion: Although microvascular decompression was commonly accepted for the standard treatment of HFS, coil embolization of aneurysms without PAO may be an effective treatment for HFS caused by VA aneurysms.

Contralateral vertebral approach for stenting and coil embolization of a large, thrombosed vertebral–posterior inferior cerebellar artery aneurysm

2007 ◽  
Vol 107 (6) ◽  
pp. 1214-1216 ◽  
Author(s):  
Robert D. Ecker ◽  
Ricardo A. Hanel ◽  
Elad I. Levy ◽  
L. Nelson Hopkins
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Ipsilateral Side ◽  
Aneurysm Neck ◽  
Cerebellar Artery

✓The authors report the successful staged stenting and coil embolization of a large vertebral artery–posterior inferior cerebellar artery (VA-PICA) aneurysm using the contralateral VA for access. A 67-year-old woman presented with a large ruptured VA-PICA aneurysm. Initial attempts to stent the wide-necked aneurysm from the ipsilateral side failed, so coil embolization of the dome was performed. During a second endovascular session, the aneurysm neck was successfully stented from the contralateral VA into the PICA. Six weeks later, coils were inserted into the aneurysm from the ipsilateral side. The coil result was stable at the 3-month follow-up examination.

Endovascular Flow Diversion for Hemifacial Spasm Induced by a Vertebral Artery Aneurysm: First Experience

2018 ◽  
Vol 17 (3) ◽  
pp. E115-E118
Author(s):  
David R Santiago-Dieppa ◽  
Marin A McDonald ◽  
Michael G Brandel ◽  
Robert C Rennert ◽  
Alexander A Khalessi ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Complete Resolution ◽  
Clinical Presentation ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Flow Diverting Stent

Abstract BACKGROUND AND IMPORTANCE Flow diversion for the treatment of aneurysm-induced hemifacial spasm (HFS) has not been previously described. CLINICAL PRESENTATION The authors present the case of a 60-yr-old woman who presented with 1 yr of progressive left HFS secondary to a vertebral artery aneurysm compressing the root entry zone of cranial nerve VII. The patient's aneurysm was successfully treated with a flow diverting stent. CONCLUSION In the immediate postoperative period, the patient had near complete resolution of her HFS symptoms. At her 6-mo follow-up the patient had no angiographic filling of the aneurysm and her HFS symptoms had completely resolved.

scholarly journals Coil embolization with overlapping horizontal low-profile stents to treat a giant thrombosed fetal posterior cerebral artery aneurysm using contralateral approach through anterior communicating artery: Case report

2021 ◽  
Vol 12 ◽  
pp. 347
Author(s):  
Yasuhisa Kanematsu ◽  
Kenji Shimada ◽  
Yoshiteru Tada ◽  
Masaaki Korai ◽  
Takeshi Miyamoto ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Coil Embolization ◽  
Posterior Cerebral Artery ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
First Case ◽  
Low Profile

Background: The treatment of internal carotid artery (ICA) – posterior communicating artery aneurysms (ICPC aneurysms) is challenging when a fetal posterior cerebral artery (PCA) arises from the saccular neck. This complex angioarchitecture renders endovascular approaches difficult. Giant thrombosed IC-PC aneurysms are also hard to treat by endovascular coiling because its flow-diversion effect is insufficient. Case Description: We report the first case of a ruptured giant thrombosed IC-PC aneurysm associated with a fetal PCA that was successfully treated by coil embolization with retrograde overlap horizontal stenting using low-profile stents introduced through the contralateral ICA. The aneurysm was completely occluded and follow-up MRI scans demonstrated the reduction of the aneurysmal size. Conclusion: Our technique is advantageous because low-profile stents can be used to treat lesions not accessible with flow-diverter stents due their presence in complex angioarchitectures, and overlap stenting may have flow-diversion effects that can result in the complete occlusion of giant thrombosed aneurysms.

Sign in / Sign up

Export Citation Format

Share Document