scholarly journals Case Report: De novo Vertebral Artery Dissection After Intravascular Stenting of the Contralateral Unruptured Vertebral Artery Aneurysm

2021 ◽  
Vol 12 ◽  
Author(s):  
Wei You ◽  
Junqiang Feng ◽  
Qinglin Liu ◽  
Xinke Liu ◽  
Jian Lv ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
De Novo ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Artery Dissection ◽  
Vertebrobasilar Artery ◽  
Fourth Segment ◽  
Stress Changes ◽  
The Right ◽  
Vertebral Artery Dissecting Aneurysm

Spontaneous vertebral artery dissecting aneurysm has been increasingly attributed as a major cause of focal neurological deficits due to vertebrobasilar artery ischemia or subarachnoid hemorrhage (SAH). Although the development of spontaneous vertebral artery dissecting aneurysm (VADA) is rare, de novo VADA after treatment of contralateral vertebral artery (VA) is more less frequently observed. There are only a few reports related to de novo VADA after treatment of the contralateral VA in the medical literature. The mechanisms responsible for de novo dissection after treatment of unilateral VADA are still not clearly understood. In this manuscript, we report an unusual case of a patient with a de novo VADA after placement of a pipeline embolization device (PED) stent on the contralateral VA along with a thorough review of the literature. A 42-years old male patient was referred to the hospital with sudden onset of dizziness, nausea, and vomiting. Initial digital subtraction angiography (DSA) images demonstrated a VADA in the fourth segment of the left VA without the involvement of the posterior inferior cerebellar artery (PICA). There were no significant abnormalities found in the right vertebral artery. He underwent an endovascular pipeline embolization to treat the dissecting aneurysm (DA). Surprisingly, follow-up DSA imaging 14 months after the initial treatment showed a segmental dilatation and narrowing of the right VA, which suggested a de novo VADA on the right side that had occurred postoperatively. This was followed by a tent-assisted coil embolization therapy for occluding this de novo VADA. This patient showed an uneventful postoperative course with no neurological abnormalities. In addition to hemodynamic stress changes, the unique clinicopathological features of dissecting aneurysms may contribute significantly to the pathogenesis of de novo VA dissection. Given that VA in VADA patients may be vulnerable on both sides, it is important to consider the risk of de novo dissection after initial aneurysm treatment. The bilateral vertebral artery has to be carefully observed when treating any VADA patient to prevent any complications.

Clinical and radiological risk factors for rupture of vertebral artery dissecting aneurysm: significance of the stagnation sign

2021 ◽  
pp. 1-6
Keyword(s):  
Risk Factors ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Significant Risk Factor ◽  
Tertiary Hospital ◽  
Dissecting Aneurysm ◽  
Irregular Surface ◽  
Vertebral Artery Dissecting Aneurysm

OBJECTIVE The aim of this study was to investigate the clinical and radiological factors associated with the rupture of a vertebral artery dissecting aneurysm (VADA) and to evaluate whether the stagnation sign is a significant risk factor for rupture of VADA. METHODS Clinical and radiological variables of 117 VADAs treated in a tertiary hospital from September 2008 to December 2020 were retrospectively reviewed. The stagnation sign is defined as the finding of contrast agent remaining in the lesion until the venous phase of angiography. Univariate and multivariate analyses were executed to reveal the associations between rupture status and VADA characteristics. RESULTS The rate of ruptured VADAs was 29.1% (34 of 117) and the stagnation sign was observed in 39.3% (46 of 117). Fusiform shape (OR 5.105, 95% CI 1.591–16.383, p = 0.006), irregular surface (OR 4.200, 95% CI 1.412–12.495, p = 0.010), posterior inferior cerebellar artery (PICA) involvement (OR 3.788, 95% CI 1.288–11.136, p = 0.016), and the stagnation sign (OR = 3.317, 95% CI 1.131–9.732, p = 0.029) were significantly related to rupture of VADA in multivariate logistic regression analysis. CONCLUSIONS This study showed that fusiform shape, irregular surface, PICA involvement, and the stagnation sign may be independent risk factors for the rupture of VADA. Therefore, when the potential risk factors are observed in unruptured VADA, more aggressive treatment rather than follow-up or medical therapy may be considered.

scholarly journals A case of unilateral vertebral artery dissection progressing in a short time period to bilateral vertebral artery dissection

2019 ◽  
Vol 10 ◽  
pp. 126
Author(s):  
Kiyoshi Tsuji ◽  
Akira Watanabe ◽  
Nobuhiro Nakagawa ◽  
Amami Kato
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
De Novo ◽  
Vertebral Artery Dissection ◽  
Contralateral Side ◽  
Sudden Onset ◽  
Acute Stage ◽  
Artery Dissection ◽  
Lateral Medullary Infarction ◽  
The Right

Background: Vertebral artery dissection (VAD) is an important cause of stroke in young and middle- aged people. Bilateral occurrence of VAD is generally considered rare, but the number of reports of bilateral VAD has been increasing in recent years. In this paper, we report a case of de novo VAD on the contralateral side presenting with subarachnoid hemorrhage in the acute stage of cerebral infarction due to unilateral VAD. Case Description: A 52-year-old man developed sudden-onset left occipital headache, dizziness, dysphagia, and right-sided hemiparesthesia and was admitted to our hospital. Head magnetic resonance imaging on admission showed a left lateral medullary infarction due to the left VAD. At this point, the right vertebral artery was normal. However, on day 9 after onset, he suddenly presented with subarachnoid hemorrhage due to the right VAD. Emergency endovascular treatment was performed for the dissecting aneurysm of the right vertebral artery. The patient’s condition improved gradually after the procedure, and he was discharged with a modified Rankin Scale score of 1. Conclusion: Bilateral occurrence of VAD may be more common than previously believed. Even in cases of unilateral VAD, we need to pay attention to the occurrence of de novo VAD on the contralateral side.

scholarly journals Dissecting Aneurysm of the Vertebral Artery Developed after Microvascular Decompression for Hemifacial Spasm

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 145-147 ◽  
Author(s):  
T. Kudo ◽  
K. Iihara ◽  
K. Murao ◽  
K. Hayashi ◽  
J. Ayabe ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
De Novo ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Root Exit Zone ◽  
Detachable Coils ◽  
One Year

We report a rare case of a ruptured de novo dissecting aneurysm induced by ethyl 2-cyanoacrylate. A 39-year-old woman underwent microvascular decompression for left hemifacial spasm. The offending vessel was left posterior inferior cerebellar artery (PICA). Left vertebral artery (VA) was mobilized and affixed to the dura mater with cyanoacrylate to remove pressure of PICA to the root exit zone of the facial nerve. The left VA was found to be intact at the time of the operation. One year later, the patient sufferd subarachnoid haemorrhage (SAH) caused by rupture of a newly-developed dissecting aneurysm of the left VA. Endovascular occlusion of the dissecting site was performed using Guglielmi detachable coils. We suppose mechanical injury and chemical reaction of ethyl 2-cyanoacrylate induced dissecting aneurysm.

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 Successful endovascular treatment of a dissecting aneurysm of vertebral artery associated with double origin of the posterior inferior cerebellar artery

2015 ◽  
Vol 22 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Yasuhiro Kawabata ◽  
Tetsuya Tsukahara ◽  
Shunichi Fukuda ◽  
Satoru Kawarazaki ◽  
Tomokazu Aoki
Keyword(s):  
Vertebral Artery ◽  
Clinical Presentation ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Left Vertebral Artery ◽  
Cerebellar Artery ◽  
Transient Loss ◽  
Magnetic Resonance Imaging Mri ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Double Origin

Background Double origin of the posterior inferior cerebellar artery (DOPICA) has been rarely reported in the literature, with a reported incidence of 1.45%. In contrast, a high concurrence rate of DOPICA and vertebral artery dissecting aneurysm has been reported. Clinical presentation A 61-year old woman presented with vomiting and diplopia with preceding headache. Magnetic resonance imaging (MRI) showed fresh infarction of the left lateral medulla and a vertebral artery dissecting aneurysm of the left vertebral artery. The next day, she exhibited transient loss of consciousness and worsening of headache, and MRI depicted subarachnoid hemorrhage. Four-vessel digital subtraction angiography showed a posterior inferior cerebellar artery (PICA) arising both intracranially and extracranially from the left vertebral artery. Although the dissecting lesion involved the V3 and V4 portion, it did not involve an extracranially originating PICA. Internal trapping of the V3 and V4 portion was chosen as the extracranial channel was expected to supply the PICA territory. This procedure was safely performed. Conclusion Early endovascular intervention should be considered in the treatment of dissecting aneurysm of vertebral artery associated with DOPICA for patients with relatively long lesions even in unruptured cases.

scholarly journals Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery

2020 ◽  
Vol 15 (2) ◽  
pp. 84-88
Author(s):  
Toshitsugu Terakado ◽  
Yasunobu Nakai ◽  
Go Ikeda ◽  
Kazuaki Tsukada ◽  
Sho Hanai ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Careful Attention ◽  
Parent Artery Occlusion ◽  
Cerebellar Artery ◽  
Vertebral Artery Dissecting Aneurysm ◽  
Vertebral Artery Stenting

We herein report a case of a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery that was treated using the stent-jack technique. After parent artery occlusion of the distal vertebral artery, stenting of the posterior inferior cerebellar artery was performed. Further coiling was needed because distal vertebral artery recanalization occurred due to transformation of the coil mass. The stent-jack technique for a ruptured vertebral artery dissecting aneurysm involving the origin of the posterior inferior cerebellar artery is effective; however, careful attention to recanalization after stenting is needed due to transformation of the coil mass.

scholarly journals Stent-assisted coil embolization of unruptured vertebral artery dissecting aneurysms with the low-profile visualized intraluminal support stent, with five techniques: Technical note and case report

2019 ◽  
Vol 10 ◽  
pp. 105
Author(s):  
Ryosuke Maeoka ◽  
Ichiro Nakagawa ◽  
Koji Omoto ◽  
Takeshi Wada ◽  
Kimihiko Kichikawa ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
High Morbidity ◽  
Low Profile ◽  
Ischemic Complications ◽  
Wall Apposition ◽  
Vertebral Artery Dissecting Aneurysm

Background: Intracranial vertebral artery dissecting aneurysm (VADA) is rare and shows high morbidity and mortality rates when the aneurysm ruptures. Endovascular treatment for VADA is one of the optimal treatments, but the dominant side VA and its branches or perforators need to be preserved. We report a novel and successful stent-assisted coil embolization technique using the low-profile visualized intraluminal support (LVIS) stent, with five technical notes in three consecutive cases of unruptured vertebral artery dissecting aneurysm (VADA). Case Description: We report three consecutive cases of unruptured VADA which involved a posterior inferior cerebellar artery (PICA), an anterior spinal artery, and perforators. Stent-assisted coil embolization with the LVIS stent was performed in all patients. The stent was carefully placed to obtain parent artery wall apposition at distal portion and with moderate pushing at aneurysm portion. The LVIS stent was placed with tailor-made wall apposition at perforating arterial side in the barrel view, and coil embolization was performed avoiding doughnut-like stent form to prevent perforator infarcts. All cases showed complete occlusion of the aneurysms with preservation of both parent artery and its branches and perforators patency. In three cases, clinical presentations were improved without ischemic complications. The median follow-up period was 1 year. At present, no recurrence and no complication have been observed. Conclusion: We demonstrate the coil embolization of VADA using LVIS stent with five techniques. Our techniques for the treatment of VADA using LVIS stent are safe and can minimize ischemic complications by creating suitable wall apposition to the orifices of branches or perforators.

scholarly journals A Case of a De Novo Vertebral Artery Dissecting Aneurysm after Trapping of the Contralateral Vertebral Artery Dissecting Aneurysm

2016 ◽  
Vol 44 (5) ◽  
pp. 395-400
Author(s):  
Hiroki MATSUI ◽  
Akihiko HINO ◽  
Kengo HIROTA ◽  
Tadashi ECHIGO ◽  
Hideki OKA ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
De Novo ◽  
Dissecting Aneurysm ◽  
Vertebral Artery Dissecting Aneurysm
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