scholarly journals Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

2021 ◽  
Vol 12 ◽  
Author(s):  
Jens Maybaum ◽  
Hans Henkes ◽  
Marta Aguilar-Pérez ◽  
Victoria Hellstern ◽  
Georg Alexander Gihr ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Main Pulmonary Artery ◽  
Clinical History ◽  
Complete Recovery ◽  
Flow Diversion ◽  
University Hospital ◽  
Target Segment ◽  
Dissecting Aneurysms

Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH.Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study.Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon-expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5).Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment.

LVIS-within-enterprise double-stent procedure without coiling beneficial as treatment of unruptured vertebral artery dissecting aneurysms

2021 ◽  
pp. 159101992110251
Author(s):  
Hyun Ho Choi ◽  
Young Dae Cho ◽  
Dong Hyun Yoo ◽  
Hyun-Seung Kang ◽  
Moon Hee Han
Keyword(s):  
Vertebral Artery ◽  
Clinical Outcomes ◽  
Local Anesthesia ◽  
Thrombus Formation ◽  
Flow Diversion ◽  
Fusiform Aneurysm ◽  
Stent Deployment ◽  
Double Stent ◽  
Dissecting Aneurysms

Stenting of vertebral artery dissecting aneurysms (VADAs) may promote mural apposition of intimal flaps, preserving the patency of injured vessels. Moreover, stent deployment may serve to alter intra-aneurysm flow, inducing saccular thrombus formation, neointimal development, and remodeling of injured vessels. Although an overlapping multistent strategy with coiling has proven successful in this setting, yielding good anatomic and clinical outcomes, coiling may be technically infeasible in some VADAs with unfavorably configured circumferential elevations. Herein, we describe three patients with VADAs for whom coiling was deemed technically problematic. Each underwent double stenting (LVIS within Enterprise), without coil insertion, using local anesthesia. Conventional angiographic follow-up regularly disclosed excellent saccular occlusion and subsequent remodeling of stented arteries. LVIS-within-Enterprise double stenting may be of particular benefit in patients with VADAs, the Enterprise providing outer support to minimize stent bulging (as a fusiform aneurysm) as the inner LVIS reinforces flow diversion.

Endovascular Treatment of Bilateral Intracranial Vertebral Artery Dissecting Aneurysms Presenting With Subarachnoid Hemorrhage

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons75-ons81 ◽  
Author(s):  
Yong Sam Shin ◽  
Byung Moon Kim ◽  
Se-Hyuk Kim ◽  
Sang Hyun Suh ◽  
Chang Woo Ryu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Endovascular Treatment ◽  
Vertebral Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Stent Insertion ◽  
Treatment Methods ◽  
Cerebellar Artery ◽  
Endovascular Methods ◽  
Dissecting Aneurysms

Abstract BACKGROUND: Optimal management of bilateral vertebral artery dissecting aneurysms (bi-VDAs) causing subarachnoid hemorrhage (SAH) remains unclear. OBJECTIVE: To investigate the treatment methods and outcomes of bi-VDA causing SAH. METHODS: Seven patients were treated endovascularly for bi-VDA causing SAH. Treatment methods and outcomes were evaluated retrospectively. RESULTS: Two patients were treated with 2 overlapping stents for both ruptured and unruptured VDAs, 2 with 2 overlapping stents and coiling for ruptured VDA and with conservative treatment for unruptured VDA, 1 with internal trapping (IT) for ruptured VDA and stent-assisted coiling for unruptured VDA, 1 with IT for ruptured VDA and 2 overlapping stents for unruptured VDA, and 1 with IT for ruptured VDA and a single stent for unruptured VDA. None had rebleeding during follow-up (range, 15-48 months). All patients had favorable outcomes (modified Rankin Scale score, 0-2). On follow-up angiography at 6 to 36 months, 9 treated and 2 untreated VDAs revealed stable or improved state, whereas 3 VDAs in 2 patients showed regrowth. Of the 3 recurring VDAs, 1 was initially treated with IT but recurred owing to retrograde flow to the ipsilateral posterior inferior cerebellar artery (PICA), the second was treated with single stent but enlarged, and the last was treated with 2 overlapping stents and coiling but recurred from the remnant sac harboring the PICA origin. All 3 recurred VDAs were retreated with coiling with or without stent insertion. CONCLUSION: Bilateral VDAs presenting with SAH were safely treated with endovascular methods. However, endovascular treatment may be limited for VDAs with PICA origin involvement.

Subarachnoid hemorrhage due to rupture of vertebral artery dissecting aneurysms: Treatments, outcomes, and prognostic factors

2021 ◽  
Author(s):  
Masaaki Korai ◽  
Yasuhisa Kanematsu ◽  
Izumi Yamaguchi ◽  
Tadashi Yamaguchi ◽  
Yuki Yamamoto ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Dissecting Aneurysms

Intracranial vertebral artery dissection resulting in fatal subarachnoid hemorrhage: clinical and histopathological investigations from a medicolegal perspective

2009 ◽  
Vol 110 (5) ◽  
pp. 948-954 ◽  
Author(s):  
Ayako Ro ◽  
Norimasa Kageyama ◽  
Nobuyuki Abe ◽  
Akihiro Takatsu ◽  
Tatsushige Fukunaga
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Clinical Features ◽  
Cross Sections ◽  
Fatal Outcome ◽  
Vertebral Artery Dissection ◽  
Clinical History ◽  
Clinical Diagnostics ◽  
Artery Dissection ◽  
Prodromal Symptoms

Object Subarachnoid hemorrhage (SAH) due to a ruptured intracranial vertebral artery (VA) dissection sometimes results in a sudden fatal outcome. The authors analyzed the relationship between clinical features and histopathological characteristics among fatal cases to establish valuable information for clinical diagnostics and prophylaxis. Methods This study included 58 medicolegal autopsy cases of ruptured intracranial VA dissection among 553 fatal nontraumatic cases of SAH that occurred between January 2000 and December 2007. Their clinical features were obtained from autopsy records. Histopathological investigations were performed on cross-sections obtained from all 4-mm segments of whole bilateral intracranial VAs and prepared with H & E and elastica van Gieson staining. Results The autopsy cases included 47 males and 11 females, showing a marked predilection for males. The mean age was 46.8 ± 7.7 years, with 78% of the patients in their 40s or 50s. Hypertension was the most frequently encountered history; it was found in 36% of cases from clinical history and in 55% of cases based on autopsy findings. Prodromal symptoms related to intracranial VA dissections were detected in 43% of patients. Headache or neck pain lasting hours to weeks was a frequent complaint. Of patients with prodromal symptoms, 44% had consulted doctors; however, in none of these was SAH or intracranial VA dissection diagnosed at a preventable stage. Autopsy revealed fusiform aneurysms with medial dissecting hematomas. Apart from ruptured intracranial VA dissection, previous intracranial VA dissection was detected in 25 cases (43%); among them, 10 showed previous dissection of the bilateral intracranial VAs. The incidence of prodromal symptoms (60%) among the patients with previous intracranial VA dissection was significantly higher than that (30%) among cases without previous dissection (chi-square test; p = 0.023). Most previous intracranial VA dissections formed a single lumen resembling nonspecific atherosclerotic lesions, with the exception of 3 cases (12%) with a double lumen. Conclusions Intracranial VA dissection resulting in fatal SAH frequently affects middle-aged men with untreated hypertension. Related to the high frequency of prodromal symptoms, latent previous intracranial VA dissection was histopathologically detected. Furthermore, intracranial VA dissection tends to induce multiple lesions affecting both intracranial VAs recurrently. This suggests the importance of an awareness of sustained whole intracranial VA vulnerability for the prevention of recurrence. The incidence of prodromal symptoms was significantly higher among patients with previous intracranial VA dissections. Thus, earlier diagnosis of intracranial VA dissections at the unruptured stage is desirable for prophylaxis against fatal SAH.

scholarly journals A Clinical and Pathological Study of Kikuchi–Fujimoto Disease in A University Hospital in Saudi Arabia

2018 ◽  
Vol 25 (1) ◽  
pp. 23-29
Author(s):  
Fahad A. Alghamdi ◽  
Mohammed S. Abdelwahed ◽  
Abdulaziz Alghamdi ◽  
Hani z. Marzouki ◽  
Ghadeer A. Mokhtar ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Retrospective Study ◽  
Histopathological Examination ◽  
Complete Recovery ◽  
Benign Disease ◽  
University Hospital ◽  
Pathological Features ◽  
Pathological Study ◽  
King Abdulaziz University ◽  
Clinical And Pathological Features

Kikuchi–Fujimoto disease is a benign disease of self-limiting course characterized by lymphadenopathy that is often mistaken clinically as lymphoma or infectious lymphadenitis. To prevent such a mistake, a clinical and pathological correlation is recommended. In this retrospective study, we are documenting the clinical and pathological features of this disease through the last 15 years (2001-2016) in King Abdulaziz University Hospital; and comparing results with that of international findings. From a total number of 1805 lymph nodes sent for histopathological examination during that period, only 9 cases had been diagnosed as Kikuchi–Fujimoto disease. Three (33%) cases were 20 years old and under; five (56%) cases were in the ages between 20 to 40 years old and only one (11%) was above 40 years old. Eight (89%) cases were females. Regarding the outcome, all cases showed complete recovery and there was no recurrence. Only two histological phases were seen, namely proliferative and necrotizing phases.  

Characteristics of Distal Posteroinferior Cerebellar Artery Aneurysms

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 589-596 ◽  
Author(s):  
Tetsuyoshi Horiuchi ◽  
Yuichiro Tanaka ◽  
Kazuhiro Hongo ◽  
Junpei Nitta ◽  
Yoshikazu Kusano ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Surgical Outcome ◽  
Intracranial Aneurysms ◽  
Obstructive Hydrocephalus ◽  
Large Series ◽  
University Hospital ◽  
Ruptured Aneurysms ◽  
Cerebellar Artery ◽  
Pica Aneurysms ◽  
Dissecting Aneurysms

Abstract OBJECTIVE Distal posteroinferior cerebellar artery (PICA) aneurysms are rare and have not been well investigated previously. We report our series of 24 patients with 27 distal PICA aneurysms. METHODS All patients with distal PICA aneurysms that were surgically treated at Shinshu University Hospital and its affiliated hospitals between 1983 and 2001 were reviewed retrospectively. Data relating to clinical, radiological, and intraoperative findings were analyzed. RESULTS In our series, distal PICA aneurysms reached an incidence of 0.28 and 0.38% of all intracranial aneurysms and ruptured aneurysms, respectively. There were 23 ruptured and 4 unruptured distal PICA aneurysms. Of these, 74.1% were saccular, 7.4% fusiform, and 18.5% dissecting aneurysms. Primarily the telovelotonsillar segment of the PICA was affected. Usually, the surgical outcome was favorable and was influenced by the obstructive hydrocephalus and the preoperative grade. It was sometimes difficult to detect the ruptured distal PICA aneurysm on the initial angiogram, and an extracranial origin of the PICA was sometimes observed. CONCLUSION This review summarizes the presentation and outcome of a large series of 24 patients with 27 distal PICA aneurysms, and we conclude that distal PICA aneurysms are benign entities compared with vertebral artery-PICA aneurysms. Characteristics that should be considered in the treatment of distal PICA aneurysms are discussed.

scholarly journals Single-stage endovascular treatment of subarachnoid hemorrhage related to bilateral vertebral artery dissecting aneurysms

2015 ◽  
Vol 22 (2) ◽  
pp. 138-142 ◽  
Author(s):  
Wen-Yuan Zhao ◽  
Kai-Jun Zhao ◽  
Qing-Hai Huang ◽  
Yi Xu ◽  
Bo Hong ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Case Series ◽  
Single Stage ◽  
Neurological Deficits ◽  
Cross Sectional ◽  
Hemodynamic Stress ◽  
Scale Scores ◽  
Acute Subarachnoid Hemorrhage ◽  
Dissecting Aneurysms

Objective Treatment of bilateral vertebral artery dissecting aneurysms presenting with subarachnoid hemorrhage remains challenging as bilateral deconstructive procedures may not be feasible. In this case series, we describe our approach to their management and review the pertinent literature. Method A retrospective review of our prospectively collected database on aneurysms was performed to identify all patients with acute subarachnoid hemorrhage in the setting of bilateral intradural vertebral artery dissections (VAD) encompassing a period from January 2000 and March 2012. Result Four patients (M/F = 2/2; mean age, 51.5 years) were identified. In two cases the site of rupture could be identified by angiographic and cross-sectional features; in these patients deconstructive treatment (proximal obliteration or trapping) of the ruptured site and reconstructive treatment of the unruptured site (using stents and coils) were performed. In the patients in whom the site of hemorrhage could not be determined, bilateral reconstructive treatment was performed. No treatment-related complications were encountered. Modified Rankin scale scores were 0–1 at discharge, and on follow-up (mean 63 months), no recurrence, in-stent thrombosis or new neurological deficits were encountered. Conclusion We believe that single-stage treatment in patients with bilateral VAD is indicated: If the site of hemorrhage can be determined, we prefer deconstructive treatment on the affected site and reconstructive treatment on the non-affected site to prevent increased hemodynamic stress on the unruptured but diseased wall. If the site of dissection cannot be determined, we prefer bilateral reconstructive treatment to avoid increasing hemodynamic stress on the potentially untreated acute hemorrhagic dissection.

Sign in / Sign up

Export Citation Format

Share Document