Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysm Arising from a Vertebral Artery-Bihemispheric Posterior Inferior Cerebellar Artery Bifurcation

ABSTRACTAlthough the anatomy of the posterior inferior cerebellar artery (PICA) is highly variable, a solitary PICA supplying both hemispheres of the cerebellum is rare. A 76-year-old woman presented with severe headache and subsequent loss of consciousness and was admitted to our hospital. Initial computed tomography showed subarachnoid hemorrhage. Three-dimensional digital subtraction angiography revealed a saccular aneurysm arising from the right vertebral artery (VA)-PICA bifurcation. The PICA branching from the right VA was enlarged, tortuous, and crossed the midline to supply both cerebellar hemispheres. This right PICA was interpreted as a bihemispheric PICA. Recognizing this variant preoperatively could help prevent complications of surgery. Careful follow-up studies are necessary in cases with bihemispheric PICA to monitor for the development of aneurysm at the junction between the bihemispheric PICA and the VA or the distal portion of the bihemispheric PICA.

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

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012507.rep ◽

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.

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

Operative Neurosurgery ◽

10.1227/neu.0b013e31822ed1f0 ◽

2011 ◽

Vol 70 (suppl_1) ◽

pp. ons75-ons81 ◽

Cited By ~ 1

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.

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Neurosurgery (Neuro Interventional)

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.197 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S43-S44

Author(s):

JJ Shankar ◽

L Hodgson

Keyword(s):

Vertebral Artery ◽

Retrospective Analysis ◽

Posterior Inferior Cerebellar Artery ◽

Artery Aneurysm ◽

The Third ◽

Cerebellar Artery ◽

Incomplete Coverage ◽

Negative Findings ◽

The Right

Purpose: CTA is becoming the frontline modality to reveal aneurysms in patients with SAH. However, in about 20% of SAH patients no aneurysm is found. In these cases, intra-arterial DSA is still performed. Our aim was to evaluate whether negative findings on CTA can reliably exclude aneurysms in patients with acute SAH. Materials and Method: We conducted a retrospective analysis of all DSA performed from August 2010 to July 2014 in patients with various indications. We selected patient who presented with SAH and had a negative CTA. Findings of the CTA were compared with DSA. Results: 857 DSA were performed during the study period. 51(5.95%) patients with SAH and negative findings on CTA who underwent subsequent DSA were identified. Of these, only 3(5.9%) of patients had positive findings on the DSA. One patient had a posterior inferior cerebellar artery aneurysm on the DSA, not seen on CTA due to the incomplete coverage of the head. Second patient’ CTA did not show any evidence of aneurysm. DSA showed suspicious dissection of the right vertebral artery, potentially iatrogenic. The third patient’s DSA showed suspicious tiny protuberance from left ICA, possibly infundibulum. Conclusion: In patients with SAH, negative CTA findings are reliable in ruling out aneurysms in any pattern of SAH on CT.

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Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

BMJ Case Reports ◽

10.1136/bcr-2019-231335 ◽

2019 ◽

Vol 12 (8) ◽

pp. e231335 ◽

Cited By ~ 1

Author(s):

Sean Thomas O’Reilly ◽

Ian Rennie ◽

Jim McIlmoyle ◽

Graham Smyth

Keyword(s):

Vertebral Artery ◽

Basilar Artery ◽

Posterior Inferior Cerebellar Artery ◽

Left Vertebral Artery ◽

Basilar Artery Thrombosis ◽

Direct Puncture ◽

Alternative Approach ◽

Cerebellar Artery ◽

First Pass ◽

The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

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Stent-assisted coil embolization for an unruptured vertebral artery–posterior inferior cerebellar artery aneurysm with retrograde access via type 1 persistent primitive proatlantal artery: A case report

Interventional Neuroradiology ◽

10.1177/1591019920973848 ◽

2020 ◽

pp. 159101992097384

Author(s):

Yasuhiko Nariai ◽

Tomoji Takigawa ◽

Ryotaro Suzuki ◽

Akio Hyodo ◽

Kensuke Suzuki

Keyword(s):

Carotid Artery ◽

Vertebral Artery ◽

Coil Embolization ◽

Posterior Inferior Cerebellar Artery ◽

External Carotid ◽

Proatlantal Artery ◽

Cerebellar Artery ◽

The Right ◽

Pica Aneurysms

Vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysms are rare lesions that are difficult to treat with both endovascular and surgical techniques. Tight angulation of the PICA from VA may make access to the PICA difficult from ipsilateral VA if adjunctive techniques are needed. Recently, the safety and efficacy of retrograde access have been reported. We report a case of endovascular treatment for a VA-PICA aneurysm with a stent-assisted technique using retrograde access via contralateral persistent primitive proatlantal artery (PPA). The patient was a 76-year-old woman with an unruptured VA-PICA aneurysm on the dominant VA side. Coil embolization with a stent-assisted technique using retrograde access seemed appropriate. However, the origin of the left VA was not confirmed. Left common carotid artery angiography demonstrated that the PPA (type 1) branching from external carotid artery joined the VA V4 segment. Retrograde access via the PPA for stenting was performed. A microcatheter for stenting was retrogradely advanced to the right PICA at ease. After deploying the stent, coil insertion was completed from the right VA, and the final angiogram showed adequate occlusion of the aneurysm with preservation of the PICA. Thus, PPA may be an approach route in the treatment of VA-PICA aneurysms with unconfirmed contralateral VA orifice and apparent PPA on angiography, when retrograde access is needed.

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