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Kitamura S, Hanaoka Y, Koyama JI, Yamazaki D, Nakamura T, Horiuchi T. Retrograde Parent Artery Occlusion for Ruptured Intracranial Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery: The "Breakwater" Technique. Clin Neuroradiol 2024; 34:723-730. [PMID: 38305799 DOI: 10.1007/s00062-024-01388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/14/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Satoshi Kitamura
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan.
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan.
| | - Jun-Ichi Koyama
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, 390-8621, Matsumoto, Japan
- Neuroendovascular Therapy Center, Shinshu University Hospital, Matsumoto, Japan
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Korai M, Kanematsu Y, Yamaguchi I, Yamaguchi T, Yamamoto Y, Yamamoto N, Miyamoto T, Shimada K, Satomi J, Hanaoka M, Matsuzaki K, Satoh K, Takagi Y. Subarachnoid Hemorrhage Due to Rupture of Vertebral Artery Dissecting Aneurysms: Treatments, Outcomes, and Prognostic Factors. World Neurosurg 2021; 152:e86-e93. [PMID: 34051365 DOI: 10.1016/j.wneu.2021.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mortality rate after subarachnoid hemorrhage due to rupture of vertebral artery dissecting aneurysms (VADAs) is high; endovascular coil trapping is the first-line therapy to prevent rerupture. To select optimal treatments, the positional relationship between the VADA and posterior inferior cerebellar artery (PICA) and the morphology of the contralateral vertebral artery must be considered, and outcome predictors of different treatment methods and their possible complications must be identified. METHODS We retrospectively studied 44 patients with ruptured VADAs who had undergone endovascular or surgical treatment. VADA morphology was assessed on conventional preoperative angiograms, and VADAs were categorized based on their site in relation to the PICA. VADA site, treatment method, and complications were used to identify prognostic factors. RESULTS The sites of the 44 VADAs were PICA-proximal (n = 3), PICA-distal (n = 22), PICA-absent (n = 7), and PICA-involved (n = 12). Treatments included internal coil trapping (n = 30), proximal coil occlusion (n = 5), and stent placement (n = 3); surgical flow alteration via an occipital artery-PICA bypass and ligation at the proximal vertebral artery and the PICA origin was performed in 6 patients. Periprocedural rebleeding was associated with a poor outcome. Internal coil trapping prevented the rerupture of PICA-proximal and PICA-absent VADAs, and flow alteration prevented rerupture of PICA-involved VADAs; there were no complications directly attributable to these procedures. CONCLUSIONS Periprocedural rebleeding was a poor prognostic factor. Internal trapping of PICA-proximal and PICA-absent VADAs and flow alteration in PICA-involved VADAs prevented rerupture.
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Affiliation(s)
- Masaaki Korai
- Department of Neurosurgery, Tokushima University, Tokushima, Japan.
| | | | - Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Tadashi Yamaguchi
- Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yuki Yamamoto
- Department of Neurology, Tokushima University, Tokushima, Japan
| | | | - Takeshi Miyamoto
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Junichiro Satomi
- Department of Neurosurgery, Kitajima Taoka Hospital, Tokushima, Japan
| | - Mami Hanaoka
- Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Kazuhito Matsuzaki
- Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Koichi Satoh
- Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
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Ayabe J, Watanabe M, Mishima H, Tsuchiya Y, Takase K, Maruyama T, Masuko Y, Tanaka Y. Treatment Outcomes of Stent-Assisted Coil Embolization for Ruptured Vertebral Artery Dissecting Aneurysms: The Preservation of Branches May Improve the Prognosis. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:14-23. [PMID: 37503455 PMCID: PMC10370613 DOI: 10.5797/jnet.oa.2019-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 06/25/2020] [Indexed: 07/29/2023]
Abstract
Objective Subarachnoid hemorrhage due to ruptured vertebral artery dissecting aneurysm (rVADA) is associated with a high frequency of acute rebleeding and requires early treatment following onset. Parent artery occlusion (PAO) or stent-assisted coiling (SAC) embolization is selected as a treatment option according to the individual patient condition. This report is a retrospective examination evaluating the treatment outcomes for rVADA. Methods The subjects were 20 rVADA patients (16 men and 4 women) who underwent endovascular treatment at our institution. The mean patient age was 52.9 years. Ten patients each were allocated to the PAO group and SAC group. We evaluated and compared the following parameters: presence of hemorrhagic complications, presence of ischemic complications, requirement of retreatment, and Glasgow Outcome Scale (GOS) after 90 days. Results The reasons for selecting SAC were contralateral occlusion or a small diameter in three patients, the posterior inferior cerebellar artery (PICA) involvement in three patients, perforating artery from dissected lesion in five patients, and anterior spinal artery in one patient. There was no rebleeding in any patient. Symptomatic ischemic complications were observed in four patients in the PAO group and in one in the SAC group. Hyper-intense lesions in the brainstem on MRI DWI were noted in five patients in PAO group and in one in the SAC group. Retreatment was required for three patients in the PAO group and for four in the SAC group. Favorable outcomes (GOS 4, 5) after 90 days were observed for three patients in the PAO group and for eight patients in the SAC group (p = 0.0257). Conclusion SAC that can preserve branches is a useful treatment option for rVADA. Further studies on a greater number of subjects are required to establish the optimal dose of antiplatelet agents and anticoagulants, and for stent selection.
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Affiliation(s)
- Junichi Ayabe
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Masahide Watanabe
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Hiroyuki Mishima
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Yusuke Tsuchiya
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Kana Takase
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Takumi Maruyama
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Yu Masuko
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Yoshihide Tanaka
- Department of Neurosurgery, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
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Terakado T, Nakai Y, Ikeda G, Tsukada K, Hanai S, Akutagawa K, Igarashi H, Konishi T, Shiigai M, Uemura K. Stent-Jack Technique for Ruptured Vertebral Artery Dissecting Aneurysm Involving the Origin of Posterior Inferior Cerebellar Artery. Neurointervention 2020; 15:84-88. [PMID: 32283912 PMCID: PMC7412653 DOI: 10.5469/neuroint.2019.00276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/15/2020] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Toshitsugu Terakado
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan,Correspondence to: Toshitsugu Terakado, MD, Department of Neurosurgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba 305-8558, Ibaraki, Japan Tel: +81-29-851-3511 Fax: +81-29-858-2773 E-mail:
| | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Go Ikeda
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazuaki Tsukada
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Sho Hanai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazuki Akutagawa
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Haruki Igarashi
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Takahiro Konishi
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masanari Shiigai
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Japan
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Kim YS, Kim TS, Yang IC, Joo SP. Staged, Combined Management of Ruptured Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery: Report of 4 Cases and Review of the Literature. World Neurosurg 2019; 128:444-447. [PMID: 31132483 DOI: 10.1016/j.wneu.2019.05.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Ruptured vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) are the most difficult to treat among variations of VADAs but require prompt treatment. The major challenge is to preserve the PICA while occluding the aneurysm. Despite advances in the management of ruptured VADAs involving the PICA, each treatment, whether it is combined or not, is associated with a significant degree of risk. CASE DESCRIPTION This study presents 4 cases of ruptured VADAs involving the PICA that were successfully treated using a staged, combined method. Embolization of the rupture point in the acute stage was followed 3-4 weeks later by occlusion of the proximal vertebral artery (VA) and PICA origin after occipital artery-PICA bypass in the chronic stage. CONCLUSIONS Although it is sometimes very difficult to determine the exact rupture point of VADAs, ruptures tend to occur at distal segments of a dissecting aneurysm presenting as bleb. Also, when planning a trapping of the VA, careful examination of angiography is needed to assess the contralateral VA and rupture point. Our staged and combined strategy may provide another valuable treatment option for treating VADAs involving the PICA with special emphasis on the safety and efficacy in our method.
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Affiliation(s)
- You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
| | - In-Chul Yang
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
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Kanematsu Y, Satomi J, Korai M, Okazaki T, Yamaguchi I, Tada Y, Uno M, Nagahiro S, Takagi Y. Flow Alteration Therapy for Ruptured Vertebral Artery Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery. Neurol Med Chir (Tokyo) 2018; 58:341-349. [PMID: 29998934 PMCID: PMC6092607 DOI: 10.2176/nmc.oa.2018-0076] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Surgery for- and endovascular treatment of vertebral artery (VA) dissecting aneurysms involving the origin of the posterior inferior cerebellar artery (PICA) remain challenging. Their ideal treatment is complete isolation of the aneurysm by surgical or endovascular trapping plus PICA reconstruction. However, postoperative lower cranial nerve palsy and medullary infarction are potential complications. We report four patients with VA dissecting aneurysms involving the PICA origin who were treated by occipital artery (OA)-PICA bypass followed by proximal occlusion of the VA and clip ligation of the PICA origin instead of trapping. There were no procedural or ischemic complications. In all patients, angiography performed 2–3 weeks later showed good patency of the bypass graft and complete obliteration of the aneurysm. During the follow-up period ranging from 1 to 14 years, none experienced bleeding. Although retrograde blood flow to the dissecting aneurysm persisted in the absence of trapping, iatrogenic lower cranial nerve injury could be avoided. The decrease in aneurysmal flow might elicit spontaneous thrombosis and prevent aneurysmal rerupture. Our technique might be less invasive than aneurysmal trapping and help to prevent rebleeding.
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Affiliation(s)
| | | | | | | | | | | | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School
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