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Yang SJ, Gu YQ, Cui SJ. Treatment of extracranial vertebral artery aneurysms with covering stents: A case report and literature review. Asian J Surg 2024; 47:1815-1818. [PMID: 38151434 DOI: 10.1016/j.asjsur.2023.12.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Sheng-Jia Yang
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Department of Vascular Surgery, Capital Medical University, Beijing, 100053, China; Institute of Vascular Surgery, Capital Medical University, Beijing, 100053, China.
| | - Yong-Quan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Department of Vascular Surgery, Capital Medical University, Beijing, 100053, China; Institute of Vascular Surgery, Capital Medical University, Beijing, 100053, China.
| | - Shi-Jun Cui
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China; Department of Vascular Surgery, Capital Medical University, Beijing, 100053, China; Institute of Vascular Surgery, Capital Medical University, Beijing, 100053, China
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Kulubya ES, Yu N, Castillo JA, Duong H. External carotid artery-radial artery-vertebral artery bypass for surgical treatment of radiculopathy caused by an extracranial vertebral artery aneurysm: A case report and review of the literature. Surg Neurol Int 2023; 14:29. [PMID: 36895229 PMCID: PMC9990782 DOI: 10.25259/sni_1099_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
Background Vertebral artery (VA) aneurysm is a rare etiology of cervical radiculopathy and there is a paucity of case reports described in the literature. Case Description We describe a case of a patient with no history of trauma presenting with a large right VA aneurysm at the C5-C6 level compressing the C6 nerve root and causing a painful radiculopathy. The patient underwent successful external carotid artery-radial artery-VA bypass followed by trapping of the aneurysm and decompression of the C6 nerve root. Conclusion VA bypass is an effective tool for treatment of symptomatic large extracranial VA aneurysms and a rare cause of radiculopathy.
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Affiliation(s)
- Edwin Samuel Kulubya
- Department of Neurosurgery, University of California Davis, Sacramento, California, United States
| | - Nina Yu
- Department of Neurosurgery, University of California Davis, Sacramento, California, United States
| | - Jose Antonio Castillo
- Department of Neurosurgery, University of California Davis, Sacramento, California, United States
| | - Huy Duong
- Department of Neurosurgery, Kaiser Permanente Medical Center, Sacramento, California, United States
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3
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Pataki Á, Nguyen DT, Nagy Z, Nardai S, Nemes B. Stent-Graft Treatment of a Giant Asymptomatic Extracranial Vertebral Artery Aneurysm: Case Report and Literature Review. Ann Vasc Surg 2021; 79:442.e1-442.e6. [PMID: 34656725 DOI: 10.1016/j.avsg.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
With the widespread appliance of endovascular techniques, a plethora of options is available in the treatment of extracranial vertebral artery aneurysms. If the vertebral artery can be sacrificed, embolization with coiling, liquid injection, or parent artery exclusion can be done. We hereby present a case of a 74-year-old male patient presenting with an asymptomatic atherosclerotic giant extracranial vertebral artery aneurysm in the V1 segment of the vertebral artery, successfully treated with balloon expandable stent-graft deployment. No neurologic symptoms occurred, and the stent-graft was patent with no signs of endoleak at 24 months follow-up with computed tomography angiography.
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Affiliation(s)
- Ákos Pataki
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Dat T Nguyen
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsuzsa Nagy
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sándor Nardai
- Department of Cardiology Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Wang Y, Jiao L. Endovascular Treatment of a Primary Extracranial Vertebral Artery Aneurysm Causing Ischemic Stroke. Neurol India 2021; 69:184-186. [PMID: 33642298 DOI: 10.4103/0028-3886.310099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aims Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; various surgical and endovascular treatment options are available. Methods We report a 44-year-old man with a symptomatic proximal extracranial vertebral artery aneurysm of unclear etiology. The patient presented with brainstem infarction, and the diagnosis of primary extracranial vertebral artery aneurysm was made by computed tomography angiography (CTA). Results This patient's aneurysm was definitively treated using an endovascular approach with placement of a covered stent in the right proximal vertebral artery. Conclusion Although aneurysms of this location are traditionally repaired with open aneurysmectomy, we show that endovascular treatment can be a safe and effective alternative approach. In the case reported here, primary extracranial vertebral artery aneurysm presenting with embolic stroke was successfully treated with a covered stent. Complete exclusion of the aneurysm from blood circulation is advisable to achieve full resolution of the embolic source.
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Affiliation(s)
- Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Evans K, Lindert RB, Dyde R, Tse GH. Chronic fusiform extracranial vertebral artery aneurysm with recurrent posterior circulation emboli: Case report and review of the literature. Interv Neuroradiol 2021; 28:9-15. [PMID: 34000865 PMCID: PMC8902263 DOI: 10.1177/15910199211018581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report a case of a 64-year-old man with a fusiform right extracranial vertebral artery aneurysm, spanning over half the extra-cranial V2 (foraminal) segment, presenting with recurrent multi-focal posterior circulation embolic ischaemic stroke. The patient was treated with endovascular embolisation of the right vertebral artery to prevent further thrombo-embolic events. Distal and proximal occlusion of the aneurysmal vertebral artery was performed with a micro-vascular plug with partial aneurysm sack embolisation to aid thrombosis and reduce the risk of recanalisation. Two months post procedure MR angiography confirmed successful aneurysm occlusion with no post-procedural complication. The patient returned to his normal independent life. Endovascular treatment with vessel sacrifice is an effective treatment with low morbidity and we believe the MVP device to be a efficacious option in the vertebral artery.
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Affiliation(s)
- Katherine Evans
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ralf-Björn Lindert
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Richard Dyde
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - George H Tse
- Department of Neuroradiology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Suliman AEA, Hamid HKS, Mekki SO. An unusual case of a giant extracranial vertebral artery aneurysm. Vascular 2019; 27:427-429. [DOI: 10.1177/1708538119843403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Objective Extracranial vertebral artery (VA) aneurysms are rare and are often post-traumatic secondary to penetrating or blunt injuries. Primary extracranial VA aneurysms are far less common. Most of these lesions are located in the proximal (V1) and middle (V2) segments of the VA. Method We report an extremely rare case of a giant aneurysm of the extracranial vertebral artery in a 50-year-old woman who presented with a right posterior neck swelling, headache and pain at the site of the mass. Angiography confirmed aneurysm of V3 segment of the right VA. Treatment included ligation of the artery and aneurysmectomy. Result Magnetic resonance angiography at 12 months showed obliterated proximal segment of the right VA with no obvious flow distally. Conclusion Aneurysms of the extracranial VA are clinically relevant because of the associated risks of rupture and distal embolization. For patients with rupture, pending rupture or a significant mass effect due to a giant lesion, surgery is the treatment modality of choice to attain symptomatic relief.
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Affiliation(s)
| | - Hytham KS Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Salwa O Mekki
- Department of Pathology, Soba University Hospital, Khartoum, Sudan
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7
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Anomalous V3 Segment Aneurysm Associated with Congenital Atlantoaxial Dislocation: Case Report and Discussing the Challenges in Management. World Neurosurg 2018; 121:59-61. [PMID: 30312814 DOI: 10.1016/j.wneu.2018.09.231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 09/28/2018] [Accepted: 09/29/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND An anomalous vertebral artery is not a deterrent for posterior C1-C2 joint manipulation and reduction of atlantoaxial dislocation (AAD). However, presence of an incidental aneurysm in the aberrant segment of artery with concurrent AAD adds to the surgical challenge. CASE DESCRIPTION A 30-year-old woman presented with neck pain and spastic quadriparesis. Her imaging revealed atlantoaxial dislocation and bony segmentation defects. Three-dimensional computed tomography angiography showed bilateral anomalous vertebral arteries (V3 segment) and an incidental aneurysm on the arterial segment that crossed the right C1-C2 joint posteriorly. Because the artery bearing the aneurysm was nondominant, it was ligated and successful C1-C2 posterior reduction and fusion could be performed. CONCLUSION The association of an incidental aneurysm with an anomalous vertebral artery in congenital AAD is unusual. The etiology could be an underlying collagen defect or repeated shearing trauma to the vessel wall due to C1-C2 instability. It would be less risky to proceed with endovascular embolization followed by occipitocervical fusion without opening the joints in case the aneurysm is present on the dominant aberrant V3 segment. Ventral decompression can be supplemented for irreducible AAD. On the contrary, if the aneurysm is present on the nondominant aberrant V3 segment, the C1-2 joint can be opened and manipulated following an initial endovascular treatment of the aneurysm. If the circumstances demand, the nondominant artery can be ligated and sacrificed, although there is a small risk of formation of stump aneurysm.
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Kollmann D, Kinstner C, Teleky K, Wressnegger A, Koppensteiner R, Huk I, Neumayer C, Funovics M. Successful Treatment of a Ruptured Extracranial Vertebral Artery Aneurysm with Onyx Instillation. Ann Vasc Surg 2016; 36:290.e7-290.e10. [DOI: 10.1016/j.avsg.2016.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
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Sultan S, Morasch M, Colgan MP, Madhavan P, Moore D, Shanik G. Operative and Endovascular Management of Extracranial Vertebral Artery Aneurysm in Ehlers-Danlos Syndrome: A Clinical Dilemma. Vasc Endovascular Surg 2016; 36:389-92. [PMID: 12244429 DOI: 10.1177/153857440203600510] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The most prevalent lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. A case of successful management of a symptomatic vertebral artery aneurysm due to Ehlers-Danlos syndrome is reported. The patient had asymptomatic posterior intracerebral artery dissection on the contralateral side. A common carotid artery to V-3 segment bypass using reversed saphenous vein graft was carried out. Avulsion of the V-2 segment occurred peroperatively and endovascular coil embolization of the vertebral artery aneurysm was performed. Endovascular equipment and training must be in the armamentarium of vascular surgeons as more complex cases are being treated, which demands new approaches for ultimate clinical success. This unique case outlines what might unexpectedly occur. Endovascular intervention as an adjuvant procedure provides a satisfactory outcome in what could have been a catastrophe.
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Affiliation(s)
- Sherif Sultan
- St James's Vascular Institute, St James's Hospital, Trinity College, Dublin, Ireland.
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10
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Morasch MD, Phade SV, Naughton P, Garcia-Toca M, Escobar G, Berguer R. Primary Extracranial Vertebral Artery Aneurysms. Ann Vasc Surg 2013; 27:418-23. [DOI: 10.1016/j.avsg.2012.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/29/2012] [Accepted: 08/06/2012] [Indexed: 10/27/2022]
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11
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Patra P, Ricco JB, Costargent A, Goueffic Y, Pillet JC, Chaillou P. Infected aneurysms of neck and limb arteries: a retrospective multicenter study. Ann Vasc Surg 2001; 15:197-205. [PMID: 11265084 DOI: 10.1007/s100160010047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Infected aneurysms (IA) of neck and limb arteries are uncommon. This report describes the results of a retrospective study undertaken by the University Association for Surgical Research (AURC) to evaluate etiology, bacteriology, location, diagnostic features, and therapeutic methods associated with IA. A total of 58 IA in 52 patients were reviewed. The lesion was located in a lower extremity artery in 47 patients (81%), internal carotid artery in 7 (12%), and upper extremity artery in 4 (6%). Eleven patients had multilocular aneurysm (21%). Symptoms of local infection were observed in 43 patients (82.6%). Rupture or splitting was the presenting manifestation in 13 patients (25%). Primary IA following bacteremia or septicemia without endocarditis was the most common type of IA observed in 34 patients (65.3%). Twelve patients (23%) presented mycotic IA secondary to bacterial endocarditis. In the remaining six patients (11.5%), IA resulted from direct contamination or spreading from a contiguous infection site. Surgical treatment included ligation of the artery without reconstruction in 19 patients and exclusion bypass in 33 patients. The duration of antibiotic treatment ranged from 15 days to 3 months. No recurrence of aneurysm was observed but three patients developed bypass infection. Primary IA was associated with high mortality due to severe septicemia.
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Affiliation(s)
- P Patra
- Service de Chirurgie Vasculaire, Hôpital G. et R. Laënnec, C.H.U. de Nantes, Boulevard Jacques Monod, St Herblain 44093 Nantes, France.
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Pötsch L, Bohl J. Traumatic lesion of the extracranial vertebral artery--a note-worthy potentially lethal injury. Int J Legal Med 1994; 107:99-107. [PMID: 7819125 DOI: 10.1007/bf01225496] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The autopsy findings from routine neuropathological investigations of the cervical spine after any history of trauma emphasized the vulnerability of the extracranial vertebral arteries. In 21 cases with trauma to the head and neck, normal autopsy procedures did not succeed in revealing an obvious cause of death. Traumatic lesions of the spinal cord such as contusion or neurorrhexis were seen in 10 cases. In 15 cases we observed different degrees and stages of traumatic lesions of the extracranial vertebral arteries. Sudden death due to acute brain stem ischemia might be considered as an explanation in some of these cases. Six case reports with traumatic vertebral artery (VA) lesions after severe or minor extracranial trauma are presented. A review of the literature revealed that this vascular injury has only rarely been directly established by gross pathological examination. Possible consequences of blunt trauma to the head and neck include angiorrhexis, subintimal, intramural and perivascular hemorrhage leading to a partial narrowing of the injured vessel. These processes can be complicated by thrombosis. Unilateral VA obliteration may be an occult risk of acute brain stem ischemia when associated with contralateral reduction of the posterior circulation.
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Affiliation(s)
- L Pötsch
- Institut für Rechtsmedizin, Johannes-Gutenberg-Universität Mainz, Deutschland
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13
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Habozit B, Battistelli JM. Spontaneous aneurysm of the extracranial vertebral artery associated with spinal osseous anomaly. Ann Vasc Surg 1990; 4:600-3. [PMID: 2261329 DOI: 10.1016/s0890-5096(06)60847-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Spontaneous aneurysms of the extracranial vertebral artery are uncommon. We report the case of an aneurysm located at the second cervical vertebra, associated with a congenital spinal malformation. Computed tomographic scan and arteriography were diagnostic. After proximal ligation of the vertebral artery, the aneurysm was incised and the distal vertebral artery was revascularized by an infraoccipital carotid-to-vertebral artery vein bypass.
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Affiliation(s)
- B Habozit
- Clinique Chirurgicale Poirier, Chambéry, France
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Rosenblum B, Rifkinson-Mann S, Sacher M, Gennuso R, Rothman A. Hemodynamic analysis of associated extracranial atraumatic vertebral artery aneurysm and arteriovenous fistula. Case report. J Neurosurg 1987; 67:940-3. [PMID: 3316533 DOI: 10.3171/jns.1987.67.6.0940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A case of atraumatic arteriovenous (AV) fistula of the extracranial vertebral artery associated with an atraumatic aneurysm of the contralateral extracranial vertebral artery is reported. The fistulous lesion was excised after distal and proximal ligation of the vessel. Subsequently, the contralateral aneurysm underwent spontaneous dissolution. Seven cases of extracranial vertebral AV fistulae associated with ipsilateral vertebral artery aneurysms (four traumatic and three as part of vascular dysplastic syndromes) have been reported previously.
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Affiliation(s)
- B Rosenblum
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
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