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Zhang J, Dai Z, Wang T, Zeng Y, Wei J, Zou R, Leng X, Xiang J, Zhou S. A multidimensional pre-operative planning method of unruptured vertebral artery dissecting aneurysms using three-dimensional AWE mapping and hemodynamic simulation. Clin Neurol Neurosurg 2024; 243:108398. [PMID: 38908320 DOI: 10.1016/j.clineuro.2024.108398] [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: 12/28/2023] [Revised: 05/23/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVE High-resolution magnetic resonance imaging (HR-MRI) can provide valuable insights into the evaluation of vascular pathological conditions, and 3D digital subtraction angiography (3D-DSA) offers clear visualization of the vascular morphology and hemodynamics. This study aimed to investigate the potential of a multimodal method to treat unruptured vertebral artery dissection aneurysms (u-VADAs) by fusing image data from HR-MRI and 3D-DSA. METHODS This observational study enrolled 5 patients diagnosed with u-VADAs, who were scheduled for interventional treatment. The image data of HR-MRI and 3D-DSA were merged by geometry software, resulting in a multimodal model. Quantified values of aneurysm wall enhancement (AWE), wall shear stress (WSS), neck velocity, inflow volume, intra-stent flow velocity (ISvelocity), and intra-aneurysmal velocity (IAvelocity) were calculated from the multimodal method. RESULTS We found the actual lengths of u-VADAs in the multimodal model were longer than the 3D-DSA model. We formulated surgical plannings based on the WSS, IA velocity, and neck velocity. The post-operative value of IAvelocity, neck velocity, and follow-up quantified values of AWE were decreased compared with the pre-operative condition. After that, u-VADAs were complete occlusion in four patients and near-complete occlusion in one patient during the 6th-month follow-up after surgery. CONCLUSION The multidimensional method combining HR-MRI with 3D-DSA may provide more valuable information for treating VADAs, with the potential to develop effective surgical planning.
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Affiliation(s)
- Jianfei Zhang
- Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, Ningbo, PR China
| | - Zifeng Dai
- Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, Ningbo, PR China
| | - Tianfan Wang
- ArteryFlow Technology Co., Ltd., Hangzhou, PR China
| | - Yiyong Zeng
- Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, Ningbo, PR China
| | - Jie Wei
- Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, Ningbo, PR China
| | - Rong Zou
- ArteryFlow Technology Co., Ltd., Hangzhou, PR China
| | | | | | - Shengjun Zhou
- Department of Neurosurgery, Ningbo Key Laboratory of Neurological Diseases and Brain Function, The First Affiliated Hospital of Ningbo University, Ningbo, PR China.
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Differentiation of Cerebral Dissecting Aneurysm from Hemorrhagic Saccular Aneurysm by Machine-Learning Based on Vessel Wall MRI: A Multicenter Study. J Clin Med 2022; 11:jcm11133623. [PMID: 35806913 PMCID: PMC9267569 DOI: 10.3390/jcm11133623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/01/2023] Open
Abstract
The differential diagnosis of a cerebral dissecting aneurysm (DA) and a hemorrhagic saccular aneurysm (SA) often depends on the intraoperative findings; thus, improved non-invasive imaging diagnosis before surgery is essential to distinguish between these two aneurysms, in order to provide the correct formulation of surgical procedure. We aimed to build a radiomic model based on high-resolution vessel wall magnetic resonance imaging (VW-MRI) and a machine-learning algorithm. In total, 851 radiomic features from 146 cases were analyzed retrospectively, and the ElasticNet algorithm was used to establish the radiomic model in a training set of 77 cases. A clinico-radiological model using clinical features and MRI features was also built. Then an integrated model was built by combining the radiomic model and clinico-radiological model. The area under the ROC curve (AUC) was used to quantify the performance of models. The models were evaluated using leave-one-out cross-validation in a training set, and further validated in an external test set of 69 cases. The diagnostic performance of experienced radiologists was also assessed for comparison. Eight features were used to establish the radiomic model, and the radiomic model performs better (AUC = 0.831) than the clinico-radiological model (AUC = 0.717), integrated model (AUC = 0.813), and even experienced radiologists (AUC = 0.801). Therefore, a radiomic model based on VW-MRI can reliably be used to distinguish DA and hemorrhagic SA, and, thus, be widely applied in clinical practice.
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Park JH. A Ruptured Vertebral Artery Dissecting Aneurysm that Grew Immediately: Case Report. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.2.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The etiology of the vertebral artery dissecting aneurysm (VADA) is unknown and they frequently occur in relatively healthy young men. Therefore, the pathological mechanism by which VADAs occur has not been accurately identified. In this paper, we will examine a case in which a young man complaining of a simple headache became unconscious due to the rupture of a VADA in grew immediately.
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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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5
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Kumar A, Dmytriw AA, Salem MM, Kuhn AL, Phan K, Bharatha A, Spears J, Thomas A, Puri A, Marotta TR. Reconstructive vs Deconstructive Endovascular Approach to Intradural Vertebral Artery Aneurysms: A Multicenter Cohort Study. Neurosurgery 2021; 87:383-393. [PMID: 32022238 DOI: 10.1093/neuros/nyaa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parent vessel sacrifice (PVS) has been a traditional way of treating complex aneurysms of the intradural vertebral artery (VA). Flow diversion (FD) has emerged as an alternative reconstructive option. OBJECTIVE To compare the long-term clinical and radiographic outcomes of intradural VA aneurysms following PVS or FD. METHODS We retrospectively reviewed and evaluated 43 consecutive patients between 2009 and 2018 with ruptured and unruptured intradural VA aneurysms treated by PVS or FD. Medical records including clinical and radiological details were reviewed. RESULTS A total of 43 intradural VA aneurysms were treated during this period. In the 14 PVS patients, the mean follow-up was 19.5 mo, and 71.4% of cases achieved modified Rankin scale (mRS) ≤2 at the last follow-up. A total of 86.5% of cases achieved complete occlusion. There was a 14.3% (2 cases) mortality rate, 14.3% (2 cases) postoperative ischemic complication rate, and 0% postoperative hemorrhaging rate. Retreatment was required in 1 case (7.1%). In the 29 FD patients, the mean follow-up was 21.8 mo, and 89.7% of cases achieved mRS ≤2 at the final follow-up. There was a 3.2% (1 case) mortality rate, 19.4% (6 cases) of postoperative ischemic complications, and 6.5% (2 cases) of postoperative hemorrhagic complications. Complete occlusion was seen in 86.5% patients. No cases required retreatment. Mortality and complication rates were not significantly different between PVS and PED (Pipeline Embolization Device) groups. CONCLUSION PVS was associated with comparable intraprocedural complications for VA aneurysms as compared to FD in the largest multicenter study to date. Both procedures have good long-term clinical and radiological outcomes.
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Affiliation(s)
- Ashish Kumar
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Adam A Dmytriw
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anna L Kuhn
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kevin Phan
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Aditya Bharatha
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Julian Spears
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ajith Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajit Puri
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Jia-Hao Z, Richard SA, Ming J, Yin-Sheng D. Low-profile visible intraluminal support stent-assisted embolization therapy for intracranial dissecting aneurysms: A retrospective analysis of six cases. Neurol Int 2020; 12:8346. [PMID: 32922705 PMCID: PMC7461105 DOI: 10.4081/ni.2020.8346] [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: 10/25/2019] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
Abstract
Endovascular Embolization (EVE) of aneurysms is a very effective and efficient treatment modality. Nevertheless, a few complications have been reported after EVE of aneurysms. Our study therefore evaluated the safety and efficacy of Low-profile Visible Intraluminal Support (LVIS) stentassisted EVE for intracranial Dissecting Aneurysms (DAs). We conducted a retrospective study to identify patients with DAs who were treated with LVIS stent from July 2015 to September 2018. The DAs were categoried into ruptured and unruptured. The arteries harbouring the aneurysm were identified in all cases. LVIS device stent assisted coil EVE treatment modality was utilized to treat all the patients. Surgical safety, immediate surgery outcome, recurrence rate and imaging follow-up results of all patients were analysed. The Glasgow Outcome Scale (GOS) score of all patients where assessed during discharge. Cerebral angiography of all patients were reevaluated on scheduled visits from three months up to one year after their operations. A total of Six DA patients were identified during our analysis. Four of the cases were ruptured DAs while two cases were unruptured. The DAs originated from the Internal Carotid Artery (ICA) in two cases, while in the remaining four cases, the DAs originated from vertebral artery (VA). Stents and coils were successfully implanted in all six patients. The DAs were embolized satisfactorily and the parent arteries were patent immediately after the operations. We obsereved 5 points GOS score in four cases and 4 points in two cases. No aneurysmal recurrece, no stent collapse or displacement was obsereved in all cases during follow-ups. Our study suggests that, LVIS stent-assisted EVE is simple, safe and effective in the treatment of DAs.
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Affiliation(s)
- Zhou Jia-Hao
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, P.R. China
| | - Seidu A Richard
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, P.R. China.,Department of Medicine, Princefield University, Ghana, West Africa
| | - Jiang Ming
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, P.R. China
| | - Deng Yin-Sheng
- Department of Neurosurgery, The Affiliated Hospital of Jiangsu University, Zhenjiang, P.R. China
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7
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Zhao X, Wang H, Liu J, Zhang Z, Li Z. Endovascular treatment of vertebral artery dissecting aneurysm: A single-center experience. Exp Ther Med 2019; 18:4838-4844. [PMID: 31798709 PMCID: PMC6880450 DOI: 10.3892/etm.2019.8128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/20/2019] [Indexed: 12/03/2022] Open
Abstract
The aim of the present study was to explore the optimal treatment strategy for patients with vertebral artery dissecting aneurysms via the endovascular approach. A total of 47 patients (50 aneurysms, including 28 ruptured and 22 unruptured) underwent endovascular treatment between January 2012 and March 2018. Of these aneurysms, 18 were treated by parent artery occlusion, 11 by stent implantation and 21 by stent-assisted coiling. The complete occlusion rate was 100% (18/18) in aneurysms treated by parent artery occlusion and 46.9% (15/32) for stent implantation with or without coiling. External drainage was performed in 8 patients with ruptured aneurysms. Post-operative bleeding occurred in 2 patients treated by stent-assisted coiling. Ventriculo-peritoneal shunt was performed in 4 patients due to delayed hydrocephalus. Post-operative frontal hematoma occurred in one patient treated by stent-assisted coiling. The mortality was 6.4% (3/47) prior to discharge. The recurrence rate was 8.3% (1/12) in aneurysms treated by parent artery occlusion and 13.6% (3/22) in those treated by stent implantation with or without coiling. A total of 39 patients were followed up for 14.56±14.91 months. The good outcome rates were 100% (28/28) in patients with unruptured aneurysms and a Hunt-Hess grade of 1–3, and 72.7% (8/11) in patients with a Hunt-Hess grade of 4 or 5. In conclusion, the present study indicated that endovascular treatment is a safe and efficient method for patients with vertebral artery aneurysm. The treatment strategy should be based on the patient's condition and aneurysmal characteristics. Parent artery occlusion may be suitable for selected patients with ruptured vertebral artery aneurysms.
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Affiliation(s)
- Xintong Zhao
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Huifang Wang
- Department of Pharmacy, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Jiaqiaing Liu
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zihuan Zhang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zhenbao Li
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
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Chen JA, Garrett MC, Mlikotic A, Ausman JI. Treatment of intracranial vertebral artery dissecting aneurysms involving the posterior inferior cerebellar artery origin. Surg Neurol Int 2019; 10:116. [PMID: 31528452 PMCID: PMC6744774 DOI: 10.25259/sni-281-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 05/02/2019] [Indexed: 02/07/2023] Open
Abstract
Background Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. We present an illustrative case and review the literature surrounding treatment strategies. Case Description We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. After consideration of the patient's cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications. Conclusion Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, University of California, Los Angeles
| | | | - Anton Mlikotic
- Department of Radiology, Harbor-UCLA Medical Center, Torrance, California, USA
| | - James I Ausman
- Department of Neurosurgery, University of California, Los Angeles
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Updates in the Management of Cerebral Infarctions and Subarachnoid Hemorrhage Secondary to Intracranial Arterial Dissection: A Systematic Review. World Neurosurg 2019; 121:51-58. [DOI: 10.1016/j.wneu.2018.09.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/10/2023]
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10
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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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11
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Tayebi Meybodi A, Gandhi S, Preul MC, Lawton MT. The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery. J Neurosurg Spine 2018; 29:18-27. [PMID: 29701566 DOI: 10.3171/2017.11.spine171068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Exposure of the vertebral artery (VA) between C-1 and C-2 vertebrae (atlantoaxial VA) may be necessary in a variety of pathologies of the craniovertebral junction. Current methods to expose this segment of the VA entail sharp dissection of muscles close to the internal jugular vein and the spinal accessory nerve. The present study assesses the technique of exposing the atlantoaxial VA through a newly defined muscular triangle at the craniovertebral junction. METHODS Five cadaveric heads were prepared for surgical simulation in prone position, turned 30°-45° toward the side of exposure. The atlantoaxial VA was exposed through the subatlantic triangle after reflecting the sternocleidomastoid and splenius capitis muscles inferiorly. The subatlantic triangle was formed by 3 groups of muscles: 1) the levator scapulae and splenius cervicis muscles inferiorly and laterally, 2) the longissimus capitis muscle inferiorly and medially, and 3) the inferior oblique capitis superiorly. The lengths of the VA exposed through the triangle before and after unroofing the C-2 transverse foramen were measured. RESULTS The subatlantic triangle consistently provided access to the whole length of atlantoaxial VA. The average length of the VA exposed via the subatlantic triangle was 19.5 mm. This average increased to 31.5 mm after the VA was released at the C-2 transverse foramen. CONCLUSIONS The subatlantic triangle provides a simple and straightforward pathway to expose the atlantoaxial VA. The proposed method may be useful during posterior approaches to the craniovertebral junction should early exposure and control of the atlantoaxial VA become necessary.
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12
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Urasyanandana K, Songsang D, Aurboonyawat T, Chankaew E, Withayasuk P, Churojana A. Treatment outcomes in cerebral artery dissection and literature review. Interv Neuroradiol 2018; 24:254-262. [PMID: 29433365 DOI: 10.1177/1591019918755692] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Methods Patients with cerebral artery dissections were reviewed in a hospital setting from 2008 to 2015. Clinical presentations, lesion locations, treatment modalities, functional outcomes, and mortality were reviewed. Parent artery occlusion was the first choice for surgery or endovascular treatment of a hemorrhagic dissecting cerebral artery. Endovascular or surgical reconstructive treatment was indicated in patients whose parent artery could not be occluded. Favorable functional outcomes were determined using modified Rankin Scale (mRS) scores of 0-2. Results In total, 61 patients with cerebral artery dissections were admitted to the hospital. Seven (11.5%) had traumatic dissections. All traumatic dissections were located in the internal carotid arteries. Overall favorable outcome rate was about 57% (4/7). Spontaneous cerebral artery dissections were found in 54 patients. No difference in favorable outcomes was observed between parent vessel occlusion and selective occlusion with parent vessel preservation (or vessel reconstruction) (70% and 63%, respectively, p = 1.000). Patients who presented with spontaneous dissection without intracranial hemorrhage had more favorable outcomes than those with intracranial hemorrhage (79% and 52%, respectively, p = 0.045). The mortality rate of patients with spontaneous dissection was 7.4%. Conclusions Most of the traumatic dissections were located on the internal carotid arteries and spontaneous dissections were commonly located on vertebral arteries. Nonhemorrhagic spontaneous cerebral dissections had better functional outcomes after treatment. Endovascular and surgical management were effective treatments by parent vessel occlusion or reconstructions.
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Affiliation(s)
- Karanarak Urasyanandana
- 1 Department of Surgery, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Dittapong Songsang
- 2 Department of Diagnostic Radiology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Taweesak Aurboonyawat
- 2 Department of Diagnostic Radiology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Ekawut Chankaew
- 2 Department of Diagnostic Radiology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Pattarawit Withayasuk
- 2 Department of Diagnostic Radiology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Anchalee Churojana
- 2 Department of Diagnostic Radiology, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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13
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Urasyanandana K, Withayasuk P, Songsaeng D, Aurboonyawat T, Chankaew E, Churojana A. Ruptured intracranial vertebral artery dissecting aneurysms: An evaluation of prognostic factors of treatment outcome. Interv Neuroradiol 2017; 23:240-248. [PMID: 28133987 DOI: 10.1177/1591019917691252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Intracranial spontaneous vertebral artery dissecting aneurysms commonly occur in the third to fifth decades of life, and are mostly associated with hypertension. Patients present with intracranial haemorrhage or thromboembolic events. Patients who present with intracranial haemorrhage carry about a 70% risk of recurrent bleeding. Patients with a posterior-inferior cerebellar artery (PICA) or ipsilateral dominant vertebral artery involve selecting which parent vessel could not be sacrificed. Recent reconstructive techniques such as stent-assisted coiling embolisation and flow-diverting stents are effective treatments of choice. Methods Seventeen patients presented subarachnoid haemorrhage and nine patients with other symptoms. Sacrificing the parent vertebral artery was the first choice for surgical or endovascular methods. Endovascular reconstructive treatment by stent-assisted coiling embolisation was indicated in dissecting vertebral artery aneurysms with ipsilateral dominant vertebral artery or PICA involvement. Clinical outcomes were determined using the modified Rankin Score (mRS) at 90 days, with favourable outcomes defined as 0 to 2. Results Of the patients presenting with ruptured aneurysms, 11 (61.1%) had a good clinical outcome, with a mRS of 0-2. Favourable Hunt and Hess grading (65%), mild to moderate GCS (65%) and total occlusion of aneurysms after treatment (65%) were significantly good prognostic factors in patients with ruptured vertebral artery dissecting aneurysms. Conclusion Endovascular parent vessel sacrifice could be the first choice to treat a ruptured vertebral artery dissecting aneurysm. Stent-assisted coiling to preserve the patency of the parent artery and its branches is a promising treatment for vertebral artery dissections.
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Affiliation(s)
- K Urasyanandana
- 1 Phramongkutklao hospital, Phramongkutklao College of Medicine, Thailand
| | - P Withayasuk
- 2 Siriraj hospital, Mahidol University, Thailand
| | - D Songsaeng
- 2 Siriraj hospital, Mahidol University, Thailand
| | | | - E Chankaew
- 2 Siriraj hospital, Mahidol University, Thailand
| | - A Churojana
- 2 Siriraj hospital, Mahidol University, Thailand
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Mehrotra M, Mehrotra A, Nair A, Srivastava A, Sahu RN, Pradhan M, Kumar R. Dissecting intracranial aneurysm in pregnancy: A rare association. Asian J Neurosurg 2017; 12:127-130. [PMID: 28413555 PMCID: PMC5379786 DOI: 10.4103/1793-5482.150224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of dissecting aneurysm of the right posterior cerebral artery presenting with sudden onset headache and altered behavior during labor. A 26-year-old P1001 with uncomplicated antenatal period, except history of headache off and on since 32 weeks of pregnancy, developed sudden onset headache and altered behavior during 3rd stage of labor. She had vaginal delivery and a live born male baby was delivered with good Apgar score. The CT was suggestive of subarachnoid hemorrhage and DSA was suggestive of dissecting aneurysm of the right P2 segment with hypoplasia of right P1 segment and A1 segment of posterior and anterior cerebral artery, respectively. The patient was managed conservatively. At 4-month follow-up, the patient was doing well. We discuss about the rare association of a dissecting aneurysm and pregnancy, especially dissection of the posterior cerebral artery.
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Affiliation(s)
- Manasi Mehrotra
- Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Anup Nair
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Arun Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Rabi Narayan Sahu
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Mandakini Pradhan
- Department of Maternal and Reproductive Health, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, India
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15
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Guan J, Li G, Kong X, He C, Long J, Qin H, Zhang H, Wang R. Endovascular treatment for ruptured and unruptured vertebral artery dissecting aneurysms: a meta-analysis. J Neurointerv Surg 2016; 9:558-563. [PMID: 27220870 DOI: 10.1136/neurintsurg-2016-012309] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/22/2016] [Accepted: 04/29/2016] [Indexed: 11/04/2022]
Abstract
BackgroundDifferent endovascular modalities have been applied to the treatment of vertebral artery dissecting aneurysms, the most commonly used being internal trapping and stent-assisted coiling, although the ideal treatment remains controversial.ObjectiveTo perform a meta-analysis to study clinical outcomes of patients with vertebral artery dissecting aneurysms who were treated with internal trapping or stent-assisted coiling.Materials and methodsWe conducted a meta-analysis of eight retrospective studies that compared internal trapping with stent-assisted coiling for the treatment of vertebral artery dissecting aneurysms. The primary outcomes of this study were immediate occlusion, long-term occlusion, good outcome ratio, perioperative mortality, and angiographic recurrence. Subgroup analyses were conducted of patients with ruptured versus unruptured vertebral artery dissecting aneurysms.ResultsEight studies comprising a total of 188 patients were included in the analysis. For ruptured cases, in comparison with stent-assisted coiling groups, the patients treated with trapping techniques had a higher rate of immediate postoperative occlusion (OR=0.165; 95% CI 0.067 to 0.405; p<0.01), although there was no significant difference in long-term occlusion (OR=1.059; 95% CI 0.033 to 34.121; p=0.974), good clinical outcome rates, recurrence rates, and perioperative mortality. For unruptured cases, patients in the trapping groups also had higher immediate occlusion rates than those who underwent stent-assisted coiling (OR=0.175; 95% CI 0.043 to 0.709; p=0.015), while rates of both recurrence and good clinical outcome were similar between the two groups.ConclusionsBoth internal trapping and stent-assisted coiling are technically feasible for ruptured vertebral artery dissecting aneurysms, with high rates of good long-term neurologic outcomes and low recurrence and mortality rates. For unruptured aneurysms, conservative treatment is recommended. When a posterior inferior cerebellar artery (PICA) origin is involved, bypass surgery or vertebral artery-to-PICA stent placement plus coil embolization should be considered.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China
| | - Xiangyi Kong
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China
| | - Jianwu Long
- Department of Neurosurgery, The 3rd Hospital of Xiamen, Fujian, P. R. China
| | - Hao Qin
- Department of Neurosurgery, Zaozhuang Municipal Hospital of Shandong Province, Shandong, P. R. China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital of Capital University of Medical Sciences, Beijing, P. R. China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
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Long-term follow-up study of 35 cases after endovascular treatment for vertebrobasilar dissecting aneurysms. Clin Neurol Neurosurg 2015. [DOI: 10.1016/j.clineuro.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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17
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Lim SH, Shin HS, Lee SH, Koh JS. Endovascular Treatment of Vertebral Artery Dissecting Aneurysms That Cause Subarachnoid Hemorrhage : Consideration of Therapeutic Approaches Relevant to the Angioarchitecture. J Korean Neurosurg Soc 2015; 58:175-83. [PMID: 26539258 PMCID: PMC4630346 DOI: 10.3340/jkns.2015.58.3.175] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 12/28/2022] Open
Abstract
Objective Intracranial ruptured vertebral artery dissecting aneurysms (VADAns) are associated with high morbidity and mortality when left untreated due to the high likelihood of rebleeding. The present study aimed to establish an endovascular therapeutic strategy that focuses specifically on the angioarchitecture of ruptured VADAns. Methods Twenty-three patients with ruptured VADAn received endovascular treatment (EVT) over 7 years. The patient group included 14 women (60.9%) and 9 men (39.1%) between the ages of 39 and 72 years (mean age 54.2 years). Clinical data and radiologic findings were retrospectively analyzed. Results Four patients had aneurysms on the dominant vertebral artery. Fourteen (61%) aneurysms were located distal to the posterior inferior cerebellar artery (PICA). Six (26%) patients had an extracranial origin of the PICA on the ruptured VA, and 2 patients (9%) had bilateral VADAns. Eighteen patients (78%) were treated with internal coil trapping. Two patients (9%) required an adjunctive bypass procedure. Seven patients (30%) required stent-supported endovascular procedures. Two patients experienced intra-procedural rupture during EVT, one of which was associated with a focal medullary infarction. Two patients (9%) exhibited recanalization of the VADAn during follow-up, which required additional coiling. No recurrent hemorrhage was observed during the follow-up period. Conclusion EVT of ruptured VADAns based on angioarchitecture is a feasible and effective armamentarium to prevent fatal hemorrhage recurrence with an acceptable low risk of procedural complications. Clinical outcomes depend mainly on the pre-procedural clinical state of the patient. Radiologic follow-up is necessary to prevent hemorrhage recurrence after EVT.
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Affiliation(s)
- Seung Hoon Lim
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Sup Shin
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jun Seok Koh
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Li H, Li XF, Zhang X, He XY, Duan CZ, Liu YC. Treatment of unruptured vertebral dissecting aneurysms: internal trapping or stent-assisted coiling. Int J Neurosci 2015; 126:243-8. [PMID: 26001201 DOI: 10.3109/00207454.2015.1010648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Endovascular treatment is an attractive approach for the treatment of unruptured vertebral dissecting aneurysms, and includes internal trapping and stent-assisted coil embolization. However, the optimal therapy remains debatable. We reviewed our experience with both endovascular treatment modalities and compared the safety, efficacy, and short-term outcomes for each approach. MATERIALS AND METHODS We retrospectively reviewed 65 consecutive patients with unruptured vertebral dissecting aneurysms who underwent endovascular treatment between January 2003 and January 2014. 24 patients underwent endovascular internal trapping (group A) while 41 patients underwent stent-assisted coiling (group B). Thirteen patients underwent single stent with coiling while 28 patients underwent double or three stent-assisted coiling. Short-term outcomes were evaluated using the modified Rankin Scale. RESULTS A favorable clinical outcome was achieved in 58 of 65 patients. Procedure-related complications included ischemic symptoms (n = 6) and recurrence (n = 4). There was no statistical difference in modified Rankin Scale scoring between groups. Group A patients had more ischemia symptoms compared with group B patients (p = 0.043), Group B patients had higher recurrence rates compared with group A patients, but the difference had no statistical significance (p = 1.00). However, recurrence only occurred in patients who underwent stent-assisted coiling alone (p = 0.046). CONCLUSION Stent-assisted coiling for unruptured vertebral dissecting aneurysms may maintain artery patency. Multilayer disposition of stents with coils may decrease complications and facilitate aneurysm occlusion. Larger, prospective studies are necessary to determine the long-term outcomes of reconstructive therapy.
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Affiliation(s)
- Hui Li
- a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China
| | - Xi-Feng Li
- a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China
| | - Xin Zhang
- a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China
| | - Xu-Ying He
- a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China
| | - Chuan-Zhi Duan
- a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China
| | - Yan-Chao Liu
- a Department of Neurosurgery , Southern Medical University , Zhujiang Hospital, 253# Industry Road, Guangzhou , Guangdong , RP China
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Individualized endovascular treatment of high-grade traumatic vertebral artery injury. Acta Neurochir (Wien) 2014; 156:1781-8. [PMID: 24781679 DOI: 10.1007/s00701-014-2074-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/19/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic vertebral artery injury (TVAI) is associated with craniocervical trauma that can lead to potentially fatal posterior circulation stroke. It presents a clinical challenge since it is hard to detect and there are no widely accepted guidelines on diagnosis and management. High-grade TVAI is more difficult to treat and no consensus has been reached yet. METHODS We performed a single-center, long-term, therapeutic study involving 272 patients with craniocervical injury, eleven of which were diagnosed with high-grade TVAI. Individualized endovascular treatments were performed on these patients based upon the hemodynamic and morphological characteristics of the injured vertebral artery. Postoperative angiography was conducted at 2 weeks, 3 months and 6 months, and then annually after intervention. RESULTS Ten vertebral pseudoaneurysms and one arteriovenous fistula (AVF) were confirmed by postoperative angiography. All the participants' neurological deficit symptoms disappeared or were significantly alleviated gradually, and no new symptoms were found after endovascular treatment. Follow-up angiography of the patients with pseudoaneurysms showed a normally shaped vertebral artery with no stenosis or aneurysms; the angiographic result of the patient with the AVF presented successful embolization in the proximal vertebral artery fistula with no progression or new stenosis. Their modified Rankin Scale (mRS) scores were also satisfactory. CONCLUSIONS Application of individualized endovascular therapy in high-grade TVAI is safe, technically feasible and clinically effective, but there is no comparison between endovascular management and other management approaches because randomized trials cannot be carried out currently.
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20
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Park W, Ahn JS, Park JC, Kwun BD, Kim CJ. Occipital artery-posterior inferior cerebellar artery bypass for the treatment of aneurysms arising from the vertebral artery and its branches. World Neurosurg 2014; 82:714-21. [PMID: 24998497 DOI: 10.1016/j.wneu.2014.06.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 02/23/2014] [Accepted: 06/10/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report experience with 7 cases of intracranial aneurysms of the vertebral artery (VA) and its branches that were treated with occipital artery (OA)-posterior inferior cerebellar artery (PICA) bypass. METHODS Over 4 years, 7 cases of intracranial aneurysms arising from the VA and its branches were treated with OA-PICA bypass. The clinical data, characteristics of aneurysms, and results of treatment were analyzed. RESULTS There were 4 aneurysms that arose from the VA-PICA junction, 2 aneurysms that occurred at the distal PICA, and 1 aneurysm that occurred at the collateral artery from the distal end of the occluded VA to the ipsilateral PICA. OA-PICA bypass was performed before obliteration of the aneurysms in all patients. Of the 7 aneurysms, 4 were totally obliterated with surgery, 2 were treated with additional endovascular coiling or trapping, and 1 was partially obliterated by surgery and gradually disappeared during the follow-up period. Postoperative angiography revealed that the patency of the grafts was good in 6 patients. In 1 patient with an occluded bypass graft, multiple infarctions developed in the left cerebellum, but the patient had almost fully recovered after rehabilitation. CONCLUSIONS OA-PICA bypass with obliteration of the aneurysm is one of the optimal treatments for intracranial aneurysms that occur at the VA and its branches because it can preserve the perforators and distal blood flow from the PICA.
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Affiliation(s)
- Wonhyoung Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Jung Cheol Park
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Jin Kim
- Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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21
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Clinical outcomes of patients with vertebral artery dissection treated endovascularly: a meta-analysis. Neurosurg Rev 2014; 37:569-77. [DOI: 10.1007/s10143-014-0541-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 02/08/2014] [Indexed: 11/25/2022]
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22
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Bulsara KR, Kuzmik GA, Hebert R, Cheung V, Matouk CC, Jabbour P, Hasan D, Pepper J. Stenting as monotherapy for uncoilable intracranial aneurysms. Neurosurgery 2014. [PMID: 23208063 DOI: 10.1227/neu.0b013e31827fcaba] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Small, blister-like aneurysms (BLAs), by virtue of their unique morphology, are difficult to treat with conventional modalities. The use of oversized self-expanding stents as monotherapy for BLAs is a relatively new and promising concept that warrants further investigation. OBJECTIVE To clarify the role of oversized self-expanding stents as monotherapy for BLAs. METHODS Five consecutive patients were treated for BLAs with oversized self-expanding stents alone by the senior author (K.R.B.). We report on their clinical and radiographic outcomes. RESULTS All 5 patients in our series were discharged in good clinical condition. Complete aneurysm occlusion was observed in all patients at the time of most recent radiographic follow-up. Mean follow-up time was 13.6 months (range, 1 month to 4.5 years). CONCLUSION The use of oversized self-expanding stents to redirect flow away from aneurysms is an effective option for patients with BLAs. This approach represents an alternative to the use of flow diverters.
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Affiliation(s)
- Ketan R Bulsara
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA.
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23
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Sikkema T, Uyttenboogaart M, Eshghi O, De Keyser J, Brouns R, van Dijk JMC, Luijckx GJ. Intracranial artery dissection. Eur J Neurol 2014; 21:820-6. [DOI: 10.1111/ene.12384] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- T. Sikkema
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - M. Uyttenboogaart
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - O. Eshghi
- Department of Radiology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - J. De Keyser
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
- Department of Neurology; University Hospital Brussels; Centre for Neurosciences (C4N); Brussels Belgium
| | - R. Brouns
- Department of Neurology; University Hospital Brussels; Centre for Neurosciences (C4N); Brussels Belgium
| | - J. M. C. van Dijk
- Department of Neurosurgery; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - G. J. Luijckx
- Department of Neurology; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
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Mauri G, Vega P, Murias E, Vega J, Ramón C, Pascual J. Fusiform aneurysms of the vertebral artery: a hidden cause of exertional headache? Cephalalgia 2012; 32:715-8. [PMID: 22684099 DOI: 10.1177/0333102412449928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is only one reported case of recurrent coital headache related to an unruptured saccular aneurysm of the carotid artery. CASE REPORTS We report on two cases of isolated recurrent coital/exertional headaches ipsilateral to unruptured fusiform aneurysms of the vertebral artery diagnosed by CT angiography. While one case is being managed conservatively, a vertebral stent has been set in the other. CONCLUSIONS CT angiography with full visualisation of intracranial and upper cervical arteries could be used as a screening diagnostic procedure in these cases. Together with saccular aneurysms, fusiform aneurysms should be added to the IHS classification as aetiology for exertional recurrent headaches.
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Affiliation(s)
- Gerard Mauri
- Neuroscience Area, University Hospital Central de Asturias, Oviedo, Spain
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