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Salih M, Taussky P, Ogilvy CS. Association between cervicocerebral artery dissection and tortuosity - a review on quantitative and qualitative assessment. Acta Neurochir (Wien) 2024; 166:285. [PMID: 38977512 DOI: 10.1007/s00701-024-06171-2] [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: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
Cervicocerebral artery dissection stands out as a significant contributor to ischemic stroke in young adults. Several studies have shown that arterial tortuosity is associated with dissection. We searched Pubmed and Embase to identify studies on the association between arterial tortuosity and cervicocerebral artery dissection, and to perform a review on the epidemiology of cervicocerebral artery tortuosity and dissection, pathophysiology, measurement of vessels tortuosity, strength of association between tortuosity and dissection, clinical manifestation and management strategies. The prevalence of tortuosity in dissected cervical arteries was reported to be around 22%-65% while it is only around 8%-22% in non-dissected arteries. In tortuous cervical arteries elastin and tunica media degradation, increased wall stiffness, changes in hemodynamics as well as arterial wall inflammation might be associated with dissection. Arterial tortuosity index and vertebrobasilar artery deviation is used to measure the level of vessel tortuosity. Studies have shown an independent association between these two measurements and cervicocerebral artery dissection. Different anatomical variants of tortuosity such as loops, coils and kinks may have a different level of association with cervicocerebral artery dissection. Symptomatic patients with extracranial cervical artery dissection are often treated with anticoagulant or antiplatelet agents, while patients with intracranial arterial dissection were often treated with antiplatelets only due to concerns of developing subarachnoid hemorrhage. Patients with recurrent ischemia, compromised cerebral blood flow or contraindications for antithrombotic agents are usually treated with open surgery or endovascular technique. Those with subarachnoid hemorrhage and intracranial artery dissection are often managed with surgical intervention due to high risk of re-hemorrhage.
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Affiliation(s)
- Mira Salih
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Philipp Taussky
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States
| | - Christopher S Ogilvy
- Neurosurgery Department, Beth Israel Deaconess Medical Center Brain Aneurysm Institute, Harvard Medical School, 110 Francis Street, Boston, MA, 02215, United States.
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2
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Zhao K, Zhao R, Yang X, Guan S, Liang G, Wang HL, Wang D, Feng W, Li Z, Wang W, Peng Y, Xu J, Wang L, Zhong M, Mao G, Li T, Zhang Y, Chen D, Cai C, Sun X, Shi H, Yu J, Wang Y, Gu Z, Zhu G, Zhu Q, Wan J, Li Q, Yang H, Li G, Chai E, Li Q, Yang P, Fang Y, Dai D, Hong B, Huang Q, Xu Y, Liu J, Xu J. Predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs): results from a multicenter study. J Neurointerv Surg 2022; 14:1008-1013. [PMID: 34753811 DOI: 10.1136/neurintsurg-2021-017619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate predictors of unfavorable outcome in stent-assisted coiling for symptomatic unruptured intracranial spontaneous vertebral artery dissecting aneurysms (uis-VADAs) based on 608 reconstructed lesions in 30 medical centres. METHODS A total of 608 patients (male:female=479:129; mean age, 53.26±10.26 years) with 608 symptomatic uis-VADAs underwent reconstructive treatments using stent(s) with coils between January 2009 and December 2015. Treatments and predictors of unfavorable outcomes were retrospectively analyzed. RESULTS Mainly, three methods were used to treat patients with uis-VADAs, including routine single-stent in 208 patients (such as Enterprise and others), new low-profile LVIS single stent in 107 patients, and multiple stents in 293 patients. During the median 66 months of clinical follow-up, 14 patients died, and 16 of the remaining 594 survivors had unfavorable outcomes (modified Rankin Scale score 3-5). The overall mortality rate was 2.3% (14/608), and the unfavorable outcome (mRS score 3-6) rate was 4.9% (30/608). Multivariate logistic regression analysis indicated that preprocedural ischemic infarctions (OR=3.78; 95% CI 1.52 to 9.40; p<0.01), diabetes mellitus (OR=3.74; 95% CI 1.31 to 10.68; p=0.01), and procedural complications (OR=14.18; 95% CI 5.47 to 36.80; p<0.01) were predictors of unfavorable outcome in the reconstructed VADAs. CONCLUSIONS This multicenter study indicated that preprocedural ischemic infarctions, diabetes mellitus, and procedural complications were related to unfavorable clinical outcomes in the reconstructed uis-VADAs.
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Affiliation(s)
- Kaijun Zhao
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
- Department of Neurosurgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rui Zhao
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing, China
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Shenyang Military Command, Shenyang, Liaoning, China
| | - Hong-Lei Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Donghai Wang
- Department of Neurosurgery, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Wenfeng Feng
- Department of Neurosurgery, Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China
| | - Zhenbao Li
- Department of Neurosurgery, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Weiwei Wang
- Department of Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Ya Peng
- Cerebral Vascular Disease Center, Changzhou First People's Hospital, Changzhou, Jiangsu, China
- Cerebral Vascular Disease Center, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Jing Xu
- Department of Neurosurgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China
| | - Lei Wang
- Department of Neurosurgery, Yichang Central People's Hospital, Yichang, Hubei, China
| | - Ming Zhong
- Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guohua Mao
- Department of Neurosurgery, Nanchang University Second Affiliated Hospital, Nanchang, Jiangxi, China
| | - Tianxiao Li
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yang Zhang
- Department of Neurosurgery, Anhui Provincial Hospital, Hefei, Anhui, China
| | - Dong Chen
- Department of Neurosurgery, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Chuwei Cai
- Department of Neurosurgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaochuan Sun
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, Sichuan, China
| | - Huaizhang Shi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jianjun Yu
- Department of Cerebrovascular Disease, Linyi People's Hospital, Linyi, Shandong, China
| | - Yang Wang
- Department of Interventional Neuroradiology, Beijing Chaoyang Hospital, Beijing, China
| | - Zhen Gu
- Department of Neurosurgery, Kunming Medical College Fourth Affiliated Hospital, Kunming, Yunnan, China
| | - Gang Zhu
- Department of Neurosurgery, Third Military Medical University Southwest Hospital, Chongqing, China
| | - Qing Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jieqing Wan
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, Shanghai, China
| | - Qiuping Li
- Department of Neurosurgery, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Hua Yang
- Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Gang Li
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, China
| | - Erqing Chai
- Department of Neurosurgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Qiang Li
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Yibin Fang
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Dongwei Dai
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Bo Hong
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Yi Xu
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital,Naval Medical University, Shanghai, China
| | - Jinyu Xu
- Department of Neurosurgery, Changhai Hospital,Naval Medical University, Shanghai, China
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Hynes N, Kavanagh EP, Sultan S, Jordan F. Surgical and radiological interventions for treating symptomatic extracranial cervical artery dissection. Cochrane Database Syst Rev 2021; 2:CD013118. [PMID: 34559418 PMCID: PMC8078186 DOI: 10.1002/14651858.cd013118.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cervical artery dissection (CeAD) is a pathological bleed or tear, or both, in the wall of the carotid or vertebral arteries as they course through the neck, and is a leading cause of stroke in young people. OBJECTIVES To assess the effectiveness of surgical and radiological interventions versus best medical treatment alone for treating symptomatic cervical artery dissection. SEARCH METHODS We performed comprehensive searches of the Cochrane Stroke Group Trials Register (last searched March 2020), the Cochrane Central Register of Controlled Trials (CENTRAL), 2020, Issue 4, in the Cochrane Library (searched March 2020), MEDLINE (1946 to March 2020) and Embase (1974 to March 2020). We searched relevant ongoing trials and research registers (searched March 2020), checked references in all relevant papers for additional eligible studies, and contacted authors and researchers in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of either surgical or endovascular intervention for the management of symptomatic CeAD were eligible for inclusion. Only studies with anticoagulants or antiplatelet treatment as the control group were included. Two review authors planned to independently extract data. DATA COLLECTION AND ANALYSIS Primary outcomes were ipsilateral stroke and disability. Secondary outcomes were death, any stroke, or transient ischaemic attack, residual stenosis (> 50%), recurrence of cervical dissection, expanding pseudoaneurysm, or major bleeding. We analysed the studies according to the first choice of treatment. We planned to assess for risk of bias and apply GRADE criteria for any included studies. MAIN RESULTS We did not find any completed RCTs or CCTs undertaken in this area of research. AUTHORS' CONCLUSIONS No RCTs or CCTs compared either surgery or endovascular therapy with control. Thus, there is no available evidence to support their use for the treatment of extracranial cervical artery dissection in addition to antithrombotic therapy in people who continue to have neurological symptoms when treated with antithrombotic therapy alone.
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Affiliation(s)
- Niamh Hynes
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
| | - Sherif Sultan
- Department of Vascular and Endovascular Surgery, The Galway Clinic, Galway, Ireland
- Department of Vascular and Endovascular Surgery, University College Hospital, Galway, Ireland
| | - Fionnuala Jordan
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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Gupta G, Eckstein DA, Narayan V, Jumah F, DePalma AA, Sozio SJ, Prendergast N, Schonfeld S, Keller I, Al-Mufti F, Nosko M, Nanda A, Roychowdhury S. Endovascular Management of Intracranial Vertebral Artery Dissection: Technical Nuances for the Preservation of Posterior Inferior Cerebellar Artery and Basilar Artery. Oper Neurosurg (Hagerstown) 2020; 19:241-248. [PMID: 32526018 DOI: 10.1093/ons/opaa174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The treatment of intracranial vertebral artery dissection (VAD) can be challenging. OBJECTIVE To evaluate the clinical presentation, endovascular treatment techniques, and prognostic outcome of patients diagnosed with intracranial VAD at our institution. METHODS A retrospective analysis of 35 patients who were diagnosed with VAD at our institution over 17-yr period (2001-2017) is presented. A total of 27 patients with a total of 30 affected arteries underwent endovascular treatment, and their outcome was evaluated. RESULTS Of the 35 total patients with VAD, 15 presented with headache, 12 with focal neurological deficits, 2 with neck pain, 2 with dizziness, 1 with syncope, and 3 after trauma. Of the 30 dissected arteries, 18 were treated with deconstruction and 12 were treated with stent reconstruction. Treatment method was determined by the dominance of the affected artery and location relative to the ipsilateral posterior inferior cerebellar artery (PICA) and the basilar artery. Deconstructive techniques were utilized in all cases of hypoplastic artery dissection and the majority of codominant artery dissections, whereas reconstruction was performed on the majority of dominant artery dissections. Rupture did not impact treatment technique. Four patients demonstrated post-treatment infarcts, and another 1 patient died because of intraparenchymal bleed. The remaining 22 patients demonstrated favorable clinical outcome. None of the patients developed recanalization or needed retreatment till the last follow-up. CONCLUSION This study suggests that endovascular treatment of intracranial VAD with deconstruction or stent reconstruction based on the patients anatomy, particularly vessel dominance and location with respect to PICA, is feasible and effective though the revascularization procedures still has its role in selected cases.
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Affiliation(s)
- Gaurav Gupta
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Donna A Eckstein
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Vinayak Narayan
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Fareed Jumah
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anthony A DePalma
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Stephen J Sozio
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Nancy Prendergast
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Steven Schonfeld
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Irwin Keller
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Fawaz Al-Mufti
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael Nosko
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anil Nanda
- Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sudipta Roychowdhury
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
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5
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Edaki H, Itami H, Ikushima K, Shinji Y, Otsuka S, Kusaka N, Nishiura T, Ogihara K. A Case of Brainstem Infarction That Was Found to Be Vertebral Artery Dissection in a Short Period after the Diagnosis of Atherothrombotic Infarction. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:428-434. [PMID: 37502663 PMCID: PMC10370534 DOI: 10.5797/jnet.cr.2019-0117] [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: 01/05/2020] [Accepted: 05/15/2020] [Indexed: 07/29/2023]
Abstract
Objective We report a case of vertebral artery dissecting aneurysm that caused right lateral medullary infarction, which was treated by endovascular therapy. Case Presentations A 57-year-old man developed right-side headache and dysarthria on the day before presentation, and exhibited mouth dropping and dysphagia the following day. Initial MRI demonstrated right lateral medullary infarction with atherothrombotic change with no vessel lesion, and we started infusion and medication administration. Later MRI revealed bilateral vertebral artery dissection, and we treated the growing right vertebral artery dissecting aneurysm by stenting and coils. Conclusion The possibility of dissecting lesions should be considered in cases of medullary infarction. Stenting and coil treatment is a useful option for bilateral dissecting vertebral aneurysms.
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Affiliation(s)
- Hisanori Edaki
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Hisakazu Itami
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Kenta Ikushima
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Yukei Shinji
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Shinji Otsuka
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Noboru Kusaka
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Tsukasa Nishiura
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
| | - Kotaro Ogihara
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan
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Hynes N, Kavanagh EP, Tawfick W, Sultan S, Jordan F. Surgical and radiological interventions for treating symptomatic extracranial cervical artery dissection. Hippokratia 2018. [DOI: 10.1002/14651858.cd013118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Niamh Hynes
- The Galway Clinic; Department of Vascular and Endovascular Surgery; Galway Ireland
| | - Edel P Kavanagh
- The Galway Clinic; Department of Vascular and Endovascular Surgery; Galway Ireland
| | - Wael Tawfick
- Western Vascular Institute, University College Hospital; Department of Vascular and Endovascular Surgery; Newcastle Road Galway Ireland
| | - Sherif Sultan
- The Galway Clinic; Department of Vascular and Endovascular Surgery; Galway Ireland
- Western Vascular Institute, University College Hospital; Department of Vascular and Endovascular Surgery; Newcastle Road Galway Ireland
| | - Fionnuala Jordan
- National University of Ireland Galway; School of Nursing and Midwifery; Arus Moyola Newcastle Road Galway Ireland
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Zhang H, Zhao Y, Naha G, Hou C, Wang Z, Yang X. Successful Management of Extracranial Vertebral Artery Aneurysm by Artificial Vessel Reconstruction. World Neurosurg 2018; 116:249-254. [DOI: 10.1016/j.wneu.2018.05.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/30/2022]
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Abstract
Cervical artery dissections (CeAD) include both internal carotid and vertebral artery dissections. They are rare but important causes of stroke, especially in younger patients. CeAD should be considered in patients with strokelike symptoms, a new-onset headache and/or neck pain, and/or other risk factors. Early imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is key to making the diagnosis. Treatment may vary depending on the extent of the dissection, timing of the dissection, and other comorbidities. The overall prognosis is good, but does depend on the initial severity of symptoms.
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Affiliation(s)
- Jennifer J Robertson
- Department of Emergency Medicine, Emory University School of Medicine, 1648 Pierce Drive Northeast, Atlanta, GA 30307, USA
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas-Southwestern, Parkland Hospital, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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9
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Cervical Artery Dissections: A Review. J Emerg Med 2016; 51:508-518. [DOI: 10.1016/j.jemermed.2015.10.044] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 09/22/2015] [Accepted: 10/17/2015] [Indexed: 01/03/2023]
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10
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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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Ishikawa T, Yamaguchi K, Anami H, Ishiguro T, Matsuoka G, Kawamata T. Stent-assisted coil embolisation for bilateral vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage. Neuroradiol J 2016; 29:473-478. [PMID: 27558993 DOI: 10.1177/1971400916666559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bilateral dissecting aneurysms presenting with subarachnoid haemorrhage are rare. The treatment strategy for bilateral vertebral artery dissecting aneurysms is controversial because the contralateral vertebral artery is already dissected and can easily undergo enlargement or bleed after non-reconstructive treatment procedures such as trapping or proximal occlusion. Here, we report a case of bilateral vertebral artery dissecting aneurysm presenting with subarachnoid haemorrhage that was treated with stent-assisted coiling for the ruptured side. A 42-year-old man was admitted to our hospital with sudden headache (WFNS grade 1). Computed tomography showed a high-density region in the basal cistern and posterior fossa with more haemorrhage on the right side (Fisher group 3). Three-dimensional computed tomography and three-dimensional rotational angiography demonstrated a bilateral round protrusion on the vertebral arteries with a diameter of 5 mm just distal to the posterior inferior cerebellar artery. Stent-assisted coiling was performed for the ruptured right side and conservative therapy was selected for the contralateral side. The ruptured side was well embolised, and the contralateral side was stable over the 12-month follow-up period after treatment. The treatment strategy for bilateral vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage is different from that for unilateral vertebral artery dissecting aneurysms. Non-reconstructive treatment procedures such as trapping may cause contralateral enlargement or rupture; therefore, reconstructive treatment may be appropriate for the ruptured side.
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Affiliation(s)
- Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Hidenori Anami
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Taichi Ishiguro
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Go Matsuoka
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
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Shi L, Xu K, Sun X, Yu J. Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery. Int J Med Sci 2016; 13:540-55. [PMID: 27429591 PMCID: PMC4946125 DOI: 10.7150/ijms.15233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/01/2016] [Indexed: 12/04/2022] Open
Abstract
Among the variations of vertebral artery dissecting aneurysms (VDAs), VDAs involving the posterior inferior cerebellar artery (PICA), especially ruptured and high-risk unruptured aneurysms, are the most difficult to treat. Because the PICA is an important structure, serious symptoms may occur after its occlusion. Retained PICAs are prone to re-bleeding because VDAs are difficult to completely occlude. There is therefore confusion regarding the appropriate treatment for VDAs involving the PICA. Here, we used the PubMed database to review recent research concerning VDAs that involve the PICA, and we found that treatments for VDAs involving the PICA include (i) endovascular treatment involving the reconstruction of blood vessels and blood flow, (ii) occluding the aneurysm using an internal coil trapping or an assisted bypass, (iii) inducing reversed blood flow by occluding the proximal VDA or forming an assisted bypass, or (iv) the reconstruction of blood flow via a craniotomy. Although the above methods effectively treat VDAs involving the PICA, each method is associated with both a high degree of risk and specific advantages and disadvantages. The core problem when treating VDAs involving the PICA is to retain the PICA while occluding the aneurysm. Therefore, the method is generally selected on a case-by-case basis according to the characteristics of the aneurysm. In this study, we summarize the various current methods that are used to treat VDAs involving the PICA and provide schematic diagrams as our conclusion. Because there is no special field of research concerning VDAs involving the PICA, these cases are hidden within many multiple-cases studies. Therefore, this study does not review all relevant documents and may have some limitations. Thus, we have focused on the mainstream treatments for VDAs that involve the PICA.
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Affiliation(s)
- Lei Shi
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 130021
| | - Kan Xu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 130021
| | - Xiaofeng Sun
- 2. Department of Ultrasonography, First Hospital of Jilin University, Changchun, China, 130021
| | - Jinlu Yu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 130021
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Lehto H, Niemelä M, Kivisaari R, Laakso A, Jahromi BR, Hijazy F, Andrade-Barazarte H, Dashti R, Hernesniemi J. Intracranial Vertebral Artery Aneurysms: Clinical Features and Outcome of 190 Patients. World Neurosurg 2015; 84:380-9. [PMID: 25828051 DOI: 10.1016/j.wneu.2015.03.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/17/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vertebral artery (VA) aneurysms comprise approximately one-third of posterior circulation aneurysms. They are morphologically variable, and located critically close to the cranial nerves and the brainstem. We aim to represent the characteristics of these aneurysms and their treatment, and to analyze the outcome. METHODS We reviewed retrospectively 9709 patients with intracranial aneurysms. Of these, we included 190 with aneurysms at the VA or VA-posterior inferior cerebellar artery junction. These patients were treated in the Department of Neurosurgery, Helsinki, Finland, between 1934 and 2011. RESULTS The 190 patients had 193 VA aneurysms, among which 131 (68%) were ruptured. The VA aneurysm caused a mass effect in 7 and ischemia in 2 patients. Compared to 4387 patients with a ruptured aneurysm in other locations, those with a VA aneurysm were older, their aneurysms were more often fusiform, and more often caused intraventricular hemorrhages. Among surgically treated aneurysms, clipping was the treatment in 91 (88%) saccular and 11 (50%) fusiform aneurysms. Treatment was endovascular in 13 (9%), and multimodal in 6 (4%) aneurysms. Within a year after aneurysm diagnosis, 53 (28%) patients died. Among the survivors, 104 (93%) returned to an independent or to their previous state of life; only 2 (2%) were unable to return home. CONCLUSIONS Microsurgery is a feasible treatment for VA aneurysms, although cranial nerve deficits are more common than in endovascular surgery. Despite the challenge of an often severe hemorrhage, of challenging morphology, and risk for laryngeal palsy, most patients surviving the initial stage return to normalcy.
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Affiliation(s)
- Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ferzat Hijazy
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Reza Dashti
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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14
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Hamasaki O, Ikawa F, Hidaka T, Kurokawa Y, Yonezawa U. Treatment of ruptured vertebral artery dissecting aneurysms. A short report. Interv Neuroradiol 2014; 20:304-11. [PMID: 24976093 DOI: 10.15274/inr-2014-10024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/19/2013] [Indexed: 02/02/2023] Open
Abstract
We evaluated the outcomes of endovascular or surgical treatment of ruptured vertebral artery dissecting aneurysms (VADAs), and investigated the relations between treatment complications and the development and location of the posterior inferior cerebellar artery (PICA). We treated 14 patients (12 men, two women; mean age, 56.2 years) with ruptured VADAs between March 1999 and June 2012 at our hospital. Six and eight patients had Hunt and Hess grades 1-3 and 4-5, respectively. Twelve patients underwent internal endovascular trapping, one underwent proximal endovascular occlusion alone, and one underwent proximal endovascular occlusion in the acute stage and occipital artery (OA)-PICA anastomosis and surgical trapping in the chronic stage. The types of VADA based on their location relative to the ipsilateral PICA were distal, PICA-involved, and non-PICA in nine, two, and three patients, respectively. The types of PICA based on their development and location were bilateral anterior inferior cerebellar artery (AICA)-PICA, ipsilateral AICA-PICA, extradural, and intradural type in one, two, two, and nine patients, respectively. Two patients with high anatomical risk developed medullary infarction, but their midterm outcomes were better than in previous reports. The modified Rankin scale indicated grades 0-2, 3-5, and 6 in eight, three, and three patients, respectively. A good outcome is often obtained in the treatment of ruptured VADA using internal endovascular trapping, except in the PICA-involved type, even with high-grade subarachnoid hemorrhage. Treatment of the PICA-involved type is controversial. The anatomical location and development of PICA may be predicted by complications with postoperative medullary infarction.
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Affiliation(s)
- Osamu Hamasaki
- Department of Neurosurgery, Shimane Prefectural Central Hospital; Izumo, Japan -
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital; Izumo, Japan
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital; Izumo, Japan
| | - Yasuharu Kurokawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital; Izumo, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital; Izumo, Japan
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15
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Lee DH, Yoon WK, Baik MW, Kim H. The difference of each angiographic finding after multiple stent according to stent type in bilateral vertebral artery dissection. J Cerebrovasc Endovasc Neurosurg 2013; 15:229-34. [PMID: 24167805 PMCID: PMC3804663 DOI: 10.7461/jcen.2013.15.3.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/24/2013] [Accepted: 07/14/2013] [Indexed: 12/17/2022] Open
Abstract
We report a case of spontaneous bilateral intracranial vertebral artery dissecting aneurysms with subarachnoid hemorrhage. One dissecting lesion was treated with a coronary balloon-mounted stent (BMS) technique; however, due to differences in access route tortuosity, the other lesion was treated with a self-expandable stent (SES) technique. After 2 months, the angiographic outcome showed complete healing of the dissected segment on the side that was treated with BMS; in contrast, the dissection lesion appeared to be re-growing on the side that was treated with SES. Complete treatment of the aggravated lesion was achieved by additional deployment of BMSs. Therefore, we have provided a discussion of the possible reasons for this difference in outcome according to the stent type.
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Affiliation(s)
- Dong Hoon Lee
- Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Woon Ki Yoon
- Department of Neurosurgery, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Min Woo Baik
- Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Hoon Kim
- Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
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16
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Jindal G, Gemmete J, Gandhi D. Interventional Neuroradiology Applications in Otolaryngology, Head and Neck Surgery. Otolaryngol Clin North Am 2012; 45:1423-49. [DOI: 10.1016/j.otc.2012.08.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Kishi S, Kanaji K, Doi T, Matsumura T. A case of traumatic intracranial vertebral artery injury presenting with life-threatening symptoms. Int Med Case Rep J 2012; 5:23-8. [PMID: 23754919 PMCID: PMC3658250 DOI: 10.2147/imcrj.s30930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Traumatic intracranial vertebral artery injury is a relatively rare but potentially fatal disease. We present a case of a 63-year-old man who presented with sudden onset of loss of consciousness after hitting his head. After immediate resuscitation, he showed quadriplegia and absence of spontaneous breathing. Brain and cervical spine magnetic resonance imaging revealed an atlantoaxial subluxation, fractured C2 odontoid process, left vertebral artery occlusion, and bilateral extensive ischemia in the medulla oblongata and high cervical spinal cord. Digital subtraction angiography demonstrated left vertebral artery dissection just below the level of vertebral body C2.
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Affiliation(s)
- Seiji Kishi
- Department of Nephrology, Tokushima University Hospital, Kuramoto-cho Tokushima, Japan
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