1
|
Yu J. Current research status and future of endovascular treatment for basilar artery aneurysms. Neuroradiol J 2024; 37:571-586. [PMID: 38560789 DOI: 10.1177/19714009241242584] [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] [Indexed: 04/04/2024] Open
Abstract
Aneurysms occurring along the basilar artery (BA) account for <1% of all intracranial aneurysms. Endovascular treatment (EVT) in particular is recommended for large unruptured BA aneurysms and ruptured BA aneurysms. Given that EVT techniques vary, a detailed review of EVT for BA aneurysms is necessary. In this review, the following issues were discussed: the anatomy and anomalies of the BA, the classification of BA aneurysms, the natural history of BA aneurysms, the status of open surgery, the use of EVT for various types of BA aneurysms and the deployment of new devices. According to the findings of this review and based on our experience in treating BA aneurysms, traditional coiling EVT is still the optimal therapy for most BA aneurysms. However, in some BA aneurysms, flow diverter (FD) deployment can be used. In addition, there are also some new devices, such as intrasaccular flow disruptors and stent-like devices that can be used to treat BA aneurysms. In general, EVT can yield good clinical and angiographic outcomes for patients with BA aneurysms. In addition, recent new devices and techniques, such as new-generation FDs generated via surface modification and virtual reality simulation techniques, show promise for EVT for BA aneurysms. These devices and techniques may further improve EVT outcomes for BA aneurysms.
Collapse
Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, China
| |
Collapse
|
2
|
Man IC, Pan TM, U KC. An unusual etiology of subarachnoid hemorrhage, basilar artery perforator aneurysms, in Macao: Three case reports and review of literature. World J Clin Cases 2024; 12:4337-4347. [PMID: 39015907 PMCID: PMC11235533 DOI: 10.12998/wjcc.v12.i20.4337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/14/2024] [Accepted: 05/27/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications. Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage. Conversely, basilar artery perforator aneurysms (BAPAs) are a rare etiology. There is no consensus on the optimal management of ruptured BAPAs in the acute setting. CASE SUMMARY We present a case series of 3 patients with ruptured BAPAs who were treated at our institution. Two patients had a modified Fisher grade of I, and one had a grade of IV on initial presentation. The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case. The 3 patients underwent endovascular treatment with Guglielmi detachable coils. Post-treatment, the patients had good clinical outcomes, and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage. However, one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition. The other 2 patients showed progressive recovery, and no aneurysm recurrence was observed at the 2-year follow-up. CONCLUSION Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management. Early detection and prompt treatment is important to achieve favorable patient outcomes.
Collapse
Affiliation(s)
- Ieong-Chon Man
- Department of Radiology, Hospital Conde S. Januário, Macao SAR 999078, China
| | - Tam-Man Pan
- Department of Radiology, Hospital Conde S. Januário, Macao SAR 999078, China
| | - Kuok-Cheong U
- Department of Radiology, Hospital Conde S. Januário, Macao SAR 999078, China
| |
Collapse
|
3
|
Kaldas A, Zolnourian A, Ewbank F, Digpal R, Narata A, Ditchfield A, Macdonald J, Bulters D. Basilar artery perforator aneurysms: a comparison with non-perforator saccular aneurysms. Acta Neurochir (Wien) 2024; 166:141. [PMID: 38499881 DOI: 10.1007/s00701-024-06026-w] [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: 01/01/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Basilar artery perforator aneurysms (BAPAs) are rare. There is no systematic description of their presentation, imaging, natural history and outcomes and how these compare to conventional non-perforator aneurysms. Thus, the authors in this study aimed to compare BAPAs to non-perforator aneurysms. METHODS Cases were identified from a prospective neurovascular database, notes and imaging retrospectively reviewed and compared to a consecutive series of patients with non-perforator aneurysms. Blood volume on CT and vessel wall imaging (VWI) were compared to controls. RESULTS 9/739 patients with aneurysmal subarachnoid haemorrhage (aSAH) harboured BAPAs. Compared to 103 with aSAH from posterior circulation aneurysms, they were more likely to be male (6/9, p = 0.008), but of equal severity (4/9 poor grade, p = 0.736) and need of CSF drainage (5/9, p = 0.154). Blood volume was similar to controls (30.2 ml vs 26.7 ml, p = 0.716). 6/9 BAPAs were initially missed on CTA. VWI showed thick (2.9 mm ± 2.7) bright enhancement (stalk ratio 1.05 ± 0.12), similar to controls with ruptured aneurysms (0.95 ± 0.23, p = 0.551), and greater than unruptured aneurysms (0.43 ± 0.11, p < 0.001). All were initially managed conservatively. Six thrombosed spontaneously. Three grew and had difficult access with few good endovascular options and were treated through a subtemporal craniotomy without complication. None rebled. At 3 months, all presenting in poor grade were mRS 3-4 and those in good grade mRS 1-2. CONCLUSIONS Despite their small size, BAPAs present with similar volume SAH, WFNS grade and hydrocephalus to other aneurysms. They are difficult to identify on CTA but enhance strikingly on VWI. The majority thrombosed. Initial conservative management reserving treatment for growth was associated with no rebleeds or complications.
Collapse
Affiliation(s)
- Antony Kaldas
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ardalan Zolnourian
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Frederick Ewbank
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ronneil Digpal
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Ana Narata
- Department of Interventional Neuroradiology, University Hospital Southampton, Southampton, UK
| | - Adam Ditchfield
- Department of Interventional Neuroradiology, University Hospital Southampton, Southampton, UK
| | - Jason Macdonald
- Department of Interventional Neuroradiology, University Hospital Southampton, Southampton, UK
| | - Diederik Bulters
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| |
Collapse
|
4
|
Shin JE, Lee JY. Ruptured basilar artery perforator aneurysm mimicking superior cerebellar artery aneurysm. Neurochirurgie 2024; 70:101544. [PMID: 38394841 DOI: 10.1016/j.neuchi.2024.101544] [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: 01/14/2024] [Revised: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND IMPORTANCE The diagnosis of basilar artery perforator aneurysm is difficult due to their small size, with high rates of negative angiography. Furthermore, due to the considerable variation of basilar artery perforator (BAP), even if an aneurysm originates from a BAP, it is often difficult to clearly identify its origin on angiography. CLINICAL PRESENTATION A 46-female patient presented with World Federation of Neurological Surgeons Scale 1 subarachnoid hemorrhage. Initial imaging study, including digital subtraction angiography (DSA), revealed no vascular lesions. Two-week after admission, DSA revealed an aneurysm arising from the left superior cerebellar artery (SCA). Endovascular coil embolization was planned first. However, aneurysm selection using microcatheter was failed. Then, surgical approach was done via pre-temporal approach. We identified SCA, but there was no aneurysm. Further dissection revealed an aneurysm arising from basilar artery perforator, which was overlapped by SCA. The parent artery of the aneurysm arose from juxtaproximal to the orifice of left SCA, and crossed SCA at the juxtadistal to the aneurismal sac. Complete clip occlusion was done preserving BAP. After the surgery, the patient developed diplopia without extraoccular movement limitations. Two-month after the surgery, she was fully recovered without any neurologic deficits. CONCLUSION It is crucial to adequately consider the possibility of open surgery as a viable option in case that endovascular treatment of aneurysms originated from the distal segment of basilar artery proves unsuccessful.
Collapse
Affiliation(s)
- Jeong Eun Shin
- Department of Neurosurgery, Hallym University Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong Young Lee
- Department of Neurosurgery, Hallym University Gangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
5
|
Alharbi A, Alharbi M, Alharbi M, Almishali F, Alzhrani H, Al-Najaidi J, Aljohani M, Sabba S, Abdulla L, Alaiwi M, Hasan M, Hatim A, Abdulla E, Maddah A. A Case Report of a Giant Basilar Artery Aneurysm. Cureus 2023; 15:e51018. [PMID: 38264370 PMCID: PMC10804338 DOI: 10.7759/cureus.51018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
Intracranial aneurysms, characterized by the localized dilation of cerebral arteries, pose a substantial risk of rupture, leading to severe consequences. Basilar artery aneurysms, in particular, present unique challenges due to their location and potential impact on vital brainstem structures. Advanced diagnostic imaging has improved the chances of early identification of the condition, enabling timely intervention. We discuss the case of a 54-year-old female with controlled hypertension, who presented with persistent severe headaches and neurological symptoms. Diagnostic investigations revealed a large saccular basilar artery aneurysm measuring 4.7 cm. The aneurysm exerted pressure on the brainstem. After comprehensive discussions, the patient underwent successful flow-diverter stent placement, which led to the gradual resolution of symptoms. The multidisciplinary team closely monitored the patient in the neurointensive care unit. Managing giant basilar artery aneurysms poses significant challenges due to the potentially life-threatening complications associated with it. The success in treating the presented case underscores the importance of a multidisciplinary approach involving neurosurgery, interventional radiology, and critical care in managing these patients.
Collapse
Affiliation(s)
- Ahlam Alharbi
- Family Medicine, Primary Health Care Center, Riyadh, SAU
| | | | | | | | | | | | | | - Sara Sabba
- General Practice, Wenzhou Medical University, Wenzhou, CHN
| | - Layla Abdulla
- General Practice, Wenzhou Medical University, Wenzhou, CHN
| | - Mahmood Alaiwi
- General Practice, First Moscow State Medical University, Moscow, RUS
| | - Mohamed Hasan
- General Practice, Wenzhou Medical University, Wenzhou, CHN
| | | | - Eman Abdulla
- General Practice, Mansoura University, Mansoura, EGY
| | | |
Collapse
|
6
|
Orenday-Barraza JM, Jabre R, Venteicher AS. Orbitozygomatic Approach for a Ruptured P1 Perforator Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2023; 25:e284-e285. [PMID: 37527017 DOI: 10.1227/ons.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/19/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- José Manuel Orenday-Barraza
- Department of Neurosurgery, Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roland Jabre
- Département de Chirurgie, Service de Neurochirurgie, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Andrew S Venteicher
- Department of Neurosurgery, Center for Skull Base and Pituitary Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
7
|
Zhu F, Liao L, Bracard S, Derelle AL, Muszynski P, Merlot I, Planel S, Schmitt E, Braun M, Gory B, Anxionnat R. Susceptibility weighted imaging for ruptured basilar artery perforator aneurysms in the setting of angiographically negative subarachnoid hemorrhage. J Neurointerv Surg 2023; 15:1046-1049. [PMID: 36163345 DOI: 10.1136/jnis-2022-019269] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Ruptured basilar artery perforator aneurysms (BAPAs), defined as microaneurysms which develop in basilar perforator arteries without direct involvement of the basilar trunk, represent a rare cause of subarachnoid hemorrhage (SAH). The diagnosis of BAPAs is difficult because of their small size, with high rates of negative angiography. The development of high-resolution MRI could increase the diagnostic performance. In this study we describe the usefulness of susceptibility weighted imaging (SWI) for the diagnosis of ruptured BAPAs. METHODS In a case series, we retrospectively collected data of patients admitted to our institution from 2018 to 2021 for SAH with negative CT angiography who underwent MRI (including SWI) and DSA during hospitalization. RESULTS Eight patients with a definitive diagnosis of ruptured BAPA and five patients with a definitive diagnosis of angiogram-negative SAH were included. In all of the patients with BAPAs MRI showed a focal, thick, semi-circumferential SWI hypointensity covering the vessel wall at the level of the BAPA subsequently revealed on DSA; this phenomen is known as 'SWI capping'. No SWI capping was observed in the five patients with a definitive diagnosis of angiogram-negative SAH. CONCLUSION SWI capping appears to be a reliable indirect sign for the diagnosis and localization of ruptured BAPAs, a rare form of microaneurysm easily misdiagnosed on DSA in initial angiogram-negative SAH.
Collapse
Affiliation(s)
- François Zhu
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Liang Liao
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- INRIA, LORIA, CNRS, Université de Lorraine, Nancy, France
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Anne-Laure Derelle
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
| | - Patricio Muszynski
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- Instituto Oulton, Cordoba, Argentina
| | | | - Sophie Planel
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
| | - Emmanuelle Schmitt
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
| | - Marc Braun
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Benjamin Gory
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - René Anxionnat
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Nancy, France
| |
Collapse
|
8
|
KUMAGAWA T, OTANI N, KAKEI Y, NEGISHI H, SUMA T, YOSHINO A. Ruptured Basilar Artery Perforator Aneurysm Definitely Diagnosed with Intraoperative Microsurgical Findings: Case Report and Literature Review. NMC Case Rep J 2023; 10:1-7. [PMID: 36778213 PMCID: PMC9894615 DOI: 10.2176/jns-nmc.2022-0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/07/2022] [Indexed: 01/22/2023] Open
Abstract
Initial three-dimensional computed tomography and cerebral angiography fail to identify any aneurysm in 20% of cases of subarachnoid hemorrhage. Basilar artery (BA) perforator aneurysms are rare, and approximately 30%-60% were not identified by initial angiography. A 71-year-old male was transferred with a sudden onset of headache and loss of consciousness. Computed tomography demonstrated subarachnoid hemorrhage, but no ruptured aneurysm was detected. Repeat preoperative cerebral angiography indicated a bifurcation aneurysm of the circumflex branch of the superior cerebellar artery perforator, but microsurgical observation identified the BA perforator aneurysm. If the location of the BA perforator aneurysm cannot be clearly identified, as in this case, repeat angiography should be considered, and the treatment strategy should be decided based on a detailed consideration of the site of the aneurysm.
Collapse
Affiliation(s)
- Takahiro KUMAGAWA
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Naoki OTANI
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Yuzo KAKEI
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi NEGISHI
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi SUMA
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Atsuo YOSHINO
- Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
9
|
Muacevic A, Adler JR, Laskay N, Hale AT, Fisher WS. Transpetrosal Approach to a Ruptured Distal Basilar Perforating Artery Aneurysm. Cureus 2023; 15:e34273. [PMID: 36860217 PMCID: PMC9969324 DOI: 10.7759/cureus.34273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/28/2023] Open
Abstract
Basilar perforating artery aneurysms are rare and underreported vascular anomalies in the cerebrovascular literature. Various open and endovascular treatment approaches can be employed to treat these aneurysms based on several patient- and aneurysm-specific factors. Some authors have even advocated for conservative, nonoperative management. Here, we report a case of a ruptured distal basilar perforating artery aneurysm secured by an open transpetrosal approach. A 67-year-old male presented to our institution with a Hunt-Hess grade 2, modified Fisher grade 3 subarachnoid hemorrhage (SAH). Initial cerebral digital subtraction angiography (DSA) did not identify an intracranial aneurysm or other vascular lesions. However, the patient had a re-rupture event several days after presentation. DSA at this time revealed a posteriorly projecting distal basilar perforating artery aneurysm. Initial attempts with endovascular coil embolization were unsuccessful. Thus, an open transpetrosal approach was taken to gain access to the middle and distal basilar trunk to secure the aneurysm. This case underscores the unpredictability of basilar perforating artery aneurysms and the challenges encountered when considering active treatment. We demonstrate an open surgical approach with an intraoperative video for definitive management after failed attempted endovascular treatment.
Collapse
Affiliation(s)
- Alexander Muacevic
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - John R Adler
- Neurological Surgery, University of Alabama at Birmingham, Birmingham, USA
| | | | | | | |
Collapse
|
10
|
Spontaneous subarachnoid hemorrhage caused by ruptured aneurysm of basilar trunk perforator: a case report and literature review. Chin Neurosurg J 2022; 8:14. [PMID: 35681227 PMCID: PMC9185891 DOI: 10.1186/s41016-022-00281-5] [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: 01/05/2022] [Accepted: 05/07/2022] [Indexed: 12/02/2022] Open
Abstract
Background Aneurysm of basilar perforator was rarely reported in the literature. It is difficult to treat due to its small size and deep-seated location. Excessive treatment may cause complications that resulted from ischemic events of parent perforators. Therefore, it is important to make clinical strategy for such patients to improve the prognosis. Case presentation One case, who presented as spontaneous subarachnoid hemorrhage, despite the negative result in computed tomography angiography firstly, was diagnosed angiographically as a ruptured aneurysm of the basilar perforator. A good clinical outcome of the case was achieved during the follow-up after conservative observation for 2 months, as well as the disappearance of previous lesion from angiography. Conclusions Aneurysm located at perforator of basilar trunk was rare and difficult to treat. Conservative observation for certain cases with periodic angiography follow-up was considered in order to prevent the patients from potential iatrogenic effects.
Collapse
|
11
|
Flow Diverter Treatment of Ruptured Basilar Artery Perforator Aneurysms. Clin Neuroradiol 2022; 32:783-789. [PMID: 35059755 PMCID: PMC9424161 DOI: 10.1007/s00062-021-01133-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/18/2021] [Indexed: 11/27/2022]
Abstract
Purpose Ruptured basilar artery perforator aneurysms (BAPAs) represent a very rare cause of subarachnoid hemorrhage and an under-reported subtype of cerebral aneurysm. There is no consensus for the optimal treatment strategy (conservative vs. surgical vs. various endovascular approaches). We aim to present a multicenter experience of BAPA treatment using flow-diverter (FD) stents. Methods At five tertiary neurovascular centers, all cases of ruptured BAPAs treated by FD were retrospectively collected. Baseline imaging and clinical characteristics, complications, as well as early and long-term angiographic and clinical outcome (mRS) were analyzed. Results Eighteen patients (mean age, 57 years; SD, ±10.7 years) with acute SAH related to a BAPA were treated using 18 FD stents. Aneurysms were detected on initial imaging study in 28%; delayed diagnosis was triggered by clinical deterioration due to rebleeding in 15%. No rebleeding after FD was seen, 28% developed FD-related ischemic complications. At long term (n = 16), overall mortality was 13% (2/16), and favorable outcome (mRS 0–2) was 81% (13/16). All BAPAs (n = 13) were completely occluded at long-term angiographic follow-up. Conclusion In our multicenter experience, FD treatment of ruptured BAPAs appears to have comparable safety and efficacy outcomes to FD treatment of other ruptured posterior circulation aneurysms as well as to the conservative management of BAPAs. This treatment strategy for a ruptured BAPA achieved a high rate of angiographic occlusion and favorable clinical outcome; however, as the conservative management also seems to offer similar clinical outcomes an individualized treatment decision is warranted. Future prospective studies comparing both approaches are required. Supplementary Information The online version of this article (10.1007/s00062-021-01133-y) contains supplementary material, which is available to authorized users.
Collapse
|
12
|
Kuhn AL, Puri AS, Massari F, Singh J. Intravascular Wrap for Treatment of Basilar Artery Perforator Aneurysm. Cureus 2021; 13:e18021. [PMID: 34692271 PMCID: PMC8523180 DOI: 10.7759/cureus.18021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/05/2022] Open
Abstract
Basilar artery perforator aneurysms are very rare and usually present with subarachnoid hemorrhage. High-quality imaging systems with digital subtraction angiography and three-dimensional rotational angiography are crucial for the detection of these posterior circulation vascular lesions, which may still be missed on the initial angiogram. We present the first use of a Flow Re-Direction Endoluminal Device (Microvention, Aliso Viejo, California) for treatment of a ruptured basilar artery perforator aneurysm via snuffbox vascular access and use of cangrelor for antiplatelet management.
Collapse
Affiliation(s)
- Anna Luisa Kuhn
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, USA
| | - Ajit S Puri
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, USA
| | - Francesco Massari
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, USA
| | - Jasmeet Singh
- Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, USA
| |
Collapse
|
13
|
Li C, Liu AF, Qiu HC, Lv X, Zhou J, Zhang YQ, Lv J, Zhang YY, Hu S, Liu F, Liu YE, Jin M, Jiang WJ. Perforator preservation technologies (PPT) based on a new neuro-interventional classification in endovascular treatment of perforator involving aneurysms (piANs). Chin Neurosurg J 2021; 7:26. [PMID: 33933161 PMCID: PMC8088693 DOI: 10.1186/s41016-021-00243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification. METHODS The piANs were classified into type I: aneurysm really arises from perforating artery, type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb), and type III: fusiform aneurysm involves perforating artery. Stent protection technology of PPT was applied in type I and III aneurysms, and coil-basket protection technology in type II aneurysms. An immediate outcome of aneurysmal obliteration after treatment was evaluated (satisfactory obliteration: the saccular aneurysm body is densely embolized (I), leaving a gap in the neck (IIa) or dome (IIb) where the perforating artery arising; fusiform aneurysm is repaired and has a smooth inner wall), and successful perforating artery preservation was defined as keeping the good antegrade flow of those perforators on postoperative angiography. The periprocedural complication was closely monitored, and clinical and angiographic follow-ups were performed. RESULTS Six consecutive piANs (2 ruptured and 4 unruptured; 1 type I, 2 type IIa, 2 type IIb, and 1 type III) in 6 patients (aged from 43 to 66 years; 3 males) underwent endovascular therapy between November 2017 and July 2019. The immediate angiography after treatment showed 6 aneurysms obtained satisfactory obliteration, and all of their perforating arteries were successfully preserved. During clinical follow-up of 13-50 months, no ischemic or hemorrhagic event of the brain occurred in the 6 patients, but has one who developed ischemic event in the territory of involving perforators 4 h after operation and completely resolved within 24 h. Follow-up angiography at 3 to 10M showed patency of the parent artery and perforating arteries of treated aneurysms, with no aneurysmal recurrence. CONCLUSIONS Our perforator preservation technologies on the basis of the new neuro-interventional classification seem feasible, safe, and effective in protecting involved perforators while occluding aneurysm.
Collapse
Affiliation(s)
- Chen Li
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Ao-Fei Liu
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Han-Cheng Qiu
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Xianli Lv
- grid.12527.330000 0001 0662 3178Neurosurgery Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ji Zhou
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Yi-Qun Zhang
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Jin Lv
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Ying-Ying Zhang
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Sushan Hu
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Fang Liu
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Yun-e Liu
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Min Jin
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| | - Wei-Jian Jiang
- grid.488137.10000 0001 2267 2324New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, 18 Xinjiekouwai Street, Beijing, 100088 China
| |
Collapse
|
14
|
Cox M, Song JW, Nabavizadeh SA, Kung D, Loevner L, Choudhri O. Detection of Angiographically Occult Ruptured Basilar Sidewall Perforator Aneurysm by Vessel Wall MR Imaging. Neurohospitalist 2021; 11:156-159. [PMID: 33791061 DOI: 10.1177/1941874420963648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Basilar artery perforator aneurysms are rare with a prevalence of less than 1%. These are particularly challenging to detect given their small size and tendency to intermittently thrombose. We describe a case of a ruptured basilar artery sidewall perforator aneurysm that was angiographically occult on computed tomographic angiogram and cerebral catheter angiogram. One day after the initial diagnostic work-up, intracranial vessel wall MR imaging (VWI) was performed which revealed a small outpouching along the right posterolateral basilar arterial wall with a punctate enhancing focus suggestive of a thrombosed basilar perforator artery aneurysm. Thrombus within the small aneurysm sac likely contributed to the poor opacification of the aneurysm sac on conventional lumen-based imaging techniques. Ruptured aneurysms have high morbidity and mortality due to their tendency to rebleed, making their expedient detection and treatment imperative. This case highlights the role VWI can play in detecting small ruptured aneurysms that intermittently thrombose and are otherwise challenging to diagnose with conventional vessel imaging.
Collapse
Affiliation(s)
- Mougnyan Cox
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jae W Song
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David Kung
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Laurie Loevner
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Omar Choudhri
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
15
|
Gardijan D, Herega T, Premužić V, Jovanović I, Ozretić D, Poljaković Z, Radoš M. Comparison between stenting and conservative management of posterior circulation perforator aneurysms: Systematic review and case series. Neuroradiology 2021; 63:639-651. [PMID: 33404790 DOI: 10.1007/s00234-020-02618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Posterior circulation perforator aneurysms (PCPAs) are a rare type of intracranial aneurysms whose natural history and optimal clinical management are still largely unexplored. This study aims to report our experience with treating ruptured PCPAs and to provide a systematic review of the literature to compare the two most established treatment options, endovascular stenting, and conservative management including administration of antifibrinolytic drugs and watchful waiting. METHODS We performed a systematic review of the literature following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Major databases were searched for case reports and case report series written in the English language between 1995 and 2020. Additionally, we retrospectively reviewed our stroke center database for cases of ruptured PCPAs between January 2014 and July 2020. Endovascular stenting and conservative treatment were compared using endpoints, including favorable outcome rate (mRS 0-2), occlusion rate, mortality rate, periinterventional complication rate, and re-hemorrhage rate. RESULTS We identified 31 patients treated endovascularly using stents and 33 patients treated conservatively, with the administration of antifibrinolytic drugs in 3 of them. Our analysis showed no statistically significant difference between the groups, except for the occlusion rate. CONCLUSIONS The optimal management strategy of PCPAs is still unknown, but stenting can be considered as an effective occlusion method with an acceptable complication rate. Preventive ventricular drainage may be necessary due to the high hydrocephalus rate encountered in ruptured PCPAs.
Collapse
Affiliation(s)
- Danilo Gardijan
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Tomislav Herega
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
| | - Vedran Premužić
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Ivan Jovanović
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - David Ozretić
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Zdravka Poljaković
- Department of Neurology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Marko Radoš
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| |
Collapse
|
16
|
Lee JJ, Huang M, Guerrero J, Desai VR, Jenson A, Austerman R, Diaz O, Britz GW. Operative Treatment of a Superior Cerebellar Artery Perforator Dissecting Aneurysm. Oper Neurosurg (Hagerstown) 2020; 19:E203-E208. [PMID: 32123901 DOI: 10.1093/ons/opz407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Superior cerebellar artery (SCA) perforator aneurysms are extremely rare, with only one other case published in the literature. There is no conclusive management strategy for these aneurysms, although endovascular treatment, open surgical treatment with clipping, and antifibrinolytic administration with spontaneous thrombosis have all been discussed. CLINICAL PRESENTATION A 61-yr-old male presented with intraventricular hemorrhage (IVH) primarily in the posterior fossa. He was found to have a dissecting left SCA perforator aneurysm lying on the floor of the fourth ventricle. The aneurysm was not amenable to endovascular treatment, and antifibrinolytic therapy failed to spontaneously thrombose the aneurysm. We performed a suboccipital craniotomy and used a supracerebellar transvermian approach to resect the aneurysm. There was total obliteration of the aneurysm on postoperative cerebral angiogram. CONCLUSION SCA perforator aneurysms represent an extremely uncommon subset of intracranial aneurysms. The best therapeutic strategy has yet to be definitively proven. When pursuing surgical treatment, the supracerebellar transvermian navigated approach can be a useful and safe option, as described and illustrated in this video.
Collapse
Affiliation(s)
- Jonathan J Lee
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Meng Huang
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Jaime Guerrero
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Virendra R Desai
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Amanda Jenson
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Ryan Austerman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Orlando Diaz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| | - Gavin W Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
17
|
Enomoto N, Shinno K, Tamura T, Shikata E, Shono K, Takase K. Ruptured Basilar Artery Perforator Aneurysm: A Case Report and Review of the Literature. NMC Case Rep J 2020; 7:93-100. [PMID: 32695555 PMCID: PMC7363639 DOI: 10.2176/nmccrj.cr.2019-0143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
Basilar artery perforator aneurysms (BAPAs) are a rare cause of subarachnoid hemorrhage (SAH), and the natural history is still unknown. Herein, we report a case of ruptured BAPA that appeared during the observation period and then spontaneously disappeared; we have also conducted a review of the literature and performed an analysis based on the type of management. This case of BAPA had a unique course, and our observations may help establish a treatment strategy. A 60-year-old man presented with acute diffuse SAH, World Federation of Neurosurgical Societies (WFNS) Grade II and Fisher Grade 3. Initial three-dimensional digital subtraction angiography (DSA) did not show the source of the hemorrhage. DSA performed on day 39 showed a BAPA with a diameter of 3 mm at the posterior surface of the upper third of the basilar artery. Conservative treatment was chosen. DSA performed on day 64 showed complete resolution of the aneurysm. BAPAs are likely pseudoaneurysms, and not saccular aneurysms, caused due to dissection of basilar perforator arteries. BAPAs are often not recognized on initial imaging, and hence, it is necessary to repeat the DSA examination. Considering the relatively high rate of spontaneous resolution, we chose conservative management. When BAPAs enlarge or do not disappear after conservative treatment, additional therapy such as multiple stents should be considered.
Collapse
Affiliation(s)
- Noriya Enomoto
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Kiyohito Shinno
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Tetsuya Tamura
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Eiji Shikata
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Kenji Shono
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| | - Kensaku Takase
- Department of Neurosurgery, Tokushima Prefectural Central Hospital, Tokushima, Tokushima, Japan
| |
Collapse
|
18
|
Shlobin NA, Cantrell DR, Ansari SA, Hurley MC, Shaibani A, Jahromi BS, Potts MB. Conservative Management and Natural History of Ruptured Basilar Perforator Artery Aneurysms: Two Cases and Literature Review. World Neurosurg 2020; 138:218-222. [PMID: 32194275 DOI: 10.1016/j.wneu.2020.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Basilar perforator aneurysms are rare causes of subarachnoid hemorrhage and their natural history is poorly characterized. Although various treatment strategies have been reported, conservative management is an option that has been associated with a high likelihood of spontaneous resolution. CASE DESCRIPTION Here we present 2 cases of subarachnoid hemorrhage, 1 diffuse and the other perimesencephalic, due to small ruptured basilar perforator artery aneurysms. These aneurysms were only identified after repeat angiography. Conservative management with serial imaging was pursued. Both patients did well clinically and repeat imaging demonstrated spontaneous resolution of the ruptured aneurysms. We also provide a literature review of ruptured basilar perforator aneurysms, showing a ~10% re-rupture rate within the early post-rupture period but otherwise a high rate of spontaneous resolution. CONCLUSIONS Although basilar perforator aneurysms can re-rupture, there is also a high likelihood of spontaneous resolution. Given the challenges of treatment, conservative management is an option that can be considered.
Collapse
Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Donald R Cantrell
- Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Sameer A Ansari
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Michael C Hurley
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Ali Shaibani
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Babak S Jahromi
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
| | - Matthew B Potts
- Department of Neurological Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA; Department of Radiology, Northwestern Memorial Hospital, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA.
| |
Collapse
|
19
|
Da Ros V, Diana F, Sabuzi F, Malatesta E, Sanna A, Scaggiante J, Di Giuliano F, Gandini R, Floris R, Ruggiero M. Flow diverters for ruptured posterior circulation perforator aneurysms: multicenter experience and literature review. J Neurointerv Surg 2020; 12:688-694. [PMID: 32051323 DOI: 10.1136/neurintsurg-2019-015558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/18/2020] [Accepted: 01/22/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The management of ruptured posterior circulation perforator aneurysms (rPCPAs) remains unclear. We present our experience in treating rPCPAs with flow diverter stents (FDs) and evaluate their safety and efficacy at mid- to long-term follow-up. A diagnostic and therapeutic algorithm for rPCPAs is also proposed. METHODS We retrospectively analyzed data from all consecutive patients with rPCPAs treated with FDs at our institutions between January 2013 and July 2019. Clinical presentations, time of treatments, intra- and perioperative complications, and clinical and angiographic outcomes were recorded, with a mid- to long-term follow-up. A systematic review of the literature on rPCPAs treated with FDs was also performed. RESULTS Seven patients with seven rPCPAs were treated with FDs. All patients presented with an atypical subarachnoid hemorrhage distribution and a low to medium Hunt-Hess grade. In 29% of cases rPCPAs were identified on the initial angiogram. In 57% of cases, FDs were inserted within 2 days of the diagnosis. Immediate aneurysm occlusion was observed in 14% of the cases and in 71% at the first follow-up (mean 2.4 months). At mean follow-up of 33 months (range 3-72 months) one case of delayed ischemic complication occurred. Six patients had a modified Rankin Scale (mRS) score of 0 and one patient had an mRS score of 4 at the latest follow-up. CONCLUSIONS The best management for rPCPAs remains unclear, but FDs seem to have lower complication rates than other treatment options. Further studies with larger series are needed to confirm the role of FDs in rPCPA.
Collapse
Affiliation(s)
- Valerio Da Ros
- Department of Biomedicine, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Francesco Diana
- Neuroradiology, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy
| | - Federico Sabuzi
- Department of Biomedicine, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Emanuele Malatesta
- Neuroradiology, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy
| | - Antioco Sanna
- Neuroradiology, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy
| | - Jacopo Scaggiante
- Department of Biomedicine, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | | | - Roberto Gandini
- Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Roberto Floris
- Department of Biomedicine, Fondazione PTV Policlinico Tor Vergata, Roma, Italy.,Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Maria Ruggiero
- Neuroradiology, Maurizio Bufalini Hospital, Cesena, Emilia-Romagna, Italy
| |
Collapse
|
20
|
Endovascular management of basilar artery perforator aneurysm – Insights. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
Granja MF, Monteiro A, Agnoletto GJ, Jamal S, Sauvageau E, Aghaebrahim A, Hanel R. A systematic review of non-trunk basilar perforator aneurysms: is it worth chasing the small fish? J Neurointerv Surg 2019; 12:412-416. [PMID: 31597686 DOI: 10.1136/neurintsurg-2019-015311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE Non-trunk basilar artery perforator aneurysms (BAPAs) are rare intracranial vascular pathologies that have long been underdiagnosed, under-reported, and under-analyzed. We performed a systematic review of the efficacy and safety endpoints between conservative and active treatment approaches for non-trunk BAPAs. METHODS Major databases were analyzed for relevant publications between 1995 and 2019. Studies comparing the outcomes between conservative and active treatment approaches such as coiling, stenting, clipping, liquid embolization, and flow diversion were included. Mortality rate, rate of permanent neurological deficit as determined by the modified Rankin Score (mRS), rate of second treatment occurrence, and perioperative complication rate were also assessed. RESULTS A total of 24 studies, including 54 patients with 56 non-trunk BAPAs, were included. The mean maximum aneurysm diameter was 2.70 mm (range 1-10). A diagnosis was achieved with the initial DSA in 50.0% (27/54) of the patients. A conservative approach was used in 16 patients while active treatment was used in the other 38. Thirteen of 15 (86.7%) patients in the conservative group and 27/34 (79.4%) in the active treatment group had an mRS score 0-2. A non-significant higher odds of a positive outcome was observed in the conservative group (OR 1.51, 95% CI 0.50 to 4.54). The event-related mortality rate was 3.55% (3/54) with one procedure-related death in the active treatment group. CONCLUSIONS In patients with non-trunk BAPAs unamenable to active treatment, conservative approaches may result in acceptable functional outcomes and low morbidity. Small sample sizes and under-reporting of outcomes warrant further study.
Collapse
Affiliation(s)
- Manuel F Granja
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Andre Monteiro
- Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Guilherme Jose Agnoletto
- Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Sara Jamal
- Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
| | - Amin Aghaebrahim
- Neurological Institute, Lyerly Neurosurgery, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| | - Ricardo Hanel
- Stroke & Cerebrovascular Center, Baptist Medical Center Jacksonville, Jacksonville, Florida, USA
| |
Collapse
|
22
|
Bhogal P, AlMatter M, Hellstern V, Pérez MA, Lehmberg J, Ganslandt O, Bäzner H, Henkes H. Basilar artery perforator aneurysms: Report of 9 cases and review of the literature. J Clin Neurosci 2019; 63:122-129. [PMID: 30732987 DOI: 10.1016/j.jocn.2019.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 12/18/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
Basilar perforator artery aneurysms (BAPA's) are an under-recognised cause of sub-arachnoid haemorrhage (SAH). We present our single centre experience of BAPA's and review of the literature. We performed a retrospective review of our prospectively maintained database to identify all BAPA's that presented acute SAH between February 2009 and February 2018. We identified 9 patients (male = 7), each with a single aneurysm, and average age 55 ± 9.7 years. All aneurysms were small, 2.1 ± 0.5 mm (range 1-3 mm). Three aneurysms were not detected on initial angiography. Six aneurysms were treated with flow diversion, 3 were managed conservatively. No repeat haemorrhage occurred in the flow diverted patients. One patient treated conservatively suffered a repeat haemorrhage and died (mRS 6). Follow up imaging (n = 7), at average 5.6 months (range 3-12 months), showed complete occlusion in all the flow-diverted aneurysms and no change in one conservatively managed patient. There was no evidence of perforator infarction on the follow-up post treatment imaging. Clinical follow-up data was available in 8 patients, 6 of whom (75%) had a good outcome (mRS ≤ 2). A high index of suspicion is required to diagnose BAPA. Flow diversion can be used to treat BAPA's with acceptable risk of perforator infarction and low risk of repeat haemorrhage.
Collapse
Affiliation(s)
- P Bhogal
- Department of Interventional Neuroradiology, The Royal London Hospital, London, UK.
| | - M AlMatter
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Germany
| | - V Hellstern
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Germany
| | - M Aguilar Pérez
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Germany
| | - J Lehmberg
- Klinik für Neurochirurgie, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - O Ganslandt
- Neurochirurgische Klinik, Neurozentrum, Klinikum Stuttgart, Germany
| | - H Bäzner
- Neurologische Klinik, Neurozentrum, Klinikum Stuttgart, Germany
| | - H Henkes
- Neuroradiologische Klinik, Neurozentrum, Klinikum Stuttgart, Germany; Medical Faculty, University Duisburg-Essen, Germany
| |
Collapse
|
23
|
Chau Y, Sachet M, Sédat J. Should we treat aneurysms in perforator arteries from the basilar trunk? Review of 49 cases published in the literature and presentation of three personal cases. Interv Neuroradiol 2017; 24:22-28. [PMID: 29022843 DOI: 10.1177/1591019917734531] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Basilar trunk perforator artery aneurysms are rare. Their diagnosis and treatment are difficult, controversial, and challenging. Analysis of 52 cases (49 documented in the literature and three personal cases) clearly shows a re-bleeding rate of 15% in patients whose aneurysm has not been occluded and 0% in treated patients ( p < 0.05). The most effective treatment, and the one that presents the least complication, is double-stenting across the basilar trunk.
Collapse
Affiliation(s)
- Yves Chau
- Unité de Neuro-interverventionnelle, Hôpital Pasteur 2, CHU de Nice, France
| | - Marina Sachet
- Unité de Neuro-interverventionnelle, Hôpital Pasteur 2, CHU de Nice, France
| | - Jacques Sédat
- Unité de Neuro-interverventionnelle, Hôpital Pasteur 2, CHU de Nice, France
| |
Collapse
|
24
|
Chau Y, Sachet M, Sédat J. Super-selective coil embolization of a basilar perforator artery aneurysm previously treated by the stent-in-stent technique, using an extremely soft bare coil delivered through a one-marker microcatheter. Interv Neuroradiol 2017; 23:492-496. [PMID: 28728537 DOI: 10.1177/1591019917720807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Aneurysms of the perforating arteries arising from the basilar artery trunk are rare and represent a therapeutic challenge. Methods A basilar perforator aneurysm was initially treated by the stent-in-stent technique. Enlargement of the aneurysm was seen on follow up and the sac was secondarily coiled using two extremely soft bare coils, delivered through a one-marker microcatheter. Results At 6 months, the patient had a modified Rankin Scale score of 0 and cerebral arteriography demonstrated complete occlusion of the lesion. Conclusions We describe, as far as we are aware, the first case of basilar perforator aneurysm occlusion using extremely soft bare coils, inserted through the mesh of two stents previously placed in the basilar trunk.
Collapse
Affiliation(s)
- Yves Chau
- Centre Hospitalier, Universitaire de Nice, Nice, France
| | - Marina Sachet
- Centre Hospitalier, Universitaire de Nice, Nice, France
| | - Jacques Sédat
- Centre Hospitalier, Universitaire de Nice, Nice, France
| |
Collapse
|