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Chavhan R, Acharya S, Wanjari A, Batra N, Rathod N. Uncommon Cause, Critical Consequence: Vertebral Artery Aneurysm Resulting in Intraventricular Hemorrhage. Cureus 2024; 16:e63179. [PMID: 39070432 PMCID: PMC11281880 DOI: 10.7759/cureus.63179] [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] [Received: 05/05/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
The vertebrobasilar system is made up of the two vertebral arteries that unite to form the basilar artery near the base of the skull. Aneurysms in the vertebrobasilar system are distinct from other cerebral aneurysms due to their unique morphologic characteristics. They can be large and bulging (massive), pressing on the brainstem. Alternatively, they might be weak and splitting apart (dissecting) or have an elongated shape (fusiform). On the other end of the spectrum, Vertebral artery aneurysms (VAAs) can also be small and rounded (saccular). These aneurysms can occur at the vertebral artery itself or where it joins the posterior inferior cerebellar artery (PICA). Anatomically, they are situated near the brainstem and cranial nerves, deep within the posterior fossa. The cerebrospinal fluid is kept in transit and flux by the ventricular system's chambers circulating the fluid within themselves. An intraventricular hemorrhage (IVH) can occasionally result from vertebral artery aneurysmal ruptures that result in bleeding into the subarachnoid space and then extravasate into the ventricles. Persistent and poorly controlled hypertension affects about 50% of individuals with IVH. In this case report, we study a 74-year-old woman who complained of a sudden onset headache that had been bothering her for three days at the medical emergency room. She had been diagnosed with systemic hypertension eight years prior and had not taken her medicines as prescribed. She was discovered to have rigidity in her neck and a blood pressure reading of 170/100 mmHg, which had been followed by an episode of vomiting. Radiological investigations revealed a VAA that had a high risk of rupturing and causing an IVH.
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Affiliation(s)
- Roma Chavhan
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anil Wanjari
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nitish Batra
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nishant Rathod
- General Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Essibayi MA, Lanzino G, Keser Z. Endovascular treatments of intracranial vertebral and internal carotid arteries dissections: An interactive systematic review and meta-analysis. Interv Neuroradiol 2024; 30:22-30. [PMID: 35450460 PMCID: PMC10956451 DOI: 10.1177/15910199221095789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/04/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Management of intracranial artery dissection (IAD) remains elusive in medical practice. Intracranially, vertebral artery dissection (VAD) is more commonly encountered than internal carotid artery dissection (ICAD). Deconstructive (EVT-d) and reconstructive (EVT-r) endovascular techniques have been utilized to treat VAD and ICAD. This meta-analysis investigates the safety and efficacy of EVT-r and EVT-d in the management of VAD and ICAD. METHODS The literature was searched for all studies with consecutive patient series evaluating EVT-d or EVT-r for VAD or ICAD management. Baseline characteristics and outcomes were compared between EVT-r and EVT-d groups using the random-effect model and meta-regression approaches. RESULTS Overall, 1095 cases pooled from 56 studies were included. There was no statistically significant difference in baseline characteristics between VAD and ICAD. EVT-r was applied in 647 cases (59.1%) and EVT-d in the rest There was no statistical difference in the rate of procedural complications between EVT-r and EVT-d. Although EVT-d was significantly associated with higher rates of complete aneurysm occlusion (86.4%), lower rates of good clinical outcomes (72.1%) and higher mortality (15.1%) were achieved compared to EVT-r (70.2%, 83.3%, and 9.5%; respectively). The mortality rate was higher, and good clinical outcomes were less common in ruptured aneurysms. Ischemic presentation was statistically associated with poor outcomes (mRS 3-5) but low mortality. ICAD often tended to grow following treatment and resulted in poor neurological outcomes. CONCLUSIONS IAD has favorable outcomes when treated appropriately. Novel reconstructive endovascular techniques are promising and should be integrated well in endovascular practice. Further studies are warranted.
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Affiliation(s)
| | | | - Zafer Keser
- Department of Neurology, Mayo Clinic, Rochester, USA
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Zhou LJ, Wang W, Wen LL, Wu Q, Liu ZS, Tang XY, Cai W, Zhou XM, He WZ, Zhang X. Application of double-stent assisted coil embolization in intracranial vertebral artery dissecting aneurysms with mass effect. J Neurosurg Sci 2023; 67:727-732. [PMID: 35416452 DOI: 10.23736/s0390-5616.22.05599-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Unruptured intracranial vertebral artery dissecting aneurysms (IVADAs) with mass effect have an extremely poor natural course, and treatment of these aneurysms remains a challenge for endovascular and surgical strategies. The aim of this study was to analyze the role of double-stent-assisted coil embolization in preventing rupture and bleeding of intracranial vertebral artery dissecting aneurysm with brainstem compression by reducing mass effect and preventing the recurrence of the aneurysm. METHODS A total of 25 patients (mean age, 56.04±13.0 years) with unruptured IVADAs with mass effect received dual-stent-assisted coil embolization. The baseline characteristics, the change of aneurysm size on MR, the rate of retreatment, and the improvement rate of clinical symptoms and signs were analyzed retrospectively. RESULTS All patients completed the surgical procedures successfully. No aneurysm bleeding or perforating artery occlusion occurred during the perioperative and follow-up periods. The initial maximum diameter of the aneurysm on MR was 17.5±3.6 mm. One year after treatment, the maximum diameter of the aneurysm on MR was 15.8±4.9 mm. The reduction rate of the maximum diameter of the aneurysm was 10.7±12.7%. The change of the maximum diameter before and after treatment of aneurysm was statistically significant (P<0.001). In terms of the improvement rate of clinical symptoms, 15 cases were completely improved (60.0%), 6 cases were partially improved (24.0%), and the total clinical improvement rate was 84%. Four cases (16.0%) showed no improvement or even had aggravation of clinical symptoms. In 5 cases (20.0%), aneurysms recurred. Among 4 cases involving posterior inferior cerebellar artery origin, 3 cases had the recurrence (75%). 5 recurred cases were treated with single-stent-assisted coil embolization. No residual aneurysm and recurrence were found on the follow-up angiography. CONCLUSIONS The double-stent-assisted coil embolization procedure is very safe and reliable. It can effectively prevent the aneurysm from continuing to grow and rupture and thereby reduce the clinical symptoms caused by the mass effect.
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Affiliation(s)
- Long-Jiang Zhou
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
- Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Wei Wang
- Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Li-Li Wen
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
| | - Qi Wu
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
| | - Zhen-Sheng Liu
- Medical Imaging Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Xiao-Yu Tang
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
| | - Wei Cai
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xiao-Ming Zhou
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
| | - Wei-Zhen He
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China
| | - Xin Zhang
- School of Medicine, Department of Neurosurgery, Jinling Hospital, Nanjing University, Nanjing, China -
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Cho WC, Lee HJ, Choi JH, Lee KS, Kim BS, Shin YS. Clinical and Radiological Outcomes of Vertebral Artery Dissecting Aneurysms Treated with Endovascular Treatments: A 12-year Single-Center Experience. World Neurosurg 2023; 175:e904-e913. [PMID: 37075898 DOI: 10.1016/j.wneu.2023.04.040] [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: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVE We aimed to compare the clinical and radiological outcomes of vertebral artery dissecting aneurysms (VADAs) stratified using different endovascular treatment methods. METHODS We retrospectively reviewed 116 patients with VADAs treated at a single tertiary institute between September 2008 and December 2020. We analyzed and compared the clinical and radiological parameters according to different treatment methods. RESULTS In total, 127 endovascular procedures were performed in 116 patients. We initially treated 46 patients with parent artery occlusion, 9 with coil embolization without stent, 43 with single stent with or without coil, 16 with multiple stents with or without coils, and 13 with flow-diverting stent. At the last follow-up (mean 37.8 ± 30.9 months), the complete occlusion rate (85.7%) was higher in the multiple-stent group than in the groups that received other reconstructive treatment methods. Moreover, the recurrence (0%) and retreatment (0%) rates were significantly lower in the multiple stent group (P < 0.001). The coil embolization-only group showed the highest recurrence (n = 5, 62.5%) and incomplete occlusion (n = 1, 12.5%) rates. The single-stent group showed higher recurrence (n = 9, 22.5%) and retreatment (n = 3, 7%) rates. Multivariate logistic regression analyses showed that coil embolization without stent placement (odds ratio = 172.76, 95% confidence interval = 6.83-4366.85; P = 0.002) was significantly associated with recurrence. At the last follow-up (mean, 42.1 ± 37.7 months), we achieved favorable clinical outcomes (modified Rankin Scale ≤2) in 106 of 127 patients. CONCLUSION When treating VADAs, multiple stent placements may play a key role in achieving favorable long-term radiological outcomes.
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Affiliation(s)
- Woo Cheul Cho
- Department of Neurosurgery and Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Hyeong Jin Lee
- Department of Neurosurgery, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Gyeonggi-do, South Korea
| | - Jai Ho Choi
- Department of Neurosurgery and Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Kwan Sung Lee
- Department of Neurosurgery and Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Yong Sam Shin
- Department of Neurosurgery and Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
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Wei H, Yao K, Tian Q, Han S, Gao W, Han W, Liu S, Wang G, Chen Q, Li M. Low Wall Shear Stress and High Intra-aneurysmal Pressure are Associated with Ruptured Status of Vertebral Artery Dissecting Aneurysms. Cardiovasc Intervent Radiol 2023; 46:240-248. [PMID: 36653659 DOI: 10.1007/s00270-022-03353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE The morphological and hemodynamic features of patients with vertebral artery dissecting aneurysms (VADAs) are yet unknown. This study sought to elucidate morphological and hemodynamic features of patients with ruptured and unruptured VADAs based on computed flow simulation. METHODS Fifty-two patients (31 unruptured and 21 ruptured VADAs) were admitted to two hospitals between March 2016 and October 2021. All VADAs were located in the intradural segment, and their clinical, morphological, and hemodynamic parameters were retrospectively analyzed. The hemodynamic parameters were determined through computational fluid dynamics simulations. Univariate statistical and multivariable logistic regression analyses were employed to select significantly different parameters and identify key factors. Receiver operating characteristic (ROC) analysis was used to assess the discrimination for each key factor. RESULTS Four hemodynamic parameters were observed to significantly differ between ruptured and unruptured VADAs, including wall shear stress (WSS), low shear area, intra-aneurysmal pressure (IAP), and relative residence time. However, no significant differences were observed in morphological parameters between ruptured and unruptured VADAs. Multivariable logistic regression analysis revealed that low WSS and high IAP were significantly observed in the ruptured VADAs and demonstrated adequate discrimination. CONCLUSIONS This research indicates significant hemodynamic differences, but no morphological differences were observed between ruptured and unruptured VADAs. The ruptured group had significantly lower WSS and higher IAP than the unruptured group. To further confirm the roles of low WSS and high IAP in the rupture of VADAs, large prospective studies and long-term follow-up of unruptured VADAs are required.
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Affiliation(s)
- Heng Wei
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Kun Yao
- Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, 434020, China
| | - Qi Tian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Shoumeng Han
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Wenhong Gao
- Department of Neurosurgery, Jingzhou Central Hospital, Jingzhou, 434020, China
| | - Wenrui Han
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Sheng Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Guijun Wang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Qianxue Chen
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China
| | - Mingchang Li
- Department of Neurosurgery, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan, 430060, Hubei Province, China.
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Lee HJ, Cho WC, Choi JH, Kim BS, Shin YS. Comparison of Parent Artery Occlusion and Stent-Assisted Treatments in Ruptured Vertebral Artery Dissecting Aneurysms. World Neurosurg 2022; 167:e533-e540. [PMID: 35977685 DOI: 10.1016/j.wneu.2022.08.047] [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: 04/10/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. METHODS This retrospective review included 36 ruptured vertebral artery dissecting aneurysms treated between February 2009 and April 2020. Treatment modalities included PAO without stent and stent-assisted treatments. Stent-assisted treatments included PAO with posterior inferior cerebellar artery (PICA) stenting and stent-assisted coiling. Univariate and multivariate analyses were conducted to evaluate risk factors for unfavorable outcomes and postprocedural complications. RESULTS Patients were treated with PAO only (24, 66.7%), PAO with PICA stenting (4, 11.1%), and PAO with stent-assisted coiling (8, 22.2%). There were only fusiform aneurysms with PICA involvement in the PAO with PICA stenting group. In the stent-assisted coiling group, 4 aneurysms incorporated PICA, and 4 aneurysms involved dominant vertebral artery. Old age (odds ratio [OR] = 1.25, 95% confidence interval [CI] = 1.01-1.56, P = 0.044) and poor Hunt-Hess grade (OR = 537.99, 95% CI = 6.73-42994.1, P = 0.005) were significantly associated with unfavorable clinical outcomes after a mean follow-up of 37.5 ± 32.8 months. Fusiform dilatation shape (OR = 15.97, 95% CI = 1.52-167.38, P = 0.021) and PICA involvement (OR = 13.71, 95% CI = 1.29-145.89, P = 0.030) were independent risk factors for ischemic complications. CONCLUSIONS Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.
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Affiliation(s)
- Hyeong Jin Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Woo Cheul Cho
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea.
| | - Bum-Soo Kim
- Department of Radiology, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, South Korea
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Suyama Y, Nakahara I, Matsumoto S, Morioka J, Hasebe A, Tanabe J, Watanabe S, Suyama K, Kuwahara K. Early spontaneous occlusion of a vertebral artery dissecting aneurysm caused by subarachnoid hemorrhage: A case report. Radiol Case Rep 2022; 17:1977-1981. [PMID: 35432669 PMCID: PMC9011024 DOI: 10.1016/j.radcr.2022.03.065] [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: 01/27/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
We report a case of vertebral artery dissecting aneurysm (VADA) that developed with subarachnoid hemorrhage and was found to be occluded based on subsequent digital subtraction angiography. Few reports have been published on ruptured VADA in which ipsilateral vertebral arteries are occluded. The proper management of this type of aneurysm is controversial. A 44-year-old woman developed a sudden onset headache. Computed tomography and three-dimensional computed tomography were immediately performed and showed subarachnoid hemorrhage and VADA distal to the right posterior inferior cerebellar artery bifurcation. We decided to treat the VADA immediately and performed digital subtraction angiography but found the VADA had spontaneously occluded. We performed coil embolization, including the aneurysm and the parent artery, with reference to the findings of three-dimensional computed tomography. On Day 16, recurrence was considered due to the finding of dilation of the distal end where the coil was embolized. An additional embolization was performed via the posterior communicating artery. No cases of endovascular treatment have been reported in VADA cases in which the rupture site is spontaneously occluded. In such cases, the treatment may be incomplete, so strict follow-up is required.
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Kidani N, Sugiu K, Terasaka K, Nakashima H, Tokunaga K, Kobayashi K, Kambara H, Hishikawa T, Hiramatsu M, Date I. Mobile endovascular therapy for acute treatment of ruptured vertebral artery dissecting aneurysm in multiple hospitals. Acta Neurochir (Wien) 2022; 164:517-523. [PMID: 34146152 DOI: 10.1007/s00701-021-04885-1] [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: 12/21/2020] [Accepted: 05/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The patients with ruptured vertebral artery dissecting aneurysm (rVADA) should be treated as early as possible because VADA carries extremely high risk of rebleeding in the acute phase. We have established a mobile endovascular strategy for the patients with rVADA between our flagship center and its affiliated local hospitals. We introduced and reviewed our mobile endovascular therapy in this study. METHODS We retrospectively evaluated 98 consecutive patients who underwent endovascular surgery for rVADA from 2000 to 2018 at our institution or five affiliated hospitals. When each patient was initially transported to the local affiliated hospitals, neuroendovascular surgeons traveled directly to the affiliated hospital from the flagship center in order to treat the patient there. Clinical outcomes using modified Rankin Scale at 6 months after treatment, radiological results, and procedure-related complications were reviewed to justify our mobile endovascular strategy. RESULTS All aneurysms were cured successfully by internal trapping. Favorable outcome was achieved in 61 patients (62.2%) even though 53 patients (54.1%) had presented with severe subarachnoid hemorrhage. Overall mortality rate, treatment-related mortality rate, and treatment related complication rate were 18.4% (18/98), 0%, and 16% (16/98), respectively. There were no differences in clinical and radiological outcomes between the patients treated in the flagship center and those who treated in the affiliated hospitals. Treatment in the affiliated hospital was not a predictive factor of unfavorable outcome in our multivariate analysis, and elderly age (≥ 60) was negatively associated with favorable outcome. CONCLUSIONS Our results prove the efficacy and safety of mobile endovascular therapy for the treatment of rVADA in the ultra-acute stage. Mobile endovascular therapy may work well in the acute treatment of rVADAs in the certain circumstance.
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Affiliation(s)
- Naoya Kidani
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Kenji Sugiu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan.
| | - Kaoru Terasaka
- Department of Neurosurgery, Kure Kyosai Hospital, Kure, Hiroshima, Japan
| | | | - Koji Tokunaga
- Department of Neurosurgery, Okayama City Municipal Hospital, Okayama, Japan
| | - Kazuki Kobayashi
- Department of Neurosurgery, Tsuyama Chuo Hospital, Tsuyama, Okayama, Japan
| | - Hirokazu Kambara
- Department of Neurosurgery, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Tomohito Hishikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Masafumi Hiramatsu
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan
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Maybaum J, Henkes H, Aguilar-Pérez M, Hellstern V, Gihr GA, Härtig W, Reisberg A, Mucha D, Schüngel MS, Brill R, Quäschling U, Hoffmann KT, Schob S. Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage-A Retrospective Study From Four Neurovascular Centers. Front Neurol 2021; 12:700164. [PMID: 34276549 PMCID: PMC8280292 DOI: 10.3389/fneur.2021.700164] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
Objective: Dissecting aneurysms (DAs) of the vertebrobasilar territory manifesting with subarachnoid hemorrhage (SAH) are associated with significant morbi-mortality, especially in the case of re-hemorrhage. Sufficient reconstruction of the affected vessel is paramount, in particular, if a dominant vertebral artery (VA) is impacted. Reconstructive options include stent-assisted coiling and flow diversion (FD). The latter is technically less challenging and does not require catheterization of the fragile aneurysm. Our study aims to report a multicentric experience with FD for reconstruction of DA in acute SAH. Materials and Methods: This retrospective study investigated 31 patients (age: 30–78 years, mean 55.5 years) who had suffered from SAH due to a DA of the dominant VA. The patients were treated between 2010 and 2020 in one of the following German neurovascular centers: University Hospital Leipzig, Katharinenhospital Stuttgart, BG Hospital Bergmannstrost Halle/Saale, and Heinrich-Braun-Klinikum Zwickau. Clinical history, imaging, implanted devices, and outcomes were reviewed for the study. Results: Reconstruction with flow-diverting stents was performed in all cases. The p64 was implanted in 14 patients; one of them required an additional balloon-expandable stent to reconstruct severe stenosis in the target segment. One case demanded additional liquid embolization after procedural rupture, and in one case, p64 was combined with a PED. Further 13 patients were treated exclusively with the PED. The p48MW-HPC was used in two patients, one in combination with two additional Silk Vista Baby (SVB). Moreover, one patient was treated with a single SVB, one with a SILK+. Six patients died [Glasgow Outcome Scale (GOS) 1]. Causes of death were periprocedural re-hemorrhage, thrombotic occlusion of the main pulmonary artery, and delayed parenchymal hemorrhage. The remaining three patients died in the acute–subacute phase related to the severity of the initial hemorrhage and associated comorbidities. One patient became apallic (GOS 2), whereas two patients had severe disability (GOS 3) and four had moderate disability (GOS 4). Eighteen patients showed a complete recovery (GOS 5). Conclusion: Reconstruction of VA-DA in acute SAH with flow-diverting stents is a promising approach. However, the severity of the condition is reflected by high overall morbi-mortality, even despite technically successful endovascular treatment.
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Affiliation(s)
- Jens Maybaum
- Institute of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Hans Henkes
- Neuroradiological Clinic, Katharinenhospital Stuttgart, Stuttgart, Germany
| | | | - Victoria Hellstern
- Neuroradiological Clinic, Katharinenhospital Stuttgart, Stuttgart, Germany
| | | | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, Leipzig, Germany
| | - André Reisberg
- Department of Diagnostic Imaging and Interventional Radiology, Bergbau-Berufsgenossenschaft Hospital Bergmannstrost Halle, Halle, Germany
| | - Dirk Mucha
- Department of Radiology, Interventional Radiology and Neuroradiology, Heinrich-Braun-Klinikum, Zwickau, Germany
| | | | - Richard Brill
- Department of Neuroradiology, Radiology and Policlinic of Radiology, University Hospital Halle (Saale), Halle, Germany
| | - Ulf Quäschling
- Institute of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Stefan Schob
- Department of Neuroradiology, Radiology and Policlinic of Radiology, University Hospital Halle (Saale), Halle, Germany
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Catapano JS, Ducruet AF, Cadigan MS, Farhadi DS, Majmundar N, Nguyen CL, Baranoski JF, Cole TS, Wilkinson DA, Fredrickson VL, Srinivasan VM, Albuquerque FC. Endovascular treatment of vertebral artery dissecting aneurysms : a 20-year institutional experience. J Neurointerv Surg 2021; 14:257-261. [PMID: 33906940 DOI: 10.1136/neurintsurg-2020-017089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The ideal treatment for unruptured vertebral artery dissecting aneurysms (VADAs) and ruptured dominant VADAs remains controversial. We report our experience in the management and endovascular treatment of patients with VADAs. METHODS Patients treated endovascularly for intradural VADAs at a single institution from January 1, 1999, to December 31, 2019, were retrospectively reviewed. Primary neurological outcomes were assessed using modified Rankin Scale (mRS) scores, with mRS >2 considered a poor neurological outcome. Additionally, any worsening (increase) in the mRS score from the preoperative neurological examination was considered a poor outcome. RESULTS Ninety-one patients of mean (SD) age 53 (11.6) years (48 (53%) men) underwent endovascular treatment for VADAs. Fifty-four patients (59%) presented with ruptured VADAs and 44 VADAs (48%) involved the dominant vertebral artery. Forty-seven patients (51%) were treated with vessel sacrifice of the parent artery, 29 (32%) with flow diversion devices (FDDs), and 15 (17%) with stent-assisted coil embolization (stent/coil). Rates of procedural complications and retreatment were significantly higher with stent/coil treatment (complications 4/15; retreatment 6/15) than with vessel sacrifice (complications 1/47; retreatment 2/47) or FDD (complications 2/29; retreatment 4/29) (p=0.008 and p=0.002, respectively). Of 37 patients with unruptured VADAs treated, only two (5%) had mRS scores >2 on follow-up. CONCLUSION Endovascular FDD treatment of VADAs appears to be associated with lower retreatment and complication rates than stenting/coiling, although further study is required for confirmation. Endovascular treatment of unruptured VADAs was safe and was associated with favorable angiographic and neurological outcomes.
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Affiliation(s)
- Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Andrew F Ducruet
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Megan S Cadigan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dara S Farhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Neil Majmundar
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Candice L Nguyen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jacob F Baranoski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tyler S Cole
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - D Andrew Wilkinson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Vance L Fredrickson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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11
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Imahori T, Yamamoto Y, Miura S, Higashino M, Sugihara M, Mizobe T, Aihara H, Hosoda K, Tanaka K, Sasayama T, Kohmura E. Ruptured vertebral artery dissecting aneurysms involving a dominant posterior inferior cerebellar artery origin: A preferred indication for bypass surgery in clinical practice. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Kumar A, Dmytriw AA, Salem MM, Kuhn AL, Phan K, Bharatha A, Spears J, Thomas A, Puri A, Marotta TR. Reconstructive vs Deconstructive Endovascular Approach to Intradural Vertebral Artery Aneurysms: A Multicenter Cohort Study. Neurosurgery 2021; 87:383-393. [PMID: 32022238 DOI: 10.1093/neuros/nyaa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 12/01/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Parent vessel sacrifice (PVS) has been a traditional way of treating complex aneurysms of the intradural vertebral artery (VA). Flow diversion (FD) has emerged as an alternative reconstructive option. OBJECTIVE To compare the long-term clinical and radiographic outcomes of intradural VA aneurysms following PVS or FD. METHODS We retrospectively reviewed and evaluated 43 consecutive patients between 2009 and 2018 with ruptured and unruptured intradural VA aneurysms treated by PVS or FD. Medical records including clinical and radiological details were reviewed. RESULTS A total of 43 intradural VA aneurysms were treated during this period. In the 14 PVS patients, the mean follow-up was 19.5 mo, and 71.4% of cases achieved modified Rankin scale (mRS) ≤2 at the last follow-up. A total of 86.5% of cases achieved complete occlusion. There was a 14.3% (2 cases) mortality rate, 14.3% (2 cases) postoperative ischemic complication rate, and 0% postoperative hemorrhaging rate. Retreatment was required in 1 case (7.1%). In the 29 FD patients, the mean follow-up was 21.8 mo, and 89.7% of cases achieved mRS ≤2 at the final follow-up. There was a 3.2% (1 case) mortality rate, 19.4% (6 cases) of postoperative ischemic complications, and 6.5% (2 cases) of postoperative hemorrhagic complications. Complete occlusion was seen in 86.5% patients. No cases required retreatment. Mortality and complication rates were not significantly different between PVS and PED (Pipeline Embolization Device) groups. CONCLUSION PVS was associated with comparable intraprocedural complications for VA aneurysms as compared to FD in the largest multicenter study to date. Both procedures have good long-term clinical and radiological outcomes.
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Affiliation(s)
- Ashish Kumar
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Adam A Dmytriw
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Anna L Kuhn
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kevin Phan
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Aditya Bharatha
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Julian Spears
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ajith Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ajit Puri
- Division of Interventional Neuroradiology, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Thomas R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
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13
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Zhao X, Wang H, Liu J, Zhang Z, Li Z. Endovascular treatment of vertebral artery dissecting aneurysm: A single-center experience. Exp Ther Med 2019; 18:4838-4844. [PMID: 31798709 PMCID: PMC6880450 DOI: 10.3892/etm.2019.8128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/20/2019] [Indexed: 12/03/2022] Open
Abstract
The aim of the present study was to explore the optimal treatment strategy for patients with vertebral artery dissecting aneurysms via the endovascular approach. A total of 47 patients (50 aneurysms, including 28 ruptured and 22 unruptured) underwent endovascular treatment between January 2012 and March 2018. Of these aneurysms, 18 were treated by parent artery occlusion, 11 by stent implantation and 21 by stent-assisted coiling. The complete occlusion rate was 100% (18/18) in aneurysms treated by parent artery occlusion and 46.9% (15/32) for stent implantation with or without coiling. External drainage was performed in 8 patients with ruptured aneurysms. Post-operative bleeding occurred in 2 patients treated by stent-assisted coiling. Ventriculo-peritoneal shunt was performed in 4 patients due to delayed hydrocephalus. Post-operative frontal hematoma occurred in one patient treated by stent-assisted coiling. The mortality was 6.4% (3/47) prior to discharge. The recurrence rate was 8.3% (1/12) in aneurysms treated by parent artery occlusion and 13.6% (3/22) in those treated by stent implantation with or without coiling. A total of 39 patients were followed up for 14.56±14.91 months. The good outcome rates were 100% (28/28) in patients with unruptured aneurysms and a Hunt-Hess grade of 1–3, and 72.7% (8/11) in patients with a Hunt-Hess grade of 4 or 5. In conclusion, the present study indicated that endovascular treatment is a safe and efficient method for patients with vertebral artery aneurysm. The treatment strategy should be based on the patient's condition and aneurysmal characteristics. Parent artery occlusion may be suitable for selected patients with ruptured vertebral artery aneurysms.
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Affiliation(s)
- Xintong Zhao
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Huifang Wang
- Department of Pharmacy, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Jiaqiaing Liu
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zihuan Zhang
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Zhenbao Li
- Department of Neurosurgery, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui 241001, P.R. China
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14
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Nakamura H, Fujinaka T, Nishida T, Kishima H, Sakai N. Endovascular Therapy for Ruptured Vertebral Artery Dissecting Aneurysms: Results from Nationwide, Retrospective, Multi-Center Registries in Japan (JR-NET3). Neurol Med Chir (Tokyo) 2018; 59:10-18. [PMID: 30531151 PMCID: PMC6350002 DOI: 10.2176/nmc.st.2018-0191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registration in Japan (JR-NET3), and analyzed factors associated with outcome at 30 days and procedure-related complications. Complete occlusion was achieved in 497 cases (93.8%) and favorable outcome was obtained in 303 cases (59.1%). Older age (≥60 years), male sex, use of general anesthesia, non-specialist as the responsible doctor, and time delay from onset to treatment (≥24 h) were negative factors for favorable outcome in multivariate analysis, although these factors were not associated with procedure-related complications. Compared with previous studies (JR-NET1 and 2), the number of endovascular treatments for patients with VADA and severe SAH increased in this decade; however, the percentage of patients with favorable outcome did not decrease. This might be due to not only the improvement of endovascular treatment itself, but also increased access to endovascular specialists or standardization of management.
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Affiliation(s)
- Hajime Nakamura
- Department of Neurosurgery, Graduate School of Medicine, Osaka University
| | - Toshiyuki Fujinaka
- Department of Neurosurgery, Graduate School of Medicine, Osaka University.,Department of Neurosurgery, Osaka National Hospital
| | - Takeo Nishida
- Department of Neurosurgery, Graduate School of Medicine, Osaka University
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital
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15
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Tjahjadi M, Rezai Jahromi B, Serrone J, Nurminen V, Choque-Velasquez J, Kivisaari R, Lehto H, Niemelä M, Hernesniemi J. Simple Lateral Suboccipital Approach and Modification for Vertebral Artery Aneurysms: A Study of 52 Cases Over 10 Years. World Neurosurg 2017; 108:336-346. [PMID: 28899830 DOI: 10.1016/j.wneu.2017.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Complex skull base approaches are frequently used to treat intracranial vertebral artery (VA) and proximal posterior inferior cerebellar artery (PICA) aneurysms. These complex procedures are associated with higher risk of neurovascular injury. Hence, a less-invasive surgical approach is needed to improve the efficacy and safety of treatment. METHODS A retrospective analysis was conducted on clinical and radiologic data from surgeries in which simple lateral suboccipital and "lateral-enough" approaches were used to clip VA aneurysms in the Department of Neurosurgery at Helsinki University Central Hospital from 2000 to 2009. RESULTS Fifty-two VA or PICA aneurysms were treated using the simple lateral suboccipital approach. Sixteen patients (31%) presented with an unruptured aneurysm, 21 patients (40%) with World Federation of Neurosurgical Societies (WFNS) grade 1-3, and 15 patients (29%) with World Federation of Neurosurgical Societies grade 4-5. The aneurysms were saccular in 48 cases (92%), dissecting in 3 cases (6%), and fusiform in 1 case (2%). The most common aneurysm location was the VA-PICA junction (81%). The mean final modified Rankin Scale score was 2, and in unruptured cases, all patients had favorable clinical outcomes. The main causes of unfavorable outcome were poor preoperative clinical grade (P = 0.002), preoperative intraventricular hemorrhage (P = 0.008), postoperative hydrocephalus (P = 0.003), brain infarction (P = 0.005), and postoperative pneumonia (P < 0.001). CONCLUSIONS We describe a 10-year experience using a simple lateral suboccipital approach and its modification by the senior author (J.H.) to treat VA and proximal PICA aneurysms. Unfavorable outcome was related to the poor preoperative clinical grade, preoperative intraventricular hemorrhage, and postoperative pneumonia.
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Affiliation(s)
- Mardjono Tjahjadi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joseph Serrone
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joham Choque-Velasquez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Lehto
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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