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Lal V, Osman K, Boyne N. Management of a primary extracranial vertebral artery aneurysm (V1). ANZ J Surg 2024. [PMID: 38831584 DOI: 10.1111/ans.19110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Vidushi Lal
- Vascular Surgical Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kareem Osman
- Vascular Surgical Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Nicholas Boyne
- Vascular Surgical Department, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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2
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Akinnusotu O, Bhatti AUR, Ghaith AK, Nieves AB, Jarrah R, Wahood W, Bydon M, Bendok BR. Outcomes following surgical and endovascular treatment of extracranial vertebral artery aneurysms (VAA): a systematic evaluation of the literature. Neurosurg Rev 2023; 46:260. [PMID: 37779135 DOI: 10.1007/s10143-023-02171-5] [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: 02/07/2023] [Revised: 07/06/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
Extracranial vertebral artery aneurysms are rare complications resulting from trauma and multiple different diseases. However, the difference between clinical and surgical profiles is well understood. To investigate the clinical and interventional outcomes following extracranial vertebral artery aneurysms (VAA) treatment through a systematic review of the literature to date, an electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on clinical and surgical outcomes for extracranial VAAs. These results included patient-specific risk factors, indications, and techniques. Our literature search resulted in 561 articles, of which 36 studies were qualified to be included in the analysis. A total of 55 patients with multiple various extracranial VAA incidents were included. The mean age of subjects was 42 years (ranging from 13.0 to 76.0 years), and the majority of patients were males (71%, n =39). Blunt trauma was the most frequent risk factor for extracranial VAA formation (35%, n = 19). The majority of aneurysms (60%) were dissected in nature. The most common form of treatment for extracranial VAAs was the use of a flow diverter (24%, n=13). Overall, five (9%) patients had long-term adverse neurological complications following intervention with 5% (n=3) mortality, 2% (n=1) resulting in unilateral vocal cord paralysis, and 2% (n=1) resulted in a positive Romberg sign. The mortality rate is 15.7% in the surgical group, whereas the endovascular treatment did not result in any mortality. The endovascular approach is a safe and effective treatment of extracranial VAAs due to its relatively low overall complication rate and lack of resulting mortality. This is in contrast to the surgical approach which results in a higher rate of complications, recurrence, and mortality outcomes. An understanding of the factors and clinical outcomes associated with the incidence of extracranial VAAs is essential for the future improvement of patient outcomes.
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Affiliation(s)
| | - Atiq Ur Rehman Bhatti
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Abdul Karim Ghaith
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Antonio Bon Nieves
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Ryan Jarrah
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
| | - Waseem Wahood
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, FL, 33328, USA
| | - Mohamad Bydon
- Neuro-Informatics Laboratory, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ, USA
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3
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Fuga M, Tanaka T, Tachi R, Nogami R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Successful Endovascular Trapping for Symptomatic Thrombosed Giant Unruptured Aneurysms of the V1 and V2 Segments of the Vertebral Artery: Case Report and Literature Review. NMC Case Rep J 2022; 8:681-690. [PMID: 35079534 PMCID: PMC8769453 DOI: 10.2176/nmccrj.cr.2021-0107] [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: 04/20/2021] [Accepted: 07/01/2021] [Indexed: 11/20/2022] Open
Abstract
A thrombosed giant aneurysm of the V1 and V2 segments of the vertebral artery (VA) is rare. Therefore, there is controversy regarding its optimal treatment. A case of a symptomatic giant VA aneurysm located in the V1 to V2 segments on the left treated successfully by endovascular trapping of the VA is reported. A 68-year-old woman presented with swelling in the left anterior neck. Computed tomography angiography (CTA) showed a giant aneurysm measuring 47 × 58 × 47 mm3 in the left neck. Ten days after her first visit, she presented with sudden onset of left anterior neck pain. Repeated CTA showed a partial thrombus in the aneurysm. Angiography showed two thrombosed giant aneurysms located in the V1 to V2 segments of the left VA. After endovascular trapping for the aneurysms, the anterior neck pain resolved and the aneurysm gradually shrank. This case demonstrates that endovascular surgery is better than open surgery because it is less invasive. When performing endovascular treatment, trapping will be an alternative strategy for a symptomatic giant thrombotic aneurysm of the V1 and V2 segments of the VA if the patient can tolerate ischemia.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Ryo Nogami
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Pataki Á, Nguyen DT, Nagy Z, Nardai S, Nemes B. Stent-Graft Treatment of a Giant Asymptomatic Extracranial Vertebral Artery Aneurysm: Case Report and Literature Review. Ann Vasc Surg 2021; 79:442.e1-442.e6. [PMID: 34656725 DOI: 10.1016/j.avsg.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/01/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022]
Abstract
With the widespread appliance of endovascular techniques, a plethora of options is available in the treatment of extracranial vertebral artery aneurysms. If the vertebral artery can be sacrificed, embolization with coiling, liquid injection, or parent artery exclusion can be done. We hereby present a case of a 74-year-old male patient presenting with an asymptomatic atherosclerotic giant extracranial vertebral artery aneurysm in the V1 segment of the vertebral artery, successfully treated with balloon expandable stent-graft deployment. No neurologic symptoms occurred, and the stent-graft was patent with no signs of endoleak at 24 months follow-up with computed tomography angiography.
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Affiliation(s)
- Ákos Pataki
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Dat T Nguyen
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zsuzsa Nagy
- Department of Vascular Surgery, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Sándor Nardai
- Department of Cardiology Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Department of Interventional Radiology, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Abdulrazeq HF, Goldstein IM, Elsamna ST, Pletcher BA. Vertebral artery aneurysm rupture and hemothorax in a patient with neurofibromatosis Type-1: A case report and review of the literature. Heliyon 2019; 5:e02201. [PMID: 31406942 PMCID: PMC6684516 DOI: 10.1016/j.heliyon.2019.e02201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/23/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hael F Abdulrazeq
- Wayne State University School of Medicine, Department of Neurosurgery, Detroit, MI, USA
| | - Ira M Goldstein
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Samer T Elsamna
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Beth A Pletcher
- Division of Clinical Genetics, Department of Pediatrics, Rutgers New Jersey Medical School, Newark, NJ, USA
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Muhammad S, Raj R, Numminen J, Niemelä M. Successful endovascular coil embolisation of a ruptured V1-segment vertebral artery dissecting aneurysm making a fistula with the adjacent vein. BMJ Case Rep 2019; 12:12/6/e229108. [PMID: 31171534 PMCID: PMC6557532 DOI: 10.1136/bcr-2018-229108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Sudden supraclavicular pain is often associated with myocardial infarction but seldom due to a rupture of V1-segment vertebral artery aneurysm. A ruptured V1 segment of vertebral artery dissecting aneurysm making a fistula with the adjacent vein has rarely been described in literature. Here we present a case of a 29-year-old healthy woman with sudden supraclavicular pain and palpable mass that developed after pain. Initial ultrasound showed suspicion of large haematoma. CT angiogram showed a left-sided dissecting V1-segment vertebral artery ruptured aneurysm. Angiography showed an additional fistula between the aneurysm and the adjacent vein. The patient was treated successfully with coil embolisation. The vertebral artery occlusion was well tolerated without any complications. Endovascular coiling is a fast and effective treatment modality. However, a parent vessel occlusion can be sometimes dangerous if the contralateral vertebral artery supply is not sufficient. Surgical possibilities to reconstruct the parent vessel should also be considered in complex cases.
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Affiliation(s)
- Sajjad Muhammad
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Numminen
- 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
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Manejo endovascular de seudoaneurisma vertebral bilateral iatrogénico en paciente con ganglioneuroma. ANGIOLOGIA 2018. [DOI: 10.1016/j.angio.2017.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kiyohira M, Ishihara H, Oku T, Kawano A, Oka F, Suzuki M. Successful endovascular treatment for thrombosed giant aneurysm of the V1 segment of the vertebral artery: A case report. Interv Neuroradiol 2017; 23:628-631. [PMID: 28750562 DOI: 10.1177/1591019917722515] [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] [Indexed: 11/16/2022] Open
Abstract
Thrombosed giant aneurysm of the V1 segment of the vertebral artery is rare, and there is controversy regarding the optimal method of treatment in this portion. Here, we report a thrombosed giant aneurysm of the V1 segment of the vertebral artery with a good clinical course with endovascular proximal artery occlusion of the vertebral artery. A 59-year-old woman presented with a large mass in the left side of the neck. Echographic examination revealed a mass measuring 42 × 38 × 48 mm in the left neck. Angiography showed a thrombosed giant aneurysm of the V1 segment of the left vertebral artery. Endovascular proximal artery occlusion of the vertebral artery was performed, and the aneurysm lessened gradually. Although a number of procedures have been developed to treat extracranial vertebral artery aneurysms, endovascular proximal artery occlusion is a good option to treat aneurysms in this portion.
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Affiliation(s)
- Miwa Kiyohira
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Takayuki Oku
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Akiko Kawano
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Fumiaki Oka
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Michiyasu Suzuki
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Treatment Challenges of a Primary Vertebral Artery Aneurysm Causing Recurrent Ischemic Strokes. Case Rep Neurol Med 2017; 2017:2571630. [PMID: 28168068 PMCID: PMC5259648 DOI: 10.1155/2017/2571630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Extracranial vertebral artery aneurysms are a rare cause of embolic stroke; surgical and endovascular therapy options are debated and long-term complication may occur. Case Report. A 53-year-old man affected by neurofibromatosis type 1 (NF1) came to our attention for recurrent vertebrobasilar embolic strokes, caused by a primary giant, partially thrombosed, fusiform aneurysm of the left extracranial vertebral artery. The aneurysm was treated by endovascular approach through deposition of Guglielmi Detachable Coils in the proximal segment of the left vertebral artery. Six years later the patient presented stroke recurrence. Cerebral angiography and Color Doppler Ultrasound well characterized the unique hemodynamic condition developed over the years responsible for the new embolic event: the aneurysm had been revascularized from its distal portion by reverse blood flow coming from the patent vertebrobasilar axis. A biphasic Doppler signal in the left vertebral artery revealed a peculiar behavior of the blood flow, alternately directed to the aneurysm and backwards to the basilar artery. Surgical ligation of the distal left vertebral artery and excision of the aneurysm were thus performed. Conclusion. This is the first described case of NF1-associated extracranial vertebral artery aneurysm presenting with recurrent embolic stroke. Complete exclusion of the aneurysm from the blood circulation is advisable to achieve full resolution of the embolic source.
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Kollmann D, Kinstner C, Teleky K, Wressnegger A, Koppensteiner R, Huk I, Neumayer C, Funovics M. Successful Treatment of a Ruptured Extracranial Vertebral Artery Aneurysm with Onyx Instillation. Ann Vasc Surg 2016; 36:290.e7-290.e10. [DOI: 10.1016/j.avsg.2016.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/21/2022]
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Neurofibromatosis Type 1-Associated Extracranial Vertebral Artery Aneurysm Complicated by Vertebral Arteriovenous Fistula After Rupture: Case Report and Literature Review. World Neurosurg 2016; 96:609.e13-609.e18. [PMID: 27647034 DOI: 10.1016/j.wneu.2016.09.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extracranial vertebral artery aneurysm related to neurofibromatosis type 1 (NF1) is rare. Aneurysmal rupture typically induces such symptoms as cervical hematoma, hemothorax, and hypotension. Here we report a case of ruptured extracranial vertebral artery aneurysm in a patient with NF1 who, rather than cervical hematoma, hemothorax, or hypotension, developed a vertebral arteriovenous fistula (AVF) after aneurysm rupture. CASE DESCRIPTION A 35-year-old woman with a family history of NF1 presented with sudden-onset right neck and shoulder pain. Computed tomography angiography showed a right extracranial vertebral artery aneurysm. She had neither a cervical hematoma nor hypotension; however, angiography showed an AVF secondary to aneurysmal rupture. The patient was treated with endovascular coil embolization to prevent re-rupture. Postoperatively, her right neck and shoulder pain improved, and she was discharged without further neurologic deficits. CONCLUSIONS This patient's clinical course suggests that if there is minimal bleeding from an NF1-associated ruptured extracranial vertebral artery aneurysm, then typical symptoms, such as cervical hematoma, hemothorax, and hypotension, may be absent. Thus, ruptured extracranial vertebral artery aneurysm should be considered in the differential diagnosis of patients with NF1 with sudden-onset radiculopathy, even in the absence of typical symptoms. The detection of a vertebral AVF provides a useful clue to the diagnosis of aneurysm rupture in such cases.
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Kim ST, Brinjikji W, Lanzino G, Kallmes DF. Neurovascular manifestations of connective-tissue diseases: A review. Interv Neuroradiol 2016; 22:624-637. [PMID: 27511817 DOI: 10.1177/1591019916659262] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/22/2016] [Indexed: 12/20/2022] Open
Abstract
Patients with connective tissue diseases are thought to be at a higher risk for a number of cerebrovascular diseases such as intracranial aneurysms, dissections, and acute ischemic strokes. In this report, we aim to understand the prevalence and occurrences of such neurovascular manifestations in four heritable connective tissue disorders: Marfan syndrome, Ehlers-Danlos syndrome, Neurofibromatosis Type 1, and Loeys-Dietz syndrome. We discuss the fact that although there are various case studies reporting neurovascular findings in these connective tissue diseases, there is a general lack of case-control and prospective studies investigating the true prevalence of these findings in these patient populations. Furthermore, the differences observed in the manifestations and histology of such disease pathologies encourages future multi-center registries and studies in better characterizing the pathophysiology, prevalence, and ideal treatment options of neurovascular lesions in patents with connective tissue diseases.
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Successful Hybrid Management of a Left Vertebral Artery Aneurysm Secondary to Type-1 Neurofibromatosis. Ann Vasc Surg 2014; 28:1936.e1-4. [DOI: 10.1016/j.avsg.2014.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 11/15/2022]
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