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Park SJ, Lee YJ, Kim WB, Kim YS, Kim TS, Joo SP. Intracranial-intracranial bypass strategies for the treatment of complex intracranial aneurysms: anatomical characteristics and surgical intervention. Acta Neurochir (Wien) 2024; 166:42. [PMID: 38280083 DOI: 10.1007/s00701-024-05945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/09/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE The effectiveness of revascularization for complex aneurysms is well-established. This study aimed to describe the technical characteristics and clinical efficacy of intracranial-to-intracranial (IC-IC) bypass for the treatment of complex intracranial aneurysms. METHODS We retrospectively reviewed all patients with aneurysms who underwent a preplanned combination of surgical or endovascular treatment and IC-IC bypass at our institution between January 2006 and September 2023. IC-IC bypass techniques included four strategies: type A (end-to-end reanastomosis), type B (end-to-side reimplantation), type C (in situ side-to-side anastomosis), and type D (IC-IC bypass with a graft vessel). RESULTS During the study period, ten patients with aneurysms each underwent IC-IC bypass surgery. Aneurysms were located in the middle cerebral artery (60.0%), anterior temporal artery (10.0%), anterior cerebral artery (20.0%), and vertebral artery (10.0%). There were three saccular aneurysms (30.0%), two fusiform aneurysms (20.0%), one dissecting aneurysm (10.0%), and four pseudoaneurysms (40.0%). We performed the type A strategy on five patients (50.0%), type B on one (10.0%), type C on one (10.0%), and type D on three (30.0%). During a mean period of 68.3 months, good clinical outcomes (modified Rankin Scale score, 0-2) were observed in all patients. Follow-up angiography demonstrated complete aneurysmal obliteration in all patients and good bypass patency in nine of ten patients (90.0%). CONCLUSION The treatment of complex aneurysms remains a challenge with conventional surgical or endovascular treatments. IC-IC bypass surgery is a useful technique, associated with favorable clinical outcomes, for treating complex aneurysms.
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Affiliation(s)
- Sue-Jee Park
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Young-Jun Lee
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Woong-Beom Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - You-Sub Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Tae-Sun Kim
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
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Kim JH, Ko YS, Kwon SM, Kim CH, Lee CY. Predictive Factors of Recurrence after Endovascular Treatment of Unruptured Vertebrobasilar Fusiform Aneurysms. Clin Neuroradiol 2023; 33:73-86. [PMID: 35763061 DOI: 10.1007/s00062-022-01184-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to investigate the predictive factors of recurrence after endovascular treatment (EVT) for unruptured vertebrobasilar fusiform aneurysms (VBFA). METHODS This single-center retrospective study evaluated 36 patients who underwent EVT of unruptured VBFA between 2008 and 2020. Variables influencing recurrence, such as size, type, thrombus, preoperative symptoms, and treatment methods, were analyzed. All patients were followed up using vessel imaging. RESULTS In total, 7 of 36 patients (19.4%) developed recurrence. The mean time from EVT to recurrence was 9.2 months (range 2-26.9 months). Maximum aneurysmal diameter on magnetic resonance imaging was decreased, increased, and remained unchanged in 1, 7, and 28 patients, respectively. Transitional type VBFA, brain compression symptoms, large aneurysmal diameter and length, preoperative modified Rankin Scale (mRS) score ≥ 2, sole stenting technique, and intra-aneurysmal thrombus significantly influenced the risk of recurrence. Post-EVT, 7 (19.4%) patients showed complete occlusion of the aneurysm on the immediate postoperative angiogram, and 22 (61.1%) patients showed complete occlusion on the 1‑year follow-up imaging. Good outcomes were observed in 32 patients (88.9%) at the last follow-up, with a mRS score of 0-1 after EVT. CONCLUSION EVT achieves good outcomes in unruptured VBFA. Transitional type VBFA, brain compression symptoms, large aneurysmal diameter and length, preoperative mRS score ≥ 2, sole stenting technique, and intra-aneurysmal thrombus are risk factors for aneurysm recurrence after EVT.
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Affiliation(s)
- Jae Hyun Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, 42601, Dalseo-gu, Daegu, Korea (Republic of)
| | - Young San Ko
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, 42601, Dalseo-gu, Daegu, Korea (Republic of)
| | - Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, 42601, Dalseo-gu, Daegu, Korea (Republic of)
| | - Chang Hyun Kim
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, 42601, Dalseo-gu, Daegu, Korea (Republic of)
| | - Chang Young Lee
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero, 42601, Dalseo-gu, Daegu, Korea (Republic of).
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Hosogai M, Okazaki T, Sakamoto S, Ishii D, Kuwabara M, Horie N. Flow Redirection Endoluminal Device Flow Diverter Placement for Recurrent Dolichoectatic Vertebrobasilar Artery Aneurysm Treated with Multiple Low-Profile Visualized Intraluminal Support Stents: A Case Study. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 17:27-31. [PMID: 37501885 PMCID: PMC10370513 DOI: 10.5797/jnet.cr.2022-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/15/2022] [Indexed: 07/29/2023]
Abstract
Objective We report a case of dolichoectatic vertebrobasilar aneurysms treated with multiple low-profile visualized intraluminal support (LVIS) stents followed by flow redirection endoluminal device (FRED) flow diverter to prevent the growth of the thrombosed aneurysm. Case Presentation A 71-year-old man developed diplopia due to oculomotor nerve palsy after 11 years of follow-up for an enlarging thrombosed dolichoectatic vertebrobasilar artery aneurysm. He initially had a fusiform thrombosed aneurysm from the right vertebral artery to the basilar artery. This lesion was tortuous and strongly compressed the pons. A total of 11 LVISs were deployed from the right posterior cerebral artery to the right vertebral artery. Six months after surgery, there was no enlargement of the thrombosed aneurysm on MRI and the contrast leakage out of the stent was markedly reduced in DSA compared to immediately after surgery. One year and seven months after surgery, contrast leakage out of the stent was increased in DSA. The FRED was placed within the overlapped LVISs, and contrast leakage was somewhat reduced. After 2 years and 7 months from the initial treatment, the contrast leakage was still observed. However, there was no enlargement of the aneurysm and no complications related to treatments were observed. Conclusion Treatment with multiple LVIS stents followed by FRED flow diverter treatment for dolichoectatic vertebrobasilar aneurysms (DVAs) may be one of the treatment options for controlling the growth of thrombotic aneurysms without complications, but the long-term prognosis of this case is unclear, and careful follow-up is mandatory.
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Affiliation(s)
- Masahiro Hosogai
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Daizo Ishii
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Hiroshima, Japan
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Li W, Zhu W, Wang Y, Zhao Y, Wang Y, Liu X, Zhang Y. Stent-alone treatment of unruptured vertebral artery fusiform aneurysms: A comparison of flow diverter and conventional stents. Front Neurol 2022; 13:1012382. [DOI: 10.3389/fneur.2022.1012382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTreatment of vertebral artery fusiform aneurysms (VAFAs) is complex and controversial. This study aimed to compare the safety and efficacy between flow diverter and conventional stents in patients with VAFAs undergoing endovascular stent-alone treatment (SAT).MethodsThirty-six patients with 36 VAFAs who underwent SAT between January 2014 and December 2018 were retrospectively analyzed. Patient and aneurysm characteristics, procedural details, complications, and angiographic and clinical outcomes were compared between flow diverter stent patients (n = 22) and conventional stent patients (n = 14).ResultsMore branches covered with stent were found in the conventional stent group (88.9 vs. 33.3%; p = 0.008). The number of stents placed was significantly higher in the conventional stent group (1.57 ± 0.76 vs. 1.09 ± 0.29; p = 0.016). The proportion of patients with significant or moderate stasis within the aneurysm immediately after stent placement was higher in the flow diverter stent group (95.5 vs. 57.1%; p = 0.004). The proportion of patients with complete obliteration or only a residual neck on follow-up angiography was significantly higher in the flow diverter stent group (86.3 vs 50.0%; p = 0.047). However, the incidence of parent artery stenosis or occlusion was also higher in the flow diverter stent group (27.3% vs. zero; p = 0.032). The rate of complications did not significantly differ between the groups.ConclusionsSAT was safe and effective in patients with VAFAs. Flow diverter stents are associated with a significantly better complete occlusion rate than conventional stents; however, they are also associated with an increased risk of parent artery stenosis.
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Wu Q, Li T, Jiang W, Hernesniemi JA, Li L, He Y. Conservative Therapy vs. Endovascular Approach for Intracranial Vertebrobasilar Artery Trunk Large Aneurysms: A Prospective Multicenter Cohort Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9682507. [PMID: 35770042 PMCID: PMC9236797 DOI: 10.1155/2022/9682507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
Background Intracranial vertebrobasilar trunk large (≥10 mm) aneurysms (IVBTLAs) are rare and challenging to manage. In this study, we describe the natural prognosis and evaluate the safety and efficacy of endovascular treatment of IVBTLAs compared with conservative therapy. Methods This prospective multicenter cohort study included patients with IVBTLAs, who chose either endovascular treatment (endovascular group) or conservative therapy (conservative group) after discussion with their doctors. The primary endpoint was the incidence of serious adverse events (SAEs) related to the target vessel, while secondary endpoints included target vessel-related mortality, major stroke, other serious adverse events, and aneurysm occlusion rate. Results In total, 258 patients were referred to our two centers for the management of vertebrobasilar aneurysms, and 69 patients had IVBTLAs. Among them, 51 patients underwent endovascular treatment, and 18 patients received conservative therapy. The incidence of target vessel-related SAEs was 15.7% (8/51) in the endovascular group and 44.4% (8/18) in the conservative group (P = 0.031). The target vessel-related mortality was 2.0% (1/51) in the endovascular group and 38.9% (7/18) in the conservative group (P < 0.001). The cumulative survival rates in the endovascular group and conservative group within 1-year, 3-year, and 5-year were 98.0% vs. 83.3%, P = 0.020; 98.0% vs. 66.7%, P = 0.001; and 98.0% vs. 35.6%, P < 0.001, respectively. Multivariate analysis revealed conservative therapy, giant aneurysm, and ischemic onset as risks factor for SAEs. Conclusions Compared with conservative treatment, endovascular treatment of the IVBTLAs may be associated with a lower incidence of SAEs, with higher 1-year, 3-year, and 5-year survival rates. Conservative therapy, giant aneurysm, and ischemic onset were associated with a high risk of SAEs.
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Affiliation(s)
- Qiaowei Wu
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tianxiao Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Weijian Jiang
- Department of Vascular Neurosurgery, Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, China
| | - Juha Antero Hernesniemi
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Li Li
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Yingkun He
- Cerebrovascular Department of Interventional Center, Zhengzhou University People's Hospital, Henan University People's Hospital and Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Najibullah M, Dangmurenjiafu G, Dou T, Abbas S, Cheng X, Maimaitili Aisha. Reconstructive endovascular treatment of symptomatic large or giant unruptured vertebrobasilar fusiform aneurysm with LVIS stent-assisted partial coil embolization. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sato K, Endo H, Fujimura M, Endo T, Matsumoto Y, Shimizu H, Tominaga T. Endovascular Treatments in Combination with Extracranial-Intracranial Bypass for Complex Intracranial Aneurysms. World Neurosurg 2018; 113:e747-e760. [DOI: 10.1016/j.wneu.2018.02.143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 10/17/2022]
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