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Liu C, Wu X, Guo K, Sun Y, Yike C, Hu X, Fang B. Flow-Diverting Devices in the Treatment of Vertebral Artery Aneurysms: Insights into Efficacy and Safety from a Systematic Review and Meta-analysis. Transl Stroke Res 2024:10.1007/s12975-024-01251-y. [PMID: 38602659 DOI: 10.1007/s12975-024-01251-y] [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: 03/04/2024] [Revised: 03/18/2024] [Accepted: 04/06/2024] [Indexed: 04/12/2024]
Abstract
The objective of this study is to conduct a systematic review and meta-analysis aimed at evaluating the efficacy and safety of flow-diverting devices (FDs) treatment for intracranial vertebral artery (VA) aneurysms. We searched PubMed, Web of Science, OVID, and Embase for English-language studies up to February 2024 and included clinical studies on FD treatment of intracranial VA aneurysms. Sensitivity analysis evaluated outcome stability. Of 2273 articles, 29 studies involving 541 aneurysms treated with FDs were included. Based on the Methodological Index for Non-Randomized Studies (MINORS), six were high-quality and 23 moderate quality. FD treatment showed a 95% rate of favorable clinical outcomes (95% CI, 89-99%), 81% (95% CI, 74-88%) complete aneurysmal occlusion, 4% (95% CI, 2-7%) ischemic complication incidence, 1% (95% CI, 0-3%) hemorrhagic complication incidence, 95% (95% CI, 87-100%) posterior inferior cerebellar artery (PICA) preservation, and 6% (95% CI, 3-10%) in-stent stenosis or occlusion across clinical and angiographic follow-up periods of 13.62 months (95% CI, 10.72-16.52) and 11.85 months (95% CI, 9.36-14.33), respectively. Subgroup analyses, based on a 12-month angiographic follow-up threshold, indicated no statistically significant differences in rates of complete aneurysm occlusion, PICA preservation, or in-stent stenosis or occlusion incidence (p > 0.05) between subgroups. Moreover, significant differences were observed in clinical and angiographic outcomes between ruptured and unruptured aneurysms, particularly in hemorrhagic complications (p < 0.05), without significant disparity in ischemic complications (p > 0.05). The results' stability was confirmed via sensitivity analysis. FDs treatment for VA aneurysms is efficacious and safe, offering high rates of positive clinical and angiographic outcomes with minimal complications, underscoring FDs' viability as a treatment option for VA aneurysms. The study was registered with PROSPERO (registration number: CRD42024499894).
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Affiliation(s)
- Changya Liu
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, NO.725 Wanping South Road, Xuhui District, Shanghai, 200032, China
| | - Xinxin Wu
- Central Laboratory, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, 200443, China
| | - Kaikai Guo
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yuting Sun
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, NO.725 Wanping South Road, Xuhui District, Shanghai, 200032, China
| | - Cai Yike
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xuebin Hu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Bangjiang Fang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, NO.725 Wanping South Road, Xuhui District, Shanghai, 200032, China.
- Chongqing General Hospital, Chongqing University, Chongqing, 401147, China.
- Institute of Emergency and Critical Care Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, 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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Ogishima T, Tone O, Sato Y, Tamaki M. Internal Trapping of an Acutely Ruptured Dissecting Aneurysm of a Dominant Vertebral Artery Following Balloon Test Occlusion: A Case Report. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:474-480. [PMID: 37502797 PMCID: PMC10370988 DOI: 10.5797/jnet.cr.2021-0105] [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: 12/23/2021] [Accepted: 04/10/2022] [Indexed: 07/29/2023]
Abstract
Objective To report a case of an acutely ruptured vertebral artery dissecting aneurysm (VADA) with a hypoplastic contralateral vertebral artery (VA) successfully treated with internal trapping following the estimation of the collateral flow from anterior circulation. Case Presentation A 46-year-old woman was diagnosed with subarachnoid hemorrhage and acute hydrocephalus. Ventriculostomy was performed under general anesthesia. CTA revealed a left VADA distal to the origin of the left posterior inferior cerebellar artery (PICA). The right VA was hypoplastic, and the right posterior communicating artery (Pcom) was fetal type. We performed balloon test occlusion (BTO) of the VA proximal to the origin of the left PICA and estimated sufficient collateral blood flow via the right Pcom and basilar artery (BA) to the anterior spinal artery (ASA) and the left PICA. Internal trapping of the left VADA was then performed. The angiograms after internal trapping revealed collateral flow from the right Pcom to the BA, and the hypoplastic right VA perfused the proximal BA and ASA. She recovered without any neurological deficits following antiplatelet therapy and vasospasm treatment. She was followed up for 6 years without any neurological events occurring. Conclusion When BTO indicates sufficient collateral flow, internal trapping could be a useful treatment for acutely ruptured VADAs on the dominant side, given a complete understanding of the angioarchitecture and the risk of vasospasm due to subarachnoid hemorrhage.
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Affiliation(s)
- Takahiro Ogishima
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Osamu Tone
- Stroke Center, Ome Municipal General Hospital, Ome, Tokyo, Japan
| | - Yohei Sato
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, Japan
| | - Masashi Tamaki
- Department of Neurosurgery, Japanese Red Cross Musashino Hospital, Musashino, Tokyo, 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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Li W, Qi L, Guo Y, Zhang Z, He G, Li Y, Wang Z. Application Value of CTA in the Computer-Aided Diagnosis of Subarachnoid Hemorrhage of Different Origins. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6638610. [PMID: 33510889 PMCID: PMC7822679 DOI: 10.1155/2021/6638610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022]
Abstract
Subarachnoid hemorrhage (SAH) is difficult to detect because of its circulation through subarachnoid space, which leads to a high rate of missed diagnosis. Based on the above background, the purpose of this study is to study the application value of brain CT angiography (CTA) in computer-aided diagnosis of subarachnoid hemorrhage with a wide range of brain digital subtraction angiography as a gold standard. This paper collected images and related medical records of 111 patients with spontaneous subarachnoid hemorrhage receiving brain CTA and DSA examinations from February 2015 to November 2019 in the neurology department of our hospital. In contrast to the number, position, length, width, and neck width of the causative aneurysm detected by DSA, we evaluated the diagnostic results of CTA and evaluated whether there was statistical difference between the two detectives of intracranial aneurysms. The results showed that the area under ROC curve of subtraction CTA and conventional CTA was 1.000 and 0.818, respectively, which indicated that the former had better display effect on internal carotid aneurysm (AUC > 0.9), while the latter had medium value (0.7 < AUC ≤ 0.9), and the difference was statistically significant (z = 2.390, p=0.017).
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Affiliation(s)
- Wei Li
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
| | - Lin Qi
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
- Railway Police College, Zhengzhou, Henan 450053, China
| | - Yulong Guo
- Railway Police College, Zhengzhou, Henan 450053, China
| | - Zhen Zhang
- Railway Police College, Zhengzhou, Henan 450053, China
| | - Guanglong He
- Institute of Forensic Science, Ministry of Public Security, Beijing 100038, China
| | - Yang Li
- Institute of Forensic Science, Ministry of Public Security, Beijing 100038, China
| | - Zhenyuan Wang
- Department of Forensic Pathology, College of Forensic Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710049, China
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Gao L, Qian Y, Luo J, Hong Y, Hu Y, Cheng H, Cheng B. Clinical Efficacy and Quality of Life Follow-Up of Reconstructive Endovascular Therapy for Acute Intracranial Vertebral Artery Dissection Aneurysms. Front Surg 2020; 7:32. [PMID: 32850942 PMCID: PMC7403182 DOI: 10.3389/fsurg.2020.00032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/11/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Intracranial vertebral artery dissection aneurysms (VADAs) may cause acute ischemia or hemorrhage, in which case urgent endovascular treatment will be needed. Although the majority of patients obtain a good functional outcome after surgery, a surprising finding has been a poor quality of life (QOL) in follow-up. The purpose of this study was to evaluate clinical efficacy in reconstructive endovascular therapy for acute intracranial VADAs and to analyze the factors contributing to subsequent QOL. Methods: In this prospective study, 33 consecutive VADA patients with subarachnoid hemorrhage were recruited for comparison with 37 VADA patients with posterior circulation cerebral ischemia. All VADA patients were treated using a reconstructive strategy. Clinical, radiological, neurological, and cognitive data, as well as QOL, were assessed at admission and 6 months after surgery. Stoke Specific Quality of Life (SS-QOL) was evaluated for patients with good functional outcome [modified Ranking Scale (mRS) scoring 0-2] for subgroup analysis. Predictors for QOL at follow-up were analyzed by regression model. Results: Immediate angiography after surgery showed complete VADA obliteration in 57 (81.4%) patients and partial obliteration in 13 (18.6%) patients. Three (4.3%) cases suffered from perioperative complications, comprising two cases of stent thrombosis in the hemorrhagic group and one case of posterior inferior cerebellar artery occlusion in the ischemic group. Twenty-five (75.8%) patients in the hemorrhagic group and 30 (81.1%) patients in the ischemic group had a favorable outcome (mRS scoring 0-2) at 6-month follow-up. Follow-up angiography displayed that one case of recurrence occurred separately in both groups. Fifteen of the 33 hemorrhagic patients (45.5%) and 19 of the 37 ischemic patients (51.4%) rated QOL at follow-up as bad (SS-QOL score ≤ 3.9) despite a good functional outcome. Severity of neurological disorder and impaired neurocognition at baseline in VADA patients are proved to be independent predictors for the decline of QOL according to regression analysis. Conclusion: Reconstructive endovascular therapy for acute intracranial VADAs is a safe and effective method with a low complication rate. VADAs lead to impaired QOL at 6-month follow-up, which is attributable to multiple factors. This study demonstrated that neurological and cognitive status at baseline is of significant importance for QOL after VADAs.
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Affiliation(s)
- Lu Gao
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Yu Qian
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Jing Luo
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Yang Hong
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Yangchun Hu
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Hongwei Cheng
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Baochun Cheng
- Department of Neurosurgery, First Affiliated Hospital of Anhui Medical University, Heifei, China
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Updates in the Management of Cerebral Infarctions and Subarachnoid Hemorrhage Secondary to Intracranial Arterial Dissection: A Systematic Review. World Neurosurg 2019; 121:51-58. [DOI: 10.1016/j.wneu.2018.09.153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/10/2023]
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Mahajan A, Goel G, Das B, Narang K. Dissecting aneurysm of vertebral artery involving the origin of posteroinferior cerebellar artery treated with retrograde stent placement and coil embolization in the era of flow diverter. Asian J Neurosurg 2018; 13:910-913. [PMID: 30283580 PMCID: PMC6159080 DOI: 10.4103/ajns.ajns_59_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ruptured vertebral artery (VA) dissecting aneurysm carries high risk of rerupture and mortality if not treated immediately. Dissecting aneurysm of the VA involving the posteroinferior cerebellar artery (PICA) origin is difficult to treat by surgical and endovascular route. With the availability of flow diversion device for reconstructive procedure, endovascular treatment has now become easy to treat difficult aneurysm while maintaining the patency of the PICA. However, instead of using flow diverter (FD) in our case, we successfully treated dissecting VA aneurysm involving the PICA origin with retrograde stent placement from distal right VA to the left PICA to maintain the patency of PICA and occlusion of dissecting aneurysm of VA with detachable coils instead of performing surgical bypass and FD placement.
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Affiliation(s)
- Anshu Mahajan
- Department of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana
| | - Gaurav Goel
- Department of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana
| | - Biplab Das
- Department of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana
| | - Karanjit Narang
- Department of Neurosciences, Medanta - The Medicity, Gurgaon, Haryana
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Tayebi Meybodi A, Gandhi S, Preul MC, Lawton MT. The subatlantic triangle: gateway to early localization of the atlantoaxial vertebral artery. J Neurosurg Spine 2018; 29:18-27. [PMID: 29701566 DOI: 10.3171/2017.11.spine171068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Exposure of the vertebral artery (VA) between C-1 and C-2 vertebrae (atlantoaxial VA) may be necessary in a variety of pathologies of the craniovertebral junction. Current methods to expose this segment of the VA entail sharp dissection of muscles close to the internal jugular vein and the spinal accessory nerve. The present study assesses the technique of exposing the atlantoaxial VA through a newly defined muscular triangle at the craniovertebral junction. METHODS Five cadaveric heads were prepared for surgical simulation in prone position, turned 30°-45° toward the side of exposure. The atlantoaxial VA was exposed through the subatlantic triangle after reflecting the sternocleidomastoid and splenius capitis muscles inferiorly. The subatlantic triangle was formed by 3 groups of muscles: 1) the levator scapulae and splenius cervicis muscles inferiorly and laterally, 2) the longissimus capitis muscle inferiorly and medially, and 3) the inferior oblique capitis superiorly. The lengths of the VA exposed through the triangle before and after unroofing the C-2 transverse foramen were measured. RESULTS The subatlantic triangle consistently provided access to the whole length of atlantoaxial VA. The average length of the VA exposed via the subatlantic triangle was 19.5 mm. This average increased to 31.5 mm after the VA was released at the C-2 transverse foramen. CONCLUSIONS The subatlantic triangle provides a simple and straightforward pathway to expose the atlantoaxial VA. The proposed method may be useful during posterior approaches to the craniovertebral junction should early exposure and control of the atlantoaxial VA become necessary.
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Kidani N, Sugiu K, Hishikawa T, Hiramatsu M, Haruma J, Nishihiro S, Takahashi Y, Date I. De novo vertebral artery dissecting aneurysm after internal trapping of the contralateral vertebral artery. Acta Neurochir (Wien) 2017; 159:1329-1333. [PMID: 28493024 DOI: 10.1007/s00701-017-3204-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 04/24/2017] [Indexed: 10/19/2022]
Abstract
We present the case of a de novo vertebral artery dissecting aneurysm (VADA) after endovascular trapping of a ruptured VADA on the contralateral side. The first ruptured VADA involved the posterior inferior cerebellar artery, which was successfully treated by endovascular internal trapping using a stent. A follow-up study at 3 months revealed a de novo VADA on the contralateral side. The second VADA was successfully embolized using coils while normal arterial flow in the vertebral artery was preserved using a stent. Increased hemodynamic stress may cause the development of a de novo VADA on the contralateral side.
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Shi L, Xu K, Sun X, Yu J. Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery. Int J Med Sci 2016; 13:540-55. [PMID: 27429591 PMCID: PMC4946125 DOI: 10.7150/ijms.15233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/01/2016] [Indexed: 12/04/2022] Open
Abstract
Among the variations of vertebral artery dissecting aneurysms (VDAs), VDAs involving the posterior inferior cerebellar artery (PICA), especially ruptured and high-risk unruptured aneurysms, are the most difficult to treat. Because the PICA is an important structure, serious symptoms may occur after its occlusion. Retained PICAs are prone to re-bleeding because VDAs are difficult to completely occlude. There is therefore confusion regarding the appropriate treatment for VDAs involving the PICA. Here, we used the PubMed database to review recent research concerning VDAs that involve the PICA, and we found that treatments for VDAs involving the PICA include (i) endovascular treatment involving the reconstruction of blood vessels and blood flow, (ii) occluding the aneurysm using an internal coil trapping or an assisted bypass, (iii) inducing reversed blood flow by occluding the proximal VDA or forming an assisted bypass, or (iv) the reconstruction of blood flow via a craniotomy. Although the above methods effectively treat VDAs involving the PICA, each method is associated with both a high degree of risk and specific advantages and disadvantages. The core problem when treating VDAs involving the PICA is to retain the PICA while occluding the aneurysm. Therefore, the method is generally selected on a case-by-case basis according to the characteristics of the aneurysm. In this study, we summarize the various current methods that are used to treat VDAs involving the PICA and provide schematic diagrams as our conclusion. Because there is no special field of research concerning VDAs involving the PICA, these cases are hidden within many multiple-cases studies. Therefore, this study does not review all relevant documents and may have some limitations. Thus, we have focused on the mainstream treatments for VDAs that involve the PICA.
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Affiliation(s)
- Lei Shi
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 130021
| | - Kan Xu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 130021
| | - Xiaofeng Sun
- 2. Department of Ultrasonography, First Hospital of Jilin University, Changchun, China, 130021
| | - Jinlu Yu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, China, 130021
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