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Yu J. Current research status and future of endovascular treatment for basilar artery aneurysms. Neuroradiol J 2024:19714009241242584. [PMID: 38560789 DOI: 10.1177/19714009241242584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Aneurysms occurring along the basilar artery (BA) account for <1% of all intracranial aneurysms. Endovascular treatment (EVT) in particular is recommended for large unruptured BA aneurysms and ruptured BA aneurysms. Given that EVT techniques vary, a detailed review of EVT for BA aneurysms is necessary. In this review, the following issues were discussed: the anatomy and anomalies of the BA, the classification of BA aneurysms, the natural history of BA aneurysms, the status of open surgery, the use of EVT for various types of BA aneurysms and the deployment of new devices. According to the findings of this review and based on our experience in treating BA aneurysms, traditional coiling EVT is still the optimal therapy for most BA aneurysms. However, in some BA aneurysms, flow diverter (FD) deployment can be used. In addition, there are also some new devices, such as intrasaccular flow disruptors and stent-like devices that can be used to treat BA aneurysms. In general, EVT can yield good clinical and angiographic outcomes for patients with BA aneurysms. In addition, recent new devices and techniques, such as new-generation FDs generated via surface modification and virtual reality simulation techniques, show promise for EVT for BA aneurysms. These devices and techniques may further improve EVT outcomes for BA aneurysms.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, China
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Feng Y, Peng H, Xiang X, Zeng X, Sun B, Lin H, Wang X, Yang H. Endovascular Intervention in a Narrowing Vessel of the Left Vertebral Artery with Bilateral Common Carotid Artery Occlusion and Aneurysm Rupture and Hemorrhage in the V4 Segment of the Right Vertebral Artery. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3279090. [PMID: 35634080 PMCID: PMC9135546 DOI: 10.1155/2022/3279090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022]
Abstract
In this study, a case of bilateral common carotid artery occlusion and aneurysm in the V4 segment of the right vertebral artery with constriction of the left vertebral artery is presented. By improving digital subtraction angiography, an elderly female patient with subarachnoid haemorrhage (SAH) was diagnosed with a V4 segment of right vertebral artery aneurysm, a microaneurysm at the beginning of basilar aneurysms, bilateral common carotid artery occlusion, and narrowing vessel of left vertebral artery (DSA). Through the compensation of the basilar artery, the bilateral vertebral arteries provide intracranial and extracranial blood. Because the vertebral artery is narrowed, the right vertebral artery has priority in intracranial and extracranial blood delivery. Many members of the patient's immediate family have vasculitis, which has yet to be proven by appropriate laboratory testing but is thought to be the major cause of big artery occlusion. After cerebral angiography, the major source of this subarachnoid haemorrhage was determined to be a V4 segment of right vertebral artery aneurysm. Endovascular stent-assisted coil embolization was used to treat a V4 section of the right vertebral artery aneurysm. Because the basilar aneurysm was distal to the artery, interventional embolization was difficult to do, and it was not the major cause of the subarachnoid haemorrhage, the patient was advised to have follow-up surveillance, and she recovered well following the procedure. The combination of endovascular intervention of bilateral common carotid artery blockage and V4 segment of right vertebral artery aneurysm yielded excellent clinical outcomes in this instance. Endovascular treatment of a bilateral common carotid artery blockage paired with a V4 segment of a right vertebral artery aneurysm yielded excellent clinical outcomes in this patient, although long-term follow-up is necessary.
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Affiliation(s)
- Yang Feng
- Guizhou Medical University, Guiyang 550000, China
| | - Han Peng
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
| | - Xin Xiang
- Guizhou Medical University, Guiyang 550000, China
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
| | - Xi Zeng
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
| | - Bin Sun
- Guizhou Medical University, Guiyang 550000, China
| | - Hongyi Lin
- Guizhou Medical University, Guiyang 550000, China
| | - Xiaofeng Wang
- Shandong First Medical University, Tai'an 250000, China
| | - Hua Yang
- Guizhou Medical University, Guiyang 550000, China
- Department of Neurosurgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
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Dange NN, Mahore A, Patil AK, Kawale J. Ruptured Posterior Circulation Aneurysms with Bilateral Internal Carotid Artery Occlusion: Surgical Nuance. Asian J Neurosurg 2018; 13:1008-1010. [PMID: 30459858 PMCID: PMC6208260 DOI: 10.4103/ajns.ajns_19_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Craniotomy and surgical clipping is the standard modality of treatment in patients of cerebral aneurysms. However, the surgical clipping of aneurysm may pose serious difficulties in the case of a bilateral carotid artery occlusion. The endovascular treatment has shown promising results in this disease. Methods: A retrospective study of all patients of posterior circulation aneurysms in the background of carotid occlusive disease at our department was performed. The aim of this study was to describe the clinical, radiological characteristics, and the treatment of this rare entity. Results: Four patients were treated from January 2009 to October 2015. The mean age of our patients was 34 years with ages that ranged from 17 to 45 without any gender predominance. The mean period between onset of symptoms and diagnosis was 6 weeks. Angiographic localization of the disease was observed in all patients. All patients were treated by endovascular techniques. The postoperative course has been satisfactory with a complete neurological recovery in all patients. Conclusions: Rupture of posterior circulation aneurysms in the setting of bilateral internal carotid artery occlusion is extremely rare. Treatment is exclusively endovascular intervention. The functional outcome of ruptured posterior circulation aneurysms in setting of bilateral carotid occlusive disease is particularly favorable with good neurological recovery.
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Affiliation(s)
- Nitin Narayan Dange
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Amit Mahore
- Department of Neurosurgery, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Ashwini Kumar Patil
- Department of Neurology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - Juhi Kawale
- Department of Internal Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Xiong Z, Lin X, Bi W, Li W, Jing Z, Huang L. Bilateral Atherosclerotic Internal Carotid Artery Occlusion with Intact Cerebral Glucose Metabolism: A Case Report. J Stroke Cerebrovasc Dis 2015; 24:e201-4. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 11/29/2022] Open
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Tutino VM, Mandelbaum M, Choi H, Pope LC, Siddiqui A, Kolega J, Meng H. Aneurysmal remodeling in the circle of Willis after carotid occlusion in an experimental model. J Cereb Blood Flow Metab 2014; 34:415-24. [PMID: 24326393 PMCID: PMC3948116 DOI: 10.1038/jcbfm.2013.209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/29/2013] [Accepted: 11/02/2013] [Indexed: 01/10/2023]
Abstract
Carotid occlusions are associated with de novo intracranial aneurysm formation in clinical case reports, but this phenomenon is not widely studied. We performed bilateral carotid ligation (n=9) in rabbits to simulate carotid occlusion, and sham surgery (n=3) for control. Upon euthanasia (n=3 at 5 days, n=6 at 6 months post ligation, and n=3 at 5 days after sham operation), vascular corrosion casts of the circle of Willis (CoW) were created. Using scanning electron microscopy, we quantified gross morphologic, macroscopic, and microscopic changes on the endocasts and compared findings with histologic data. At 5 days, CoW arteries of ligated animals increased caliber. The posterior communicating artery (PCom) increased length and tortuosity, and the ophthalmic artery (OA) origin presented preaneurysmal bulges. At 6 months, calibers were unchanged from 5 days, PComs further increased tortuosity while presenting segmental dilations, and the OA origin and basilar terminus presented preaneurysmal bulges. This exploratory study provides evidence that flow increase after carotid occlusion produces both compensatory arterial augmentation and pathologic remodeling such as tortuosity and saccular/fusiform aneurysm. Our findings may have considerable clinical implications, as these lesser-known consequences should be considered when managing patients with carotid artery disease or choosing carotid ligation as a therapeutic option.
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Affiliation(s)
- Vincent M Tutino
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Biomedical Engineering, Buffalo, New York, USA
| | - Max Mandelbaum
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Mechanical & Aerospace Engineering, Buffalo, New York, USA
| | - Hoon Choi
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Mechanical & Aerospace Engineering, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo, New York, USA
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Liza C Pope
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo, New York, USA
| | - Adnan Siddiqui
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo, New York, USA
- Department of Radiology, Buffalo, New York, USA
| | - John Kolega
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center, University at Buffalo, Clinical and Translational Research Center, Buffalo, New York, USA
- Department of Biomedical Engineering, Buffalo, New York, USA
- Department of Mechanical & Aerospace Engineering, Buffalo, New York, USA
- Department of Neurosurgery, Buffalo, New York, USA
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Crobeddu E, D’Urso PI, Meyer FB, Lanzino G. Intracranial aneurysms in patients with internal carotid artery occlusion: management and outcome in 22 cases. Acta Neurochir (Wien) 2013; 155:2001-7. [PMID: 24043416 DOI: 10.1007/s00701-013-1879-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is little information about clinical characteristics, management, and outcome of patients with intracranial aneurysms and internal carotid artery occlusion. We will describe clinical characteristics, treatment and outcome of patients with coexistent internal carotid artery occlusion and intracranial aneurysms. METHODS We conducted a retrospective chart review of 22 patients (eight males and 14 females) with coexistent internal carotid artery (ICA) occlusion and intracranial aneurysms. RESULTS This series includes 14 females and eight males with a mean age of 63 years (range, 49 to 80). These patients harbored a total of 35 aneurysms, which were located on the same side of the ICA occlusion in five cases, on the contralateral side in 20 cases, while in ten cases the aneurysm had a midline location (AcomA 9, Basilar tip 1). Treatment consisted of surgery for eight aneurysms and endovascular embolization for 13 aneurysms. No invasive treatment was recommended for 14 aneurysms (eight patients with single aneurysm). No permanent perioperative or periprocedural complications occurred in the selected group of patients undergoing invasive treatment. At a mean follow-up of 57 months (range, 3-203), no patient had a subarachnoid hemorrhage and three patients had died of causes not related to the aneurysm. CONCLUSION Surgical and endovascular treatment can be accomplished safely in selected patients with coexistent ICA occlusion and intracranial aneurysms. Conservative treatment is a valid alternative, especially in elderly patients or in patients with very small aneurysms, especially if not located along the collateral pathway.
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Kim SS, Park DH, Lee NJ, Kang SH, Lim DJ, Chung YG. Coil embolization of a ruptured basilar tip aneurysm associated with bilateral cervical internal carotid artery occlusion: a case report and literature review. J Cerebrovasc Endovasc Neurosurg 2012; 14:44-9. [PMID: 23210029 PMCID: PMC3471248 DOI: 10.7461/jcen.2012.14.1.44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 02/21/2012] [Accepted: 02/27/2012] [Indexed: 11/23/2022] Open
Abstract
We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.
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Affiliation(s)
- Sang-Shin Kim
- Department of Neurosurgery, Anam Hospital, Korea University Medical Center, Korea University College of Medicine, Seoul, Korea
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