Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion

Awad, Ahmed J.; Mascitelli, Justin; Haroun, Reham R.; Leacy, Reade De; Fifi, Johanna T; Mocco, J

doi:10.3171/2017.3.focus1748

Cited by 92 publications

(71 citation statements)

References 38 publications

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“…In a series of 102 MCa Fa (3), the authors advocate for maximal interventional treatment (occlusion of parent vessel with trapping of the aneurysm, resection and vascular bypass). Moreover, endovascular therapies are increasingly utilized, with Ciceri et al and Taqi et al successfully treating a small series of mostly saccular PCa aneurysms by means of endovascular coiling (11,16); the efficiency of these methods was also confirmed in a review by awad et al (12) for posterior circulation Fa (proposing flow-diversion in addition to stenting and coiling).…”

Section: Discussionmentioning

confidence: 99%

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Multiple intracranial vascular anomalies in a patient with stroke – a case report and short review of literature

Dimancea¹,

Ene²,

Dorobăț³

et al. 2019

Ro J Neurol.

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Introduction. Non-saccular aneurysms are independent vascular entities, characterized by particular pathogenesis, localization, natural history and treatment. The fusiform subtype comprises an estimated tenth of all intracranial aneurysm, while the dolichoectatic subtype has different reported prevalence values, owing to several proposed diagnostic criteria (Smoker et al. criteria1 being the most widely used). The most frequent initial clinical presentations are ischemic stroke and transient ischemic attack, due to different hemodynamics and mechanism of formation. Prognosis is usually poor and progression can be demonstrated in almost half of ectatic vessels. Treatment can be either conservative in asymptomatic or ischemic presentations or by endovascular or microsurgical conduit in other cases. case presentation. We report the case of a hypertensive 63-year old male patient with multiple intracranial vascular anomalies; he was initially admitted for ischemic stroke, with right hemiplegia and mixt aphasia. Non-contrast CT demonstrated a thrombosed left posterior cerebral artery aneurysm and contrast enhanced CT revealed a middle cerebral artery saccular aneurysm, two saccular and fusiform right PCA aneurysms and vertebrobasilar dolichoectasia. Cerebral angiography confirmed the previous findings and revealed lack of contrast at the level of the left PCA in the P2 segment. The patient was treated conservatively with aspirin and high-dose statins and had a favorable outcome, regaining part of his right-side function, object-naming and simple sentence construction capabilities. conclusions. Upon ischemic presentation in the case of non-saccular aneurysms, a conservative attitude is recommended. These aneurysms commonly have an unfavorable prognosis, demanding periodic follow-up for detecting recurrent ischemic events, possible hemorrhage and progression.

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Section: Discussionmentioning

confidence: 99%

“…Treatment for non-saccular aneurysms varies: if asymptomatic or in the case of initial ischemic presentation, conservative treatment is elected (2,3). Otherwise, an open microsurgical conduit might be employed (clipping wrapping, bypass (2,4)), along with endovascular techniques (coiling, parent vessel occlusion, flow-diversion (11,12).…”

mentioning

confidence: 99%

Multiple intracranial vascular anomalies in a patient with stroke – a case report and short review of literature

Dimancea¹,

Ene²,

Dorobăț³

et al. 2019

Ro J Neurol.

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“…Endovascular treatments, including parent vessel coil embolization, stenting, stentassisted coiling, and flow diversion (FD), have recently emerged as alternatives to open surgery. 1,3,9,19,25 FD represents a particularly promising treatment option in the case of unruptured fusiform VA aneurysms. Li et al used computational fluid dynamics to model hemodynamic changes following FD in fusiform VA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Fusiform vertebral artery aneurysms involving the posterior inferior cerebellar artery origin associated with the sole angiographic anterior spinal artery origin: technical case report and treatment paradigm proposal

Rāviņa¹,

Strickland

Rennert

et al. 2019

Journal of Neurosurgery

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Fusiform aneurysms of the vertebral artery (VA) involving the posterior inferior cerebellar artery (PICA) origin are uncommon and challenging. The anterior spinal artery (ASA) commonly originates from a unilateral ramus just distal to the PICA. Occlusion of an unpaired ASA can result in bilateral medial medullary syndrome. The authors propose a treatment paradigm for ASA preservation based on the artery’s proximity to fusiform VA aneurysms, and they present 3 representative cases. In the first case, they performed a V3-PICA bypass using an interposition graft and then performed endovascular coil embolization of the parent VA. A complete occlusion of the aneurysm and VA was complicated by ASA thrombosis. The subsequent cases were treated with PICA-PICA bypass and subsequent endovascular embolization of the VA. Filling of the sole angiographic ASA remote from the aneurysm was preserved in both cases. The anatomy of the ASA is the most critical determinant of treatment recommendations for fusiform VA aneurysms involving PICA. When the ASA originates from the aneurysm, proximal occlusion with or without a PICA bypass is suggested. In cases in which the ASA is removed from the aneurysm, the authors recommend revascularization followed by endovascular sacrifice. When the aneurysm is immediately adjacent to the ASA, revascularization and open trapping should be considered.

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“…As reconstructive treatments for unruptured, non-saccular aneurysms in the posterior circulation, overlapping stenting, 1,8,12) and treatment with a flow diverter 4,13) have been performed, and favorable results have been reported. However, many studies investigated small aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Endovascular treatment has been increasingly indicated for non-saccular vertebral artery (VA) aneurysms. [1][2][3][4][5] Deconstructive treatment by parent artery occlusion (PAO), and internal coil trapping, [5][6][7] reconstructive treatment by stent-assisted coiling, stenting, and flow diverter, 1,3,8,9) and combined treatment consisting of endovascular treatment and direct surgery 10,11) are performed. Therapeutic strategies are selected in accordance with individual patients.…”

Section: Introductionmentioning

confidence: 99%

Internal Trapping of a Symptomatic Unruptured Giant Vertebral Artery Aneurysm Using the Coiling-in-bridging-stent Technique: A Case Report

Ishikawa

Tsutsumi

Shojima

et al. 2019

JNET

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Objective:We report a patient in whom a devised stent-assisted internal trapping was effective to eliminate the mass effect of a symptomatic giant vertebral artery (VA) aneurysm. Case Presentation:A 63-year-old female. Detailed examination of gait disorder showed a brainstem-compressing, nonthrombotic, giant, fusiform aneurysm at an area distal to the posterior inferior cerebellar artery (PICA) bifurcation of the left VA. Endovascular internal trapping was planned, but the exacerbation of mass effects related to the coils inserted into the aneurysm cavity was concerned. Thus, before the usual internal trapping procedure, a self-expanding stent was deployed across the aneurysm to limit the coils in the stent during the internal trapping procedure. Six months later, the aneurysm decreased markedly in size with a complete relief of neurological symptom. Conclusion:Our devised stent-assisted internal trapping method, coiling-in bridging-stent technique, was successful to exclude a symptomatic giant VA aneurysm from the circulation with a minimum amount of coil in the aneurysm cavity.With this method, marked decrease in size could be expected since coils would not interfere with the shrinkage of the aneurysm. This method would be useful in giant cerebral aneurysms which need endovascular internal trapping.

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Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion

Cited by 92 publications

References 38 publications

Multiple intracranial vascular anomalies in a patient with stroke – a case report and short review of literature

Multiple intracranial vascular anomalies in a patient with stroke – a case report and short review of literature

Fusiform vertebral artery aneurysms involving the posterior inferior cerebellar artery origin associated with the sole angiographic anterior spinal artery origin: technical case report and treatment paradigm proposal

Internal Trapping of a Symptomatic Unruptured Giant Vertebral Artery Aneurysm Using the Coiling-in-bridging-stent Technique: A Case Report

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