Endovascular Treatment of Ruptured and Unruptured Vertebral Artery Aneurysms

Lv, Xianli; Lv, Ming; Li, Y.; Yang, Xuan; Che, Jing; Wu, Zhongxue

doi:10.1177/197140091102400503

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…These procedures can be classified as artery sacrificing or artery preserving. 7,10,12,14 Artery sacrificing would occlude the involved parent arteries to lower the rebleeding risk by relieving the flow pressure on the aneurysm wall. It is very interesting that we present here a VA dissection, which was treated 20 years ago by VA occlusion using detachable balloons and the lesion has shown no progression over the 20 years (Figure 3).…”

Section: Discussionmentioning

confidence: 99%

“…6 Endovascular treatment has been reported to be safe and effective in small series or case reports with or without stent placement, and initial complete occlusion was a favorable factor for stable follow-up and improved outcomes. [7][8][9][10] This report presented seven CADs, for which diagnosis and treatment are difficult, as source of subarachnoid hemorrhage (SAH).…”

Section: Introductionmentioning

confidence: 99%

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Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment

Zhang

et al. 2020

Neuroradiol J

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Objective Acute hemorrhagic cerebral artery dissection may show a subtle stenosis and bulge on an angiogram, for which diagnosis and treatment are difficult. This report describes seven cases of acute hemorrhagic cerebral artery dissection treated by endovascular techniques. Patients and methods From January 2018 to April 2019, seven patients (22–76 years old) were diagnosed with subarachnoid hemorrhage caused by cerebral artery dissection. Six patients were treated by low-profile visualized intraluminal support stent-assisted coiling and there was a sacrifice of the posterior cerebral artery in one patient. Cerebral angiography results were obtained immediately after intervention and at follow-up. Clinical outcome was evaluated by a modified Rankin Scale score. Results Four dissections were angiographic changes of subtle stenosis and small bulges; three were apparent angiographic changes of stenosis or fusiform morphologies. All seven aneurysms were completely obliterated, a low-profile visualized intraluminal support stent was used in six patients and coil occlusion of the parent artery in one patient. Complications occurred in two cases of proximal posterior cerebral artery dissection. One bleeding complication was observed intra-procedure and one ischemic complication was observed after stent-assisted coiling. The angiographic and clinical follow-up was obtained at 3–8 months in five patients. Good recovery was achieved for six patients (modified Rankin Score 0); one patient who presented Weber syndrome caused by ischemic complication had a modified Rankin Score of two at 8 months follow-up. Conclusion Hemorrhagic cerebral artery dissection may show subtle stenosis, small bulges or fusiform morphologies on angiograms. Treatment of proximal posterior cerebral artery dissection is challenging. Endovascular reconstruction with a low-profile visualized intraluminal support stent was effective depending on the angiographic morphology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment

Zhang

et al. 2020

Neuroradiol J

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“…However, the use of EVT for ruptured intracranial DAs and BAs has been widely accepted in recent years and an increasing number of studies reporting their encouraging experience with endovascular techniques reflects the growing experience in this field. 1,2,[14][15][16][17][18] Endovascular techniques can be divided into two major approaches, the reconstructive and the deconstructive technique. Deconstructive endovascular trapping after a balloon occlusion test might be a feasible option in selected patients.…”

Section: Discussionmentioning

confidence: 99%

Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

et al. 2019

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IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

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“…[ 3 4 ] Robust data concerning the treatment of UPCIAs were not available and the information available today is still based on a small number of treated patients, and data on the midterm stability and protection against SAH are lacking. [ 1 3 4 5 6 7 13 ] As future prevention of SAH is the primary goal of treatment, the availability of these data is vital.…”

Section: Discussionmentioning

confidence: 99%

“…The perception that endovascular therapy is superior to microsurgical clipping for posterior circulation aneurysms is not based on clear evidence. Because very little data concerning the endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs) are available to date,[ 1 2 3 4 5 6 7 ] our study evaluated the results obtained in a large series over a 4-year period at a single center.…”

Section: Introductionmentioning

confidence: 99%

Endovascular treatment of unruptured posterior circulation intracranial aneurysms

Jin

et al. 2016

Ann Indian Acad Neurol

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Background and Purpose:Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs) is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA). The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs.Materials and Methods:Retrospective analysis of all patients treated in a 2-year period (89 patients: 10–78 years of age, mean: 45.5 ± 14.3/92 UPCIAs). Fifty-eight aneurysms were found incidentally, 12 in association with mass effect symptoms and 22 with stroke.Results:A clinical improvement or stable outcome was achieved in 84 patients (94.4%). The two cases of permanent morbidity included a patient with paralysis and another patient with hemianopia. One patient died after treatment of a giant fusiform vertebrobasilar aneurysm. In one patient, the aneurysm ruptured during treatment, resulting in death. Another patient suffered a fatal aneurysm rupture 4 days after treatment. Giant size (P = 0.005) and mass effect presentation (P = 0.029) were independent predictors of unfavorable outcomes in UPCIAs. Angiographic follow-up was available in 76 of the 86 surviving patients (88.4%) with a mean of 6.8 months (range: 1–36 months). Recanalization in six patients (7.9%) at 3 months, 4 months, 4 months, 24 months, and 36 months required retreatment in three patients. In-stent stenosis of >50% was found in three patients.Conclusion:Endovascular therapy is an attractive option for UPCIAs with stable midterm outcome. However, the current endovascular option seems to have a limitation for the treatment of the aneurysm with giant size or mass effect presentation.

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Endovascular Treatment of Ruptured and Unruptured Vertebral Artery Aneurysms

Cited by 8 publications

References 23 publications

Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment

Acute hemorrhagic cerebral artery dissection: Characteristics and endovascular treatment

Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

Endovascular treatment of unruptured posterior circulation intracranial aneurysms

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