Internal Trapping Following Proximal Clipping for a Ruptured Partially Thrombosed Giant Aneurysm of the Vertebral Artery -Case Report-

Abstract

A 52-year-old woman presented with a partially thrombosed giant aneurysm of the vertebral artery (VA) manifesting as a 3-month history of left hemiparesis. She developed subarachnoid hemorrhage during hospitalization and underwent emergency surgery for surgical proximal clipping and ventricular drainage with decompressive suboccipital craniectomy. She underwent additional surgery for endovascular coil embolization of the aneurysm and the affected distal VA on the 7th postoperative day. Although she suffered transient lower cranial nerve pareses and respiratory failure, her neurological condition improved gradually and she returned home with only slight ataxia and hoarseness 3 months after surgery. Magnetic resonance imaging obtained 28 months postoperatively revealed a remarkable decrease in the size of the aneurysm as well as reduction of the mass effect on the brainstem. Combined proximal clipping and internal trapping can solve the problems associated with treatment of giant aneurysms of VA by either direct surgery or endovascular surgery, and should be considered as a therapeutic option for giant aneurysms of the VA.

Partially Thrombosed Vertebral Artery Aneurysm With Wall Enhancement Treated by Stent-Assisted Coil Embolization -Case Report-

“…The appropriate treatment strategy for partially thrombosed aneurysms is controversial, 6) but a case was successfully treated by internal trapping following proximal clipping of VA. 11) On the other hand, partially thrombosed aneurysms showed rapid growth after endovascular parent artery occlusion. 5) In the latter case, T 1 -weighted MR imaging detected intramural hematoma in the thickened wall.…”

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

“…When deconstructively occluding non-saccular aneurysms, PAO by blockage of a proximal artery, or internal trapping is performed in accordance with individual patients. 5,6,10) In the present case, the distance between the VA union and distal end of the aneurysm was short, and aneurysm occlusion by blockage of a proximal artery alone was considered to be difficult due to residual retrograde blood flow from the distal area; therefore, we considered internal trapping necessary. Moreover, the distance between the distal edge of the aneurysm and VA union and that between the proximal edge of the aneurysm and PICA bifurcation was relatively short; therefore, we considered it impossible to achieve blood flow blockage by coil insertion into the parent blood vessel alone.…”

“…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.…”

Therapeutic dilemmas regarding giant aneurysms of the intracranial vertebral artery causing medulla oblongata compression

“…A total of 45 articles containing 53 patients (53 aneurysms) were identified. 3–47 In addition to the 53 patients identified in the literature, we also included two typical cases for illustration which were not included in the final analysis (Figures 2, 3 and 4).…”