Intracranial Bleeding in Patients With Vertebrobasilar Dolichoectasia

Passero, S.; Calchetti, Benedetta; Bartalini, Sabina

doi:10.1161/01.str.0000172311.64662.9c

Cited by 94 publications

(100 citation statements)

References 42 publications

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“…1,5,8,22,23 It is important to note, however, that there are no specific medical, surgical, or endovascular therapies specific to the treatment of VBDAs. In terms of stroke prevention, some studies have suggested that anticoagulation and antiplatelet therapy are not effective in preventing stroke in VBDAs and may be associated with higher hemorrhage rates, 24,25 whereas other studies have suggested that anticoagulation may be protective against mortality. 26 Surgical options include parent vessel occlusion with or without bypass and clip reconstruction or wrapping.…”

Section: Discussionmentioning

confidence: 99%

Imaging Characteristics of Growing and Ruptured Vertebrobasilar Non-Saccular and Dolichoectatic Aneurysms

Nasr

Brinjikji

Rouchaud

et al. 2016

Stroke

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Background and Purpose— Vertebrobasilar, nonsaccular, and dolichoectatic aneurysms generally have a poor natural history. We performed a study examining the natural history of vertebrobasilar, nonsaccular, and dolichoectatic aneurysms receiving serial imaging and studied imaging characteristics associated with growth and rupture. Methods— We included all vertebrobasilar dolichoectatic, fusiform, and transitional aneurysms with serial imaging follow-up seen at our institution over a 15-year period. Two radiologists and a neurologist evaluated aneurysms for size, type, mural T1 signal, mural thrombus, daughter sac, mass effect, and tortuosity. Primary outcomes were aneurysm growth or rupture. Univariate analysis was performed with chi-squared tests for categorical variables and Student’s t test or analysis of variance for continuous variables. Multivariate logistic regression analysis was performed to identify variables independently associated with aneurysm growth or rupture. Results— One hundred and fifty-two patients with 542 patient-years (mean 3.6±3.5 years) of imaging follow-up were included. Aneurysms were fusiform in 45 cases (29.6%), dolichoectatic in 75 cases (49.3%), and transitional in 32 cases (21.1%). Thirty-five aneurysms (23.0%) grew (growth rate=6.5%/year). Eight aneurysms (5.3%) ruptured (rupture rate=1.5%/year). Variables associated with growth and rupture on univariate analysis were size >10 mm (57.6% versus 16.0%, P <0.0001), mural T1 signal (39.7% versus 16.3%, P =0.001), daughter sac (56.3% versus 21.3%), and mural thrombus (45.5% versus 13.4%, P <0.0001). 26.7% of fusiform aneurysms, 9.3% of dolichoectatic aneurysms, and 59.4% of transitional aneurysms grew or ruptured ( P <0.0001). The only variable independently associated with rupture was transitional morphology ( P =0.003). Conclusions— Vertebrobasilar, nonsaccular, and dolichoectatic aneurysms are associated with a poor natural history with high growth and rupture rates. Further research is needed to determine the best treatments for this disease.

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Section: Discussionmentioning

confidence: 99%

Imaging Characteristics of Growing and Ruptured Vertebrobasilar Non-Saccular and Dolichoectatic Aneurysms

Nasr

Brinjikji

Rouchaud

et al. 2016

Stroke

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“…VFAs most commonly manifest as posterior circulation ischemic strokes, but they may also cause cranial nerve palsies, brainstem compression, obstructive hydrocephalus, and intraparenchymal or subarachnoid hemorrhage (SAH). 5,14,[18][19][20][21][22]29 VFAs have an ominous natural history with a reported mortality up to 30%. 3,24,29 Passero and Rossi reported that 43% of patients without treatment experienced anatomical progression and 60% experienced new symptoms.…”

Section: ©Aans 2014mentioning

confidence: 99%

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

Munich¹,

Tan²,

Keigher³

et al. 2014

JNS

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Object. Vertebrobasilar fusiform aneurysms (VFAs) are rare lesions characterized by abnormal dilation and tortuosity of the vertebral and/or basilar arteries. Untreated, these aneurysms have a tendency to progress, often resulting in neurological symptoms or rupture leading to subarachnoid hemorrhage. The microsurgical treatment of these lesions can be difficult due to their location and the circumferential involvement of the arteries. These features make microsurgical treatment prone to high morbidity. The Pipeline Embolization Device (PED) has gained popularity for the treatment of aneurysms of the internal carotid artery. Its use in the posterior circulation has been limited, likely due to a fear of perforating artery occlusion.Methods. The authors retrospectively reviewed their database of patients treated with the PED and identified 12 patients who had VFAs. The clinical features, complications, and outcomes of these patients were analyzed.Results. At an average follow-up of 11 months, the mean modified Rankin Scale score was 1.9. Complete aneurysm occlusion was seen in 90% of the patients with radiographic follow-up. Three patients suffered new neurological deficits postoperatively. One of these patients died, while the remaining 2 demonstrated significant clinical improvement at follow-up.Conclusions. With attention to the anatomy of perforating arteries, staged contralateral vertebral artery sacrifice, and adequate platelet inhibition, PED may be an effective treatment option-alone or in a hybrid construct with stents of less coverage for VFAs-with an acceptable complication rate. (http://thejns.org/doi/abs/10.3171/2014.7.JNS132595) Key WorDS • basilar artery • cerebral aneurysm • Pipeline • stent • vertebral artery • vascular disordersAbbreviations used in this paper: AICA = anterior inferior cerebellar artery; DSA = digital subtraction angiography; MRA = MR angiography; mRS = modified Rankin Scale; PED = Pipeline Embolization Device; PRU = P2Y12 reaction unit; SAH = subarachnoid hemorrhage; VFA = vertebrobasilar fusiform aneurysm.

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“…The causes of hemifacial spasm are listed in Table I VBD is also classified as one of vertebrobasilar nonsaccular intracranial aneurysms (1), the progression of VBD is associated with a high risk of hemorrhage and even death (1,2,6,7,8). Saccular aneurysm of basilar artery is very rare and of totally different pathogenesis from nonsaccular intracranial aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Hemifacial spasm and recurrent stroke due to vertebrobasilar dolichoectasia coexisting with saccular aneurysm of basilar artery: case report

Yuan¹,

Lin²,

Ding³

et al. 2011

Turkish Neurosurgery

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We describe a patient presented with sequential events of hemifacial spasm, cerebral infarction and fatal subarachnoid hemorrhage. All of them are seemingly separate entities. Radiological examination revealed that the cause was vertebrobasilar dolichoectasia (VBD) coexisting with a giant saccular aneurysm of basilar artery. VBD is a dilatation and elongation of vertebral artery (VA) and basilar artery (BA) which is of different mechanism from saccular aneurysm. The condition is very rare and its progression may result in compression of brainstem and cranial nerves, ischemic and/or hemorrhagic stroke. The treatment of such condition is difficult and further research on the risk stratification of VBD for predicting stroke. Close monitoring and aggressive surgical interventions might be needed for high-risk patients. KeywoRds: Hemifacial spasm, Stroke, Vertebrobasilar dolichoectasia, Aneurysm ÖZArka arkaya hemifasiyal spazm, serebral enfarktüs ve ölümcül subaraknoid kanama olaylarıyla gelen bir hastayı tanımlıyoruz. Bunların tümü ayrı olaylar gibi görünüyordu. Radyolojik inceleme nedenin baziler arterin dev bir sakküler anevrizmasıyla birlikte vertebrobaziler dolikoektazi (VBD) olduğunu gösterdi. VBD, vertebral arter (VA) ve baziler arterin (BA) dilatasyonu ve uzamasıdır ve mekanizması sakküler anevrizmadan farklıdır. Bu durum çok nadirdir ve ilerlemesi beyin kökü ve kraniyal sinirlerin kompresyonu ve ayrıca iskemik ve/veya hemorajik inmeye neden olabilir. Tedavisi zordur ve inme gelişmesini öngörmek açısından VBD risk katmanlandırması için daha fazla araştırma gereklidir. Yüksek riskli hastalarda yakından izleme ve agresif cerrahi girişim gerekebilir.

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Intracranial Bleeding in Patients With Vertebrobasilar Dolichoectasia

Cited by 94 publications

References 42 publications

Imaging Characteristics of Growing and Ruptured Vertebrobasilar Non-Saccular and Dolichoectatic Aneurysms

Imaging Characteristics of Growing and Ruptured Vertebrobasilar Non-Saccular and Dolichoectatic Aneurysms

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

Hemifacial spasm and recurrent stroke due to vertebrobasilar dolichoectasia coexisting with saccular aneurysm of basilar artery: case report

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