Natural History and Management of Basilar Trunk Artery Aneurysms

Abstract

patients were referred to our institution for the management of a cerebral aneurysm (58.3% unruptured and 41.7% ruptured; Figure 1). There were a total Background and Purpose-Basilar trunk aneurysms (BTAs), defined as aneurysms distal to the basilar origin and proximal to the origin of the superior cerebellar artery, are rare and challenging to manage. We describe the natural history and management in a consecutive series of BTAs. Methods-Between 2000 and 2013, 2522 patients with 3238 aneurysms were referred to our institution for aneurysm management. A retrospective review of this database was conducted to identify all patients with BTAs. Results-In total, 52 patients had a BTA. Mean age was 56 (SD±18) years. Median clinical follow-up was 33 (interquartile range, 8-86) months, and imaging follow-up was 26 (interquartile range, 2-80.5) months. BTAs were classified into 4 causal subtypes: acute dissecting aneurysms, segmental fusiform ectasia, mural bleeding ectasia, and saccular aneurysms. Multiple aneurysms were more frequently noticed among the 13 saccular aneurysms when compared with overall population (P=0.021). There was preponderance of segmental ectasia or mural bleeding ectasia (P=0.045) in patients presenting with transit ischemic attack/stroke or mass effect. Six patients with segmental and 4 with mural bleeding ectasia demonstrated increasing size of their aneurysm, with 2 having subarachnoid hemorrhage caused by aneurysm rupture. None of the fusiform aneurysms that remained stable bled. Conclusions-BTAs natural histories may differ depending on subtype of aneurysm. Saccular aneurysms likely represent an underlying predisposition to aneurysm development because more than half of these cases were associated with multiple intracranial aneurysms. Intervention should be considered in segmental ectasia and chronic dissecting aneurysms, which demonstrate increase in size over time as there is an increased risk of subarachnoid hemorrhage. (Stroke. 2015;46:948-953.

A Case of Repeatedly Recurrent Basilar Trunk Dissecting Aneurysm Successfully Treated by the “Coil Sandwich Technique”

“…BA trunk AN is a relatively rare aneurysm accounting for 1%-2.1% of all cerebral aneurysms 1,2) and causing about 1% of SAH. 1,3) Treatment for BA trunk dissecting AN is very difficult and challenging.…”

“…From the literature, PAO or stent-assisted incidence of SAH (40%-60%) 3,[6][7][8] and a high mortality rate (17%-79%), 2,[6][7][8][9][10] and the percentage of patients with a favorable outcome is low (25%-33%). [7][8][9] Moreover, the re-bleeding rate is high (19%-86%) in patients who have developed SAH, 2,7,8,10,11) and, once re-bleeding occurs, the mortality rises markedly (70%-90%). [10][11][12] Also, rebleeding is reported to occur frequently within 24 hours after the initial bleeding, 2,5) and prompt prevention of re-bleeding and treatment that maintains a high aneurysm occlusion rate must be evaluated.…”

“…[7][8][9] Moreover, the re-bleeding rate is high (19%-86%) in patients who have developed SAH, 2,7,8,10,11) and, once re-bleeding occurs, the mortality rises markedly (70%-90%). [10][11][12] Also, rebleeding is reported to occur frequently within 24 hours after the initial bleeding, 2,5) and prompt prevention of re-bleeding and treatment that maintains a high aneurysm occlusion rate must be evaluated.…”

State-of-art in surgical treatment of dissecting posterior circulation intracranial aneurysms

“…Since male predominance observed in children could not be explained by trauma, it suggests a sex influence on their pathogenesis [26]. Finally, whereas the incidence of SAH in VB IDAs ranges from 61 to 86 % [3,58,68,70,125,171] and 24 % of them rebleed [171], ischemic events associated with the dissections were observed only in 26-62 % of patients [70,150]. In addition, Ono et al [111] reported that 18 % of initially unruptured IDAs showed clinical symptomatic recurrence and 90 % of them had major or minor strokes caused by occlusion of perforating arteries with a mean interval of 8.6 months.…”

“…Kim et al [69] reported that 100 % of conservatively managed patients with acute BA IDAs experienced rebleeding with the mortality 67 %, while the rest 33 % were only moderately disabled. Interestingly, the chronic BA dissecting aneurysms, also known as chronic mural bleeding ectasias, are diagnosed incidentally in 64 %, as a cause of compressive syndrome or stroke in the remaining 36 % of cases [125]. Even though, these aneurysms have traditionally been considered to follow a benign course without clinical or imaging progression, they may increase in size over time, rupture, or cause a stroke in 25, 4, and 14 % of cases, respectively [125].…”