1st VER was found to be a helpful index for estimating aneurysmal recanalization after coil embolization. The target 1st VER was 17.5-20.0% for obtaining a higher VER and avoiding recanalization.
To examine a case of basilar artery (BA) occlusion caused by traumatic vertebral artery (VA) dissection after incomplete endovascular therapy. Case Presentation: A 32-year-old man who got caught sustained injuries in a truck accident wherein he was stuck between two trucks was transported to a nearby hospital. Stenting was performed for the left common carotid artery (CCA). For left VA dissection, coil embolization of the VA was performed to prevent thromboembolic infarction because floating thrombus was found at the V3 segment. On postoperative day 1, he exhibited conscious disturbance. MRA revealed BA occlusion. Upon transfer to our hospital, thrombectomy was performed. After revascularization, the patient was alert. Conclusion: Although optimal treatment of traumatic VA injury is still debated, proximal coil occlusion is regarded as an effective preventive treatment for thromboembolic stroke. In case of VA dissection with floating thrombus, proximal VA occlusion is insufficient to prevent thromboembolic stroke, and thrombus capture should be considered. Keywords▶ traumatic vertebral artery dissection, basilar artery occlusion, proximal coil occlusion, revascularization This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.
BACKGROUND
A vertebral artery–anterior spinal artery (VA-ASA) aneurysm is very rare. The authors report a case of successful coil embolization of a ruptured aneurysm of the VA-ASA.
OBSERVATIONS
A 54-year-old man with World Federation of Neurosurgical Societies grade II subarachnoid hemorrhage presented with an aneurysm located at the region involving the origin of ASA on the VA. Endovascular treatment was chosen to prevent rerupture and preserve the perforating branches. The catheter shape was modified with steam forming to allow access to the aneurysm. Partial embolization was performed to preserve the ASA. The authors also prevented further rupture. On day 16, angiography showed thrombosis within the aneurysm and preserved blood flow in the ASA despite a neck remnant. The patient was discharged home with a modified Rankin Scale score of 0. Careful follow-up has been continued.
LESSONS
Endovascular coiling in the acute phase of rupture of a VA-ASA aneurysm achieved favorable results. The aneurysm could be safely treated by selecting the appropriate device and catheter geometry.
We report a case of arteriovenous malformation (AVM) with symptomatic venous outflow impairment, which improved following percutaneous transluminal angioplasty (PTA). A 48-year-old woman, diagnosed with Spetzler-Martin Grade 4 AVM, was admitted to our hospital for an epileptic seizure. Magnetic resonance imaging (MRI) demonstrated AVM in the left frontal lobe with edema.The edema was not observed earlier. Angiography revealed severe stenosis of the superior sagittal sinus (SSS), which is the main drainage route of AVM. Comparison with angiography that was performed one month prior to admission revealed that the SSS stenosis had progressed. We performed PTA to decrease the risk of hemorrhage and improve the symptoms. After PTA, patient's aphasia, paresthesia, and headache improved within a day. These observations suggest that for AVM with symptomatic venous outflow impairment, especially in inoperable or difficult cases, PTA is a valid approach.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.