Clinical Outcomes of Ruptured and Unruptured Vertebral Artery-Posterior Inferior Cerebellar Artery Complex Dissecting Aneurysms after Endovascular Embolization

Lv, Xianli; Jiang, Chao; Li, Y; Wu, Zhongxue

doi:10.3174/ajnr.a2087

Cited by 55 publications

(44 citation statements)

References 14 publications

(35 reference statements)

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“…10 However, these surgical strategies may be inconvenient because they may take a relatively longer time and result in some postoperative complications, such as lower cranial nerve palsy. 11 With EVT, the choice of treatment for patients with vertebral arteryϪPICA lesions depends on the patency of the contralateral vertebral artery as well as the relationship between the vertebral artery lesion and the location of the PICA origin. 7 If the vertebral artery dissection/aneurysm is located proximal or distal to the PICA without hypoplasia of the opposite vertebral artery, the lesion can be treated easily with total occlusion of the lesion segment so that the PICA will be filled from the ipsilateral or contralateral vertebral artery.…”

Section: Discussionmentioning

confidence: 99%

“…4 There are no reports on the feasibility and safety of the stents in small intracranial vessels of Ͻ2 mm in diameter, and the longer term effects of the presence of the stent have not yet been reported. 11 However, there are some reports on the safety of stents in small cerebral arteries from case series studies. Turk et al 12 concluded that the use of self-expanding stents in vessel diameters Ͻ2 mm could be performed safely and efficaciously for short-and intermediate-term results.…”

Section: Discussionmentioning

confidence: 99%

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Stenting from the Vertebral Artery to the Posterior Inferior Cerebellar Artery

Kim¹,

Chung²,

Kim³

et al. 2011

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stenting from the Vertebral Artery to the Posterior Inferior Cerebellar Artery

Kim¹,

Chung²,

Kim³

et al. 2011

AJNR Am J Neuroradiol

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“…While our results do not specifically address these issues, the endovascular literature provides some insights (Table 4). 3,10,[16][17][18]21,23 The use of stents, stent-assisted coiling, or balloon-assisted coiling improves the rates of PICA preservation, but even in the largest and most recent experience selective aneurysm coiling was possible in 60 of 76 (79%) patients and the PICA was sacrificed deliberately in 11 (14%) patients. PICA occlusion was accompanied by infarcts in 6 (8%) patients, and 4 (5%) patients in the series died in hospital.…”

Section: Bypass Indicationsmentioning

confidence: 99%

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Abla¹,

McDougall²,

Lawton³

2016

JNS

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I ntracranIal-to-IntracranIal (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize efferent branches with in situ donor arteries, and reconstruct bifurcated anatomy with interposition grafts that are entirely intracranial. 25 These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites in the neck toward a more local and reconstructive approach, or, in other words, a more minimally invasive approach to byabbreviatioNs DSA = digital subtraction angiography; EC-IC = extracranial-to-intracranial; IC-IC = intracranial-to-intracranial; mRS = modified Rankin Scale; PICA = posterior inferior cerebellar artery; RAG = radial artery interposition graft; VA = vertebral artery. obJective Intracranial-to-intracranial (IC-IC) bypasses are alternatives to traditional extracranial-to-intracranial (EC-IC) bypasses to reanastomose parent arteries, reimplant efferent branches, revascularize branches with in situ donor arteries, and reconstruct bifurcations with interposition grafts that are entirely intracranial. These bypasses represent an evolution in bypass surgery from using scalp arteries and remote donor sites toward a more local and reconstructive approach. IC-IC bypass can be utilized preferentially when revascularization is needed in the management of complex aneurysms. Experiences using IC-IC bypass, as applied to posterior inferior cerebellar artery (PICA) aneurysms in 35 patients, were reviewed. methods Patients with PICA aneurysms and vertebral artery (VA) aneurysms involving the PICA's origin were identified from a prospectively maintained database of the Vascular Neurosurgery Service, and patients who underwent bypass procedures for PICA revascularization were included. results During a 17-year period in which 129 PICA aneurysms in 125 patients were treated microsurgically, 35 IC-IC bypasses were performed as part of PICA aneurysm management, including in situ p3-p3 PICA-PICA bypass in 11 patients (31%), PICA reimplantation in 9 patients (26%), reanastomosis in 14 patients (40%), and 1 V 3 VA-to-PICA bypass with an interposition graft (3%). All aneurysms were completely or nearly completely obliterated, 94% of bypasses were patent, 77% of patients were improved or unchanged after treatment, and good outcomes (modified Rankin Scale ≤ 2) were observed in 76% of patients. Two patients died expectantly. Ischemic complications were limited to 2 patients in whom the bypasses occluded, and permanent lower cranial nerve morbidity was limited to 3 patients and did not compromise independent function in any of the patients. coNclusioNs PICA aneurysms receive the application of IC-IC bypass better than any other aneurysm, with nearly one-quarter of all PICA aneurysms treated microsurgically at our center requiring bypass without a single EC-IC bypass. The selection of PICA bypass is almost algorithmic: trapped aneurysms at the PICA origin or p1 segment are revasculari...

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“…A 6-French, 90 cm Envoy guiding catheter (Cordis Neurovascular, Miami Lakes, FL) was catheterized into the cervical segment of the parent vessel, which included the internal carotid artery (ICA) and vertebral artery (VA). Our technique for stent-assisted coil embolization of wide-necked aneurysm has been described in detail (8)(9)(10)(11). In brief, patients without SAH were administered with 75 mg of clopidogrel and 300 mg of aspirin (Plavix; Bristol-Myers Squibb/Sanofi Pharmaceuticals, NY) for 3 days preceding stent placement and patients with SAH were pretreated with 300 mg of clopidogrel 2 hours before procedure.…”

Section: Technique Descriptionmentioning

confidence: 99%

“…Various adjunctive techniques, such as remodeling balloon and self-expandable microstents have been used to assist coil embolization of these lesions (1,2,4,5,(10)(11)(12). The microstents can be deployed prior to coil placement with the microcatheter delivered through the stent struts; after the deployment of a first coil without detachment, named the stent-jack technique; alone without coil placement; or following coil occlusion performed with balloon remodeling (1,6,7,13,14).…”

Section: Introductionmentioning

confidence: 99%

Stent-jail technique in endovascular treatment of wide-necked aneurys

Jin²,

Wang³

et al. 2012

Turkish Neurosurgery

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AIm: To describe a reconstructive technique using single stent for wide-necked aneurysms. mAterIAl and methOds: This technique was described as stent-jail technique consisting of the aneurismal catheterization before the deployment of a self-expandable stent across the aneurysm neck. Following the deployment of the stent, embolization coils were delivered with the microcatheter positioned within the aneurysm dome and wedged between the stent and the aneurysm dome. The microstents, such as Neuroform, Leo and Wingspan stents, were used in in our series for electively treated aneurysms.results: During a 3-year period,13 patients with wide-necked aneurysms were treated electively with this technique. The aneurysms arose from the internal carotid artery (5), anterior cerebral artery (4), anterior communicating artery (1), vertebral artery ( 1), middle cerebral artery (1) and middle cerebral artery (1). Thirteen stents (6 Leo stents, 4 Neuroform stents and 3 Wingspan stents) were successfully deployed across the aneurysm neck to constrain subsequent embolization coils of a wide-necked cerebral aneurysm. None of the patients experienced any periprocedural or delayed neurological complications. This maneuver enabled us to support the coil loops within the aneurismal sac with stabilization of the microcatheter. COnClusIOn:The stent-jail technique represents an efficacious adjuvant technique to assist coiling of selected wide-necked cerebral aneurysms. This technique is particularly helpful for wide-necked aneurysms.KeywOrds: Aneurysm, Stent, Endovascular ÖZ AmAÇ: Geniş boyunlu anevrizmalarda tek stent kullanarak rekonstrüktif bir tekniği tanımlamak. yÖntem ve GereÇler: Bu teknik anevrizma boynu içinde kendiliğinden genişleyen bir stentin yerine yerleştirilmesinden önce anevrizmal kateterizasyondan oluşan stent-jail tekniği olarak tanımlanmıştır. Stent yerine yerleştirilmesinden sonra anevrizma kubbesi içinde konumlandırılan mikrokateterle embolizasyon sarmalları iletilmiş ve stent ile anevrizma kubbesi arasına kama şeklinde sokulmuştur. Neuroform, Leo ve Wingspan stentleri gibi mikrostentler serimizde elektif olarak tedavi edilen anevrizmalar için kullanılmışlardır.BulGulAr: 3 yıllık bir dönemde bu teknik ile geniş boyunlu anevrizması olan 13 hasta elektif olarak tedavi edilmiştir. Anevrizmaların kökeni internal karotid arter (5), anterior serebral arter (4), anterior kommunikan arter (1), vertebral arter (1), orta serebral arter (1) ve orta serebral arter (1) olmuştur. On üç stent (6 Leo stenti, 4 Neuroform stent ve 3 Wingspan stenti) geniş boyunlu serebral anevrizmada daha sonraki embolizasyon sarmallarını sınırlandırmak üzere anevrizma boynu içinde başarılı şekilde yerine yerleştirilmiştir. Hastaların hiçbiri işlem sırasında veya gecikmiş nörolojik komplikasyon yaşamamıştır. Bu manevra sarmal halkalarını mikrokateter stabilizasyonuyla anevrizma kesesi içinde desteklememizi mümkün kılmıştır.sOnuÇ: Stent-jail tekniği seçilen geniş boyunlu serebral anevrizmalarda sarmal konmasına yardımcı olmak üzere etkin bir ya...

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Clinical Outcomes of Ruptured and Unruptured Vertebral Artery-Posterior Inferior Cerebellar Artery Complex Dissecting Aneurysms after Endovascular Embolization

Cited by 55 publications

References 14 publications

Stenting from the Vertebral Artery to the Posterior Inferior Cerebellar Artery

Stenting from the Vertebral Artery to the Posterior Inferior Cerebellar Artery

Intracranial-to-intracranial bypass for posterior inferior cerebellar artery aneurysms: options, technical challenges, and results in 35 patients

Stent-jail technique in endovascular treatment of wide-necked aneurys

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