Direct Vertebral Artery Access for the Endovascular Treatment of Basilar Artery Aneurysms

Vanzin, José Ricardo; Manzato, Luciano Bambini; Slaviero, Felipe; Strzelecki, Michelle; Annes, Rafael D'Agostini

doi:10.1177/159101991201800104

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…The reported complication rates related to percutaneous or direct access approaches range from 0% to 50%. [7][8][9][10][11][12][13] The major complications include hematoma, arteriovenous fistula, pseudoaneurysm, and thrombosis. However, the benefits of aneurysm obliteration and reduction of future rupture risk outweigh the potential risks of direct vertebral artery access.…”

Section: Discussionmentioning

confidence: 99%

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Direct Vertebral Artery Access for Coil Embolization of a Partially Thrombosed Mid-Basilar Trunk Aneurysm: Technical Limitations

Miller

Felbaum

Liu

et al. 2021

ONSURG

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BACKGROUND AND IMPORTANCE Partially thrombosed basilar aneurysms have a high morbidity from the rupture risk and mass effect prompting early treatment. Depending on the size and location, they pose a surgical challenge often requiring multiple endovascular treatment modalities. Here we present a partially thrombosed mid-basilar aneurysm successfully coil embolized with direct vertebral artery access and discuss the technical limitations of direct V1 access. CLINICAL PRESENTATION A 70-yr-old woman presented with acute onset headache, nausea, and vomiting. A computed tomography (CT) head demonstrated a hyperdense prepontine mass which was further characterized as a partially thrombosed basilar aneurysm on CT angiography. After multiple failed attempts to access the vertebral artery via femoral and radial access the patient was taken to the operating room (OR) for surgical exposure of the right V1 segment and direct cannulation of the vertebral artery. The aneurysm was successfully coiled and the vertebral artery closed primarily. The patient was discharged home without any neurological deficits. CONCLUSION Partially thrombosed mid-basilar aneurysms are difficult to treat both surgically and endovascularly. We present a case where endovascular access to the aneurysm was very challenging requiring direct exposure and cannulation of the V1 segment to successfully embolize with coils and discuss the technical limitations of this approach.

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Section: Discussionmentioning

confidence: 99%

“…The case reports reporting direct puncture typically describe percutaneous access. [7][8][9][10][11][12] Only one recent case series detailed 3 cases of direct surgical access to the V1 segment for basilar aneurysms. 13 The one unsuccessful coiling resulted from an inability to insert the sheath due to the angle of access to the V1 segment.…”

Section: Discussionmentioning

confidence: 99%

Direct Vertebral Artery Access for Coil Embolization of a Partially Thrombosed Mid-Basilar Trunk Aneurysm: Technical Limitations

Miller

Felbaum

Liu

et al. 2021

ONSURG

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“…[25][26][27][28] Percutaneous vertebral artery puncture, initially used for diagnostic exams, 29,30 has been used as an alternative access for the treatment of cerebral aneurysms of the basilar top, in patients with unfavorable aortic arch, with presence of proximal looping. 31,32 Children are rarely able to complete an angiography study with local anesthesia due to anxiety, agitation, pain and discomfort at the puncture site, contrast injection, and cerebral dysfunction caused by bleeding or ischemia. The diagnostic study in children and infants is a safe procedure and currently preferred because it is performed with deep sedation instead of general endotracheal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Neurosurgery in the Northern Macro- region of Rio Grande do Sul: Part I

Vanzin¹,

Azambuja²,

Frighetto³

et al. 2016

Arq Bras Neurocir

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Introduction The city of Passo Fundo, in the north of the Rio Grande do Sul state, has been standing out in the health care field for many years. The state has become a reference in endovascular interventional neuroradiology. We will cover 10 years of experience in this area and divide our observations in 3 parts: cerebral angiograms (part I), carotid angioplasties (part II) and intracranial aneurysms (part III). The goal of part I is to statistically assess the cerebral angiograms, their indications, risks and complications, as well as to do a technical review. Materials and Methods A retrospective study from 2005 to 2015 with a total of 5,567 interventional neuroradiology procedures performed. A total of 4,114 angiograms, 639 embolizations of intracranial aneurysms, 414 carotid angioplasties, 143 embolizations of cerebral arteriovenous malformations, 32 embolizations of dural arteriovenous fistulas, 102 cerebral vasospasm treatments, 21 treatments of epistaxis, 36 embolizations of craniocervical tumor, 25 thrombolysis of ischemic stroke, 18 vertebroplasties and 13 embolizations of arteriovenous malformations of the face. Results A total of 4,084 procedures performed, 21,811 vessels studied, average vase 7.62/2.82 vessel and patient/procedure. Of these, 2,536 were diagnostic procedures and 1,548 angiographic controls. Of the total, 1,188 patients received only an angiogram, 27.14% of which were therapeutic procedures. We obtained a total of 3.89% complications: 2.33% reflection vasovagal, 0.56% allergic skin reaction, anaphylactic shock 0.07%, 0.27% femoral hematoma, 0.26% transient neurological deficit, 0.12% permanent neurological deficit and no case of death. Conclusion Cerebral angiography in adults, children and infants is a safe procedure with low risk of permanent neurological complications.

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“…At times, the arch may be so difficult that it is impossible to access a carotid artery. 3 For example, in a patient who has got chronic type A dissection or an extremely unfolded aortic arch, the only way out is the direct carotid puncture.…”

Section: Direct Carotid Accessmentioning

confidence: 99%

“…This article attempts to help a beginner overcome some of the challenges one can face during endovascular treatment of vascular pathology in a patient with tortuous vascular anatomy. [1][2][3]…”

Section: Introductionmentioning

confidence: 99%

Overcoming Tortuous Anatomy in Intracranial Intervention

Cherian

Mehta

Poyyamoli

et al. 2018

J Clin Interv Radiol ISVIR

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Intracranial interventions comprise a set of procedures, which are complex and challenging. Further, they are extremely risky because complications in the brain are usually associated with significant mortality and morbidity. Thus, a clear understanding is necessary to handle tortuous vessels because improper planning can result in a higher rate of complications. The combination of long sheaths, specialty wires, and preshaped catheters can enable us to access some of the most complex vascular anatomy. There are several conditions that can contribute to a difficult access. There are few techniques described by different authors. The authors have listed the techniques found useful based on their experience. These challenges include tortuous iliac arteries, dilated tortuous aortic arch, acute takeoff of the arch vessels, tortuous neck vessels with prominent loops, crossing a large aneurysm, extensive peripheral vascular disease, etc.

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Direct Vertebral Artery Access for the Endovascular Treatment of Basilar Artery Aneurysms

Cited by 9 publications

References 6 publications

Direct Vertebral Artery Access for Coil Embolization of a Partially Thrombosed Mid-Basilar Trunk Aneurysm: Technical Limitations

Direct Vertebral Artery Access for Coil Embolization of a Partially Thrombosed Mid-Basilar Trunk Aneurysm: Technical Limitations

Endovascular Neurosurgery in the Northern Macro- region of Rio Grande do Sul: Part I

Overcoming Tortuous Anatomy in Intracranial Intervention

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