Embolization from a fusiform middle cerebral artery aneurysm.

Cohen, Max M.; Hemalatha, C P; D'Addario, R T; Goldman, Howard

doi:10.1161/01.str.11.2.158

Cited by 49 publications

(11 citation statements)

References 19 publications

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“…Cohen 22 and Antunes 23 have established criteria by which a diagnosis of arterial embolism from an intra cranial aneurysm may be established: 1) clinical TIA or stroke, 2) arteriographic or pathologic confirmation of the aneurysm, 3) no other leesion which could pro duce TIA or stroke, and 4) no evidence of subarach noid hemorrhage or vasospasm. Our case satisfies these criteria.…”

Section: Discussionmentioning

confidence: 99%

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Fusiform basilar aneurysm as a cause of embolic stroke.

Steel¹,

Thomas²,

Strollo³

1982

Stroke

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SUMMARY Giant fusiform basilar aneurysms (dolicho-ectatic basilar anomalies) are rare and have not previously been reported to cause embolic infarction in territory distal to the aneurysm. They most commonly present as posterior fossa mass lesions with brainstem compression and cranial neuropathies. Originally considered atherosclerotic in etiology, recent authors feel that they may represent a unique arteriopathy characterized by loss of elastin in the vessel wall. We report a case which presented solely as an occipital lobe infarction. To our knowledge, this is the first case in which a fusiform basilar aneurysm presented with an embolic infarction as its only manifestation. Stroke, Vol 13, No 5, 1982 GIANT FUSIFORM BASILAR ANEURYSMS (doli cho-ectatic basilar anomalies') are aneurysmal dilations of the basilar artery and usually present clinically as posterior fossa mass lesions ( 5 Emboli arising from in tracerebral aneurysms are unusual 22 -23 and to our knowledge have not been reported originating from a fusiform basilar aneurysm. We report a case which presented solely as an embolic occipital lobe in farction.Case Report A 59-year-old man with mild hypertension and Type IV hyperlipidemia experienced abrupt onset of right periorbital headache accompanied by loss of vision in the left visual field. He had no previous history of transient ischemic attacks (TIAs) or stroke. Several weeks prior to the event, he noted frequent right peri orbital headachees lasting 45-60 minutes without neurologic symptoms. Nine years previously he under went surgery for repair of an abdominal aortic aneu rysm. His risk factors included a 20 year history of mild hypertension (highest recorded pressure 140/100 mg Hg), smoking, hypertriglyceridemia, and moder ate obesity. His general physical examination was normal ex cept for early retinal vessel sclerosis. Blood pressure was 130/84 mm Hg. There were no carotid bruits. Neurologic examination demonstrated a left superior _, quadrantanopsia, but was otherwise unremarkable.The following studies were normal: serum electro lytes, complete blood count, syphilis serology, urinal ysis, coagulation profile, echocardiogram, and lumbar puncture. Serum triglycerides were 261 mg/dl (nor mal, 30-150 mg/dl). The electrocardiogram demon strated borderline nonspecific ST-T wave changes and rare multifocal premature ventricular contractions.A computed tomographic (CT) scan of the head demonstrated a nonhemorrhagic right occipital lobe infarction ( fig. 1), and a large eccentrically positioned basilar artery, with calcification in its walls, extending well above the posterior clinoids ( fig. 2a). The contrast enhanced ( fig. 2b) and reformatted coronal ( fig. 3) images revealed the presence of incomplete thrombo sis in the aneurysm which measured up to 2 cm in diameter. Pancerebral angiography ( fig. 4) confirmed the diagnosis of a partially thrombosed giant fusiform basilar aneurysm and showed the lesion to be continu ous with an ectatic and elongated dominant right verte bral artery. In additio...

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Section: Discussionmentioning

confidence: 99%

“…Cohen 22 concisely summarized why emboli seldom arise from intracranial aneurysms. First, giant aneu rysms, those most likely to contain thrombus, account for only 3 to 5% [27][28] of intracranial aneurysms.…”

mentioning

confidence: 99%

Fusiform basilar aneurysm as a cause of embolic stroke.

Steel¹,

Thomas²,

Strollo³

1982

Stroke

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“…Age, gender, presenting symptoms, clinical diagnosis, cerebrovascular risk factors, and initial treatment were noted. Ischemia was ascribed to the NIA only if Cohen’s criteria were fulfilled [3]. …”

Section: Methodsmentioning

confidence: 99%

The Natural History of Radiographically Defined Vertebrobasilar Nonsaccular Intracranial Aneurysms

Flemming¹,

Wiebers²,

Brown³

et al. 2005

Cerebrovasc Dis

165

153

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Background: Vertebrobasilar nonsaccular intracranial aneurysms (VBNIA) are characterized by dilatation, elongation, and tortuosity of the vertebrobasilar system. Methods:The medical records and imaging of patients with vertebrobasilar fusiform aneurysms or dolichoectasia between 1989 and 2001 were reviewed. Prospective follow-up was obtained. Results: One hundred and fifty-nine patients were identified (74% male) with 719 patient years of follow-up. Presenting events included: hemorrhage (3%), ischemia (28%), and compression (22%). The remainder were incidental. The 1-, 5-, and 10-year risk of cerebral infarction (CI) due toVBNIA is 2.7, 11.3, and 15.9% respectively. The risk of recurrent CI is 6.7% per patient year. Median survival was 7.8 years and death was most commonly due to ischemia. Conclusions:VBNIA are more common in men and typically present in the 6–7th decade. Recurrent CI is more common than hemorrhage risk.

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“…14,15,35 Fusiform, dysplastic, and otherwise complex aneurysms may not be amenable to direct clipping and may require alternative management strategies. 1,3,11,[15][16][17]26,33,34,65 We have previously reported our experience with wrapping and clip-wrapping these types of aneurysms with cotton. 15,35 However, our wrapping strategies have evolved over the past decade, and we now most frequently use Gore-Tex membrane (W. L. Gore & Associates, Inc.) when circumferentially wrapping unclippable aneurysms.…”

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confidence: 99%

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

Safavi–Abbasi

Moron²,

Sun

et al. 2016

JNS

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obJective To address the challenges of microsurgically treating broad-based, frail, and otherwise complex aneurysms that are not amenable to direct clipping, alternative techniques have been developed. One such technique is to use cotton to augment clipping ("cotton-clipping" technique), which is also used to manage intraoperative aneurysm neck rupture, and another is to reinforce unclippable segments or remnants of aneurysm necks with cotton ("cottonaugmentation" technique). This study reviews the natural history of patients with aneurysms treated with cotton-clipping and cotton-augmentation techniques. methods The authors queried a database consisting of all patients with aneurysms treated at Barrow Neurological Institute in Phoenix, Arizona, between January 1, 2004, and December 31, 2014, to identify cases in which cotton-clipping or cotton-augmentation strategies had been used. Management was categorized as the cotton-clipping technique if cotton was used within the blades of the aneurysm clip and as the cotton-clipping technique if cotton was used to reinforce aneurysms or portions of the aneurysm that were unclippable due to the presence of perforators, atherosclerosis, or residual aneurysms. Data were reviewed to assess patient outcomes and annual rates of aneurysm recurrence or hemorrhage after the initial procedures were performed. results The authors identified 60 aneurysms treated with these techniques in 57 patients (18 patients with ruptured aneurysms and 39 patients with unruptured aneurysms) whose mean age was 53.1 years (median 55 years; range 24-72 years). Twenty-three aneurysms (11 cases of subarachnoid hemorrhage) were treated using cotton-clipping and 37 with cotton-augmentation techniques (7 cases of subarachnoid hemorrhage). In total, 18 patients presented with subarachnoid hemorrhage. The mean Glasgow Outcome Scale (GOS) score at the time of discharge was 4.4. At a mean follow-up of 60.9 ± 35.6 months (median 70 months; range 10-126 months), the mean GOS score at last follow-up was 4.8. The total number of patient follow-up years was 289.4. During the follow-up period, none of the cotton-clipped aneurysms increased in size, changed in configuration, or rebled. None of the patients experienced early rebleeding. The annual hemorrhage rate for aneurysms treated with cotton-augmentation was 0.52% and the recurrence rate was 1.03% per year. For all patients in the study, the overall risk of hemorrhage was 0.35% per year and the annual recurrence rate was 0.69%. coNclusioNs Cotton-clipping is an effective and durable treatment strategy for intraoperative aneurysm rupture and for management of broad-based aneurysms. Cotton-augmentation can be safely used to manage unclippable or partially clipped intracranial aneurysms and affords protection from early aneurysm re-rupture and a relatively low rate of late rehemorrhage.

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Embolization from a fusiform middle cerebral artery aneurysm.

Cited by 49 publications

References 19 publications

Fusiform basilar aneurysm as a cause of embolic stroke.

Fusiform basilar aneurysm as a cause of embolic stroke.

The Natural History of Radiographically Defined Vertebrobasilar Nonsaccular Intracranial Aneurysms

Techniques and long-term outcomes of cotton-clipping and cotton-augmentation strategies for management of cerebral aneurysms

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