Endovascular management of intracranial vertebral artery dissecting aneurysms

Albuquerque, Felipe C.; Fiorella, David; Han, Patrick; Deshmukh, Vivek R.; Kim, Louis J.; McDougall, Cameron G.

doi:10.3171/foc.2005.18.2.4

Cited by 48 publications

(74 citation statements)

References 21 publications

(64 reference statements)

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“…During the past 10 years, there have been a significant number of investigations into the feasibility of this technique [1][2][3][4][5][6][7][8][9][10]. Some articles have described the stability of occlusions treated with detachable coils and the efficacy of providing protection against VAD recurrence and consequent bleeding [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Conventional surgical treatment includes trapping the aneurysm, proximal ligation of the vertebral artery (VA ), or wrapping the aneurysm. Previous reports have suggested that endovascular parent artery occlusion is a safe and effective treatment for VAD [1][2][3][4][5][6][7][8][9][10]. Although some case series have reported on the feasibility of stent replacement, endovascular internal trapping has been performed in most of the cases.…”

Section: Introductionmentioning

confidence: 99%

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Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

et al. 2012

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2 Abstract PurposePrevious reports have suggested that endovascular parent artery occlusion is an effective and safe procedure for the treatment of vertebral artery dissection (VAD). However, the results of long-term outcomes are still unclear. This study reviewed the clinical and imaging outcomes of patients with VAD treated by endovascular internal trapping. MethodsA total of 73 patients were treated for VAD by endovascular internal trapping between March 1998 and March 2011. Patients were regularly followed up by magnetic resonance imaging, magnetic resonance angiography, and clinical examinations. Clinical outcomes were evaluated using the modified Rankin Scale. ResultsForty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data were obtained for 61 patients (83.6%). The follow-up period ranged from 6 to 145 months (mean ± SD, 55.6 ± 8.9 months). Two patients with ruptured VADs had recurrence (2.74%). Cranial nerve paresis (CNP) was observed in 6 patients (8.21%), spinal cord infarction in 2 patients(2.74%) and a perforating artery ischemia was diagnosed in 7 patients (9.59%); all patients with CNP and 5 of the patients with partial Wallenberg syndrome experienced only temporary symptoms; 2 of the patients with partial Wallenberg syndrome had permanent neurological deficits. Despite their symptoms, most patients were in good general condition, as shown by their clinical scores. ConclusionsThe results of this study have proven that endovascular internal trapping is a stable and durable treatment for closure of VADs. Recanalization is rather rare and occurred only in ruptured cases., both within 3months after tnitial treatment without rupture. CNP were observed in 8.21%, perforating ischemia in 9.59%, and spinal cord infarction in 2.74%. The former two are temporaly, while the last can be a factor that affect mRS. Patients rated their quality of life as good, as corroborated by their posttreatment clinical score. Endovascular internal trapping for VAD is a therapy with a satisfactory long-term outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term clinical and radiological results of endovascular internal trapping in vertebral artery dissection

et al. 2012

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“…Presenting symptoms are various and are associated with pathologic process such as mass effect, ischemic event from thromboembolism or hemorrhage. In cases of vertebral artery dissection, the rebleeding rate is extremely high (> 30%) 2,24) . Due to fragile aneurysm wall, deep location, circumferential shape and incorporated perforators, fusiform aneurysms are too difficult and dangerous to be treated by clip or coil.…”

Section: Fusiform Dissecting Aneurysm and Sole Stentmentioning

confidence: 99%

“…Nevertheless, the fusiform aneurysm, especially dissecting aneurysm, is extremely fatal condition and mortality rate in 5 years is up to 80% in ruptured cases 28) . Intracranial arterial dissections can cause an ischemic stroke or devastating hemorrhage 1,2,4,6,13,14,20,21,23,26,30) . Presenting symptoms are various and are associated with pathologic process such as mass effect, ischemic event from thromboembolism or hemorrhage.…”

Section: Fusiform Dissecting Aneurysm and Sole Stentmentioning

confidence: 99%

Sole Stenting Technique for Treatment of Complex Aneurysms

Kim

2009

J Korean Neurosurg Soc

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Objective : Complex aneurysms such as fusiform and very small aneurysms (< 3 mm) are challenging in neurovascular and endovascular surgery. Author reports follow-up results of 9 cases treated by sole stent technique with pertinent literature review. Methods : A retrospective study was made of 9 patients who were treated by sole stenting technique for cerebral aneurysm between January 2003 and January 2009. Two of them had fusiform aneurysm, 5 had very small aneurysm, and 2 had small saccular aneurysm. Five patients had ruptured aneurysms and four had unruptured aneurysms. Seven aneurysms were located in the internal carotid artery (ICA), 1 in the middle cerebral artery (MCA) and 1 in the basilar artery. Follow-up cerebral angiography was performed at post-procedure 3 months, 6 months, and 12 months. Mean follow-up period is 30 months (ranged from 3 days to 30 months). Results : Aneurysm size was decreased in 6 of 9 cases on follow-up images and was not changed in 3 cases. Although total occlusion was not seen, patients had stable neurological condition and angiographic result. The procedural complication occurred in 2 cases. One was coil migration and the other was suboptimal deployment of stent, and both were asymptomatic. Re-bleeding and thromboembolic complication had not been occurred. Conclusion : Sole stenting technique is relatively effective and safe as an alternative treatment for fusiform and very small aneurysms.

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“…[1][2][3][4][5][6][7] Although there have been recent reports documenting the effectiveness of stent-assisted coil embolization or flow diverter stent placement, [8][9][10] but parent artery occlusion remains as a safe and effective treatment, particularly in the acute phase of rupture. 11,12) To minimize the risk of re-hemorrhage and developing cerebral infarction following parent artery occlusion, it is important to make a strategy based on the location of the lesion relating to the posterior inferior cerebellar artery (PICA) origin.…”

Section: Introductionmentioning

confidence: 99%