Giant Vertebrobasilar Aneurysms: Endovascular Treatment and Long-term Follow-up

Abstract

Giant vertebrobasilar aneurysms are rare and challenging lesions for both neurosurgeons and neurointerventionalists. Their treatment by endovascular PAO remains safe and effective. Early clinical worsening may be observed, but long-term follow-up shows good or excellent results in most patients. This treatment can be carried out with minimal morbidity and mortality using clinical and angiographic monitoring.

Partially Thrombosed Intracranial Aneurysms Presenting with Mass Effect: Long-Term Clinical and Imaging Follow-Up after Endovascular Treatment

“…20,21 In comparing ours to previous studies regarding clinical follow-up and neurologic outcome of patients presenting with neurologic symptoms from all types of endovascularly treated aneurysms, we found no apparent worse outcome of the endovascularly treated partially thrombosed aneurysms in our study. 2,6,8,10,15,[22][23][24] Partially thrombosed aneurysms might have a different pathogenesis and, therefore, may form a different disease than aneurysms without intraluminal thrombus. Some propose that the vasa vasorum of the aneurysmal wall play a crucial role in the development and growth of aneurysms with intraluminal thrombus by proliferation, inflammation, and rupture.…”

“…Results of endovascular treatment of partially thrombosed aneurysms are scarce and are often presented in case reports or small case series or are embedded in studies reporting the overall results of endovascular treatment of giant and large aneurysms. [11][12][13][14][15][16] In this study, we present management and long-term clinical and angiographic results of 56 endovascularly treated partially thrombosed aneurysms that presented with symptoms of mass effect.…”

A New Covered Stent Designed for Intracranial Vasculature: Application in the Management of Pseudoaneurysms of the Cranial Internal Carotid Artery

“…Several studies have indicated that the clinical outcome is better in patients who are treated by sacrifice of the carotid artery and that these patients have a lower rate of complications. 8,9 However, ischemic complications including cerebral infarct after occlusion of the ICA occur in 5% to 22% of patients, despite a normal BOT. [10][11][12] Some reports have also demonstrated formation or growth of a cerebral aneurysm after permanent occlusion of the carotid artery.…”

Internal Trapping Following Proximal Clipping for a Ruptured Partially Thrombosed Giant Aneurysm of the Vertebral Artery -Case Report-

“…Endovascular surgery has recently been used as a therapeutic alternative for giant VA aneurysms, 10,15) but its efficacy remains uncertain. Treatment of a partially thrombosed aneurysm by endosaccular coil embolization resulted in a high rate of recanalization of the aneurysm at follow-up angiography due to either thrombus resolution or coil migration into the thrombus.…”

“…Recently, endovascular surgery has been used as an alternative form of treatment for giant aneurysms, but high rates of incomplete occlusion or recanalization of aneurysms have been reported with only endosaccular embolization 3,5,14) or proximal coiling of the parent artery. 10) Here we present a case of a partially thrombosed giant VA aneurysm manifesting as a mass effect on the brainstem followed by subarachnoid hemorrhage, which was treated successfully by combined surgical proximal clipping and internal trapping of the VA.…”