Long-Term Follow Up of Antegrade Recanalization of Vertebral Artery Dissecting Aneurysm After Internal Trapping  -Case Report-

Kojima, Atsuhiro; Okui, S; Onozuka, Satoshi

doi:10.2176/nmc.50.910

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…Moreover, additional recanalizations were not observed after that time. This observation is supported by other published reports in which recurrence has been most commonly observed within a comparatively short time after the procedure [12][13][14][15]. In these 8…”

Section: Radiological Results and Follow-upsupporting

confidence: 84%

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: Radiological Results and Follow-upsupporting

confidence: 84%

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

et al. 2012

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“…Recanalization of a coil-occluded VA is a well-known endovascular phenomenon. [12481011] In particular, coil compaction due to loose packing of the lesion frequently causes recanalization. [41011] However, we considered that recanalization had not been caused by coil compaction, because the framing coil remained unchanged in comparison with the first operation and antegrade blood flow to proximal to the coil mass was seen.…”

Section: Discussionmentioning

confidence: 99%

“…[10] Several investigators have subsequently documented this type of recanalization. [14] They suggest that the mechanism underlying this recanalization involves occlusion of a pseudolumen in the initial procedure, allowing the compressed true lumen to reexpand and undergo recanalization by gradual healing. Because their reports demonstrated a morphologically normal arterial configuration for the recanalized route, recanalization by the antegrade blood stream was suggested to flow via the true lumen.…”

Section: Discussionmentioning

confidence: 99%

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Recanalization of a ruptured vertebral artery dissecting aneurysm after occlusion of the dilated segment only

et al. 2014

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Background:Internal trapping in which the dissecting aneurysm is occluded represents reliable treatment to prevent rebleeding of ruptured vertebral artery (VA) dissecting aneurysms. Various methods of internal trapping are available, but which is most appropriate for preventing both recanalization of the VA and procedural complications is unclear.Case Description:A 61-year-old male presented with subarachnoid hemorrhage caused by rupture of a left VA dissecting aneurysm. Only the dilated segment of the aneurysm was occluded by coil embolization. Sixteen days after embolization, angiography showed recanalization of the treated left VA with blood supplying the dilated segment of the aneurysm, which showed morphological change between just proximal to the coil mesh and just distal to a coil, and antegrade blood flow through this part. Pathological examination showed that the rupture site that had appeared to be the most dilated area on angiography was located just above the orifice of the entrance. However, we think that this case of ruptured aneurysm had an entrance into a pseudolumen that existed proximal to the dilated segment, with antegrade recanalization occurring through the pseudolumen with morphological change because of insufficient coil obliteration of the entrance in the first therapy.Conclusions:This case suggests that occlusion of both the proximal and dilated segments of a VA dissecting aneurysm will prevent recanalization, by ensuring that any entrance to a pseudolumen of the aneurysm is completely closed. Careful follow-up after internal trapping is important, since antegrade recanalization via a pseudolumen may occur in the acute stage.

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“…Because the PICA is derived from the aneurysm, the aneurysm cannot be densely filled, and regrowth and rupture hemorrhage occasionally occur after treatment, and some VDAs can recanalize and bleed after dense embolization. VDAs involving the PICA are therefore difficult to treat 33 , 34 .…”

Section: Endovascular Treatment For the Reconstruction Of Blood Vementioning

confidence: 99%

Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery

Shi

Xiao-feng

et al. 2016

Int. J. Med. Sci.

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Among the variations of vertebral artery dissecting aneurysms (VDAs), VDAs involving the posterior inferior cerebellar artery (PICA), especially ruptured and high-risk unruptured aneurysms, are the most difficult to treat. Because the PICA is an important structure, serious symptoms may occur after its occlusion. Retained PICAs are prone to re-bleeding because VDAs are difficult to completely occlude. There is therefore confusion regarding the appropriate treatment for VDAs involving the PICA. Here, we used the PubMed database to review recent research concerning VDAs that involve the PICA, and we found that treatments for VDAs involving the PICA include (i) endovascular treatment involving the reconstruction of blood vessels and blood flow, (ii) occluding the aneurysm using an internal coil trapping or an assisted bypass, (iii) inducing reversed blood flow by occluding the proximal VDA or forming an assisted bypass, or (iv) the reconstruction of blood flow via a craniotomy. Although the above methods effectively treat VDAs involving the PICA, each method is associated with both a high degree of risk and specific advantages and disadvantages. The core problem when treating VDAs involving the PICA is to retain the PICA while occluding the aneurysm. Therefore, the method is generally selected on a case-by-case basis according to the characteristics of the aneurysm. In this study, we summarize the various current methods that are used to treat VDAs involving the PICA and provide schematic diagrams as our conclusion. Because there is no special field of research concerning VDAs involving the PICA, these cases are hidden within many multiple-cases studies. Therefore, this study does not review all relevant documents and may have some limitations. Thus, we have focused on the mainstream treatments for VDAs that involve the PICA.

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Long-Term Follow Up of Antegrade Recanalization of Vertebral Artery Dissecting Aneurysm After Internal Trapping -Case Report-

Cited by 4 publications

References 26 publications

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

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

Recanalization of a ruptured vertebral artery dissecting aneurysm after occlusion of the dilated segment only

Therapeutic Progress in Treating Vertebral Dissecting Aneurysms Involving the Posterior Inferior Cerebellar Artery

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