Natural history of vertebrobasilar dolichoectasia

Passero, S.; Rossi, Símone

doi:10.1212/01.wnl.0000286947.89193.f3

Cited by 188 publications

(241 citation statements)

References 26 publications

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“…VFAs most commonly manifest as posterior circulation ischemic strokes, but they may also cause cranial nerve palsies, brainstem compression, obstructive hydrocephalus, and intraparenchymal or subarachnoid hemorrhage (SAH). 5,14,[18][19][20][21][22]29 VFAs have an ominous natural history with a reported mortality up to 30%. 3,24,29 Passero and Rossi reported that 43% of patients without treatment experienced anatomical progression and 60% experienced new symptoms.…”

Section: ©Aans 2014mentioning

confidence: 99%

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

Munich¹,

Tan²,

Keigher³

et al. 2014

JNS

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Object. Vertebrobasilar fusiform aneurysms (VFAs) are rare lesions characterized by abnormal dilation and tortuosity of the vertebral and/or basilar arteries. Untreated, these aneurysms have a tendency to progress, often resulting in neurological symptoms or rupture leading to subarachnoid hemorrhage. The microsurgical treatment of these lesions can be difficult due to their location and the circumferential involvement of the arteries. These features make microsurgical treatment prone to high morbidity. The Pipeline Embolization Device (PED) has gained popularity for the treatment of aneurysms of the internal carotid artery. Its use in the posterior circulation has been limited, likely due to a fear of perforating artery occlusion.Methods. The authors retrospectively reviewed their database of patients treated with the PED and identified 12 patients who had VFAs. The clinical features, complications, and outcomes of these patients were analyzed.Results. At an average follow-up of 11 months, the mean modified Rankin Scale score was 1.9. Complete aneurysm occlusion was seen in 90% of the patients with radiographic follow-up. Three patients suffered new neurological deficits postoperatively. One of these patients died, while the remaining 2 demonstrated significant clinical improvement at follow-up.Conclusions. With attention to the anatomy of perforating arteries, staged contralateral vertebral artery sacrifice, and adequate platelet inhibition, PED may be an effective treatment option-alone or in a hybrid construct with stents of less coverage for VFAs-with an acceptable complication rate. (http://thejns.org/doi/abs/10.3171/2014.7.JNS132595) Key WorDS • basilar artery • cerebral aneurysm • Pipeline • stent • vertebral artery • vascular disordersAbbreviations used in this paper: AICA = anterior inferior cerebellar artery; DSA = digital subtraction angiography; MRA = MR angiography; mRS = modified Rankin Scale; PED = Pipeline Embolization Device; PRU = P2Y12 reaction unit; SAH = subarachnoid hemorrhage; VFA = vertebrobasilar fusiform aneurysm.

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Section: ©Aans 2014mentioning

confidence: 99%

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

Munich¹,

Tan²,

Keigher³

et al. 2014

JNS

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“…Approximately 43% of VBD patients, especially with rapid expansion, exacerbate during follow-up and the mortality is high [3]. The long-term prognosis of VBD is mostly associated with the severity of the condition at initial diagnosis and on its evolution characteristics, which was associated with a higher mortality and morbidity [4].…”

Section: Journal Of Neurology and Neurosciencementioning

confidence: 99%

“…The most common outcome of VBD is ischemic stroke mainly characterized by posterior cerebral ischemia [2]. Previous studies suggest that cases characterized by the diameter expansion of blood vessels are more likely to result in stroke while compression symptoms can be found more common in cases featured by tortuous expansion [3]. The most commonly symptoms are related with ischemic, hemorrhagic and mass effect of the lesion [4].…”

Section: Introductionmentioning

confidence: 99%

Vertebral Artery Dolichoectasia with Fusiform Aneursym Presented By Internuclear Ophthalmoplegia: A Case Report

Şengeze¹,

Yürekli²

2016

J Neurol Neurosci

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Dolichoectasia is a term used to describe marked widening, tortuosity and elongation of an artery. Intracranial vertebral and basilar arteries are most commonly involved. Vertebrobasilar dolichoectasia is usually asymptomatic. Cranial nerve compression and cerebral ischemia findings are frequently seen in symptomatic patients. However, vertebrobasilar artery dolichoectasia with internuclear ophthalmoplegia (INO) clinical presentation has not been reported in literature yet. In our case, we report of a 67 year old female who had symptoms of diplopia, left abducens palsy and headache with no prior medical or family history of cerebrovascular disease. She has been presented with INO due to left vertebrobasilar dolichoectasia. Atypical presentation of INO is rare and vertebral artery dolichoectasia as the underlying aetiology, like in our case is even rarer and has not been seen in literature so far.

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“…Vertebrobasilar dolichoectasia (VBD) was a clinical entity characterized by elongated, dilated and/or tortuous vertebral artery, and basilar artery (BA),1, 2, 3 ranging from 0.05% to 18% 4, 5, 6. VBD presentation includes symptoms by cerebral ischemia in the vertebrobasilar territory 2, 3, 4, 5, 6…”

Section: Introductionmentioning

confidence: 99%

“…VBD presentation includes symptoms by cerebral ischemia in the vertebrobasilar territory 2, 3, 4, 5, 6…”

Section: Introductionmentioning

confidence: 99%

Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo

Peng

Zhang

et al. 2018

Ann Clin Transl Neurol

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ObjectiveTo investigate the association between the perfusion magnetic resonance imaging (MRI) and vertebrobasilar dolichoectasia (VBD) in vertigo patients and at least one vascular risk factor.MethodsWe studied 289 patients with vertigo (spinning, swaying, nausea, vomiting, and unsteady gait) who performed multimode MRI. Maximum diameter and tortuous parameters of the basilar artery and vertebral arteries were calculated using magnetic resonance angiography. Relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), mean transit time (MTT), and time to peak (TTP) maps were evaluated by dynamic susceptibility contrast‐enhanced perfusion imaging. Association of perfusion MRI and VBD was evaluated by nonparametric tests and receiver‐operating characteristic curve was constructed to predict posterior ischemic stroke in VBD patients.ResultsThe prevalence of VBD was 26.6% (n = 77/289) in our study. Male gender was the risk factor of VBD by multivariate analysis. BA diameter was significant statistics between ischemic stroke and nonischemic stroke patients. TTP in bilateral lower cerebellum, superior cerebellum, bilateral pons, and occipital and temporal lobes region of interests was significantly delayed in VBD versus non‐VBD patients, while rCBF, rCBV, and MTT parameters were not significant differences. TTP in the right temporal lobe delayed by 21.96 ms was the best predictive value and the mean TTP predictive threshold value in all ROIs was 22.67 ± 1.48 ms.Interpretation VBD leads to the hypoperfusion of posterior circulation territory characterized by delayed TTP. Delayed TTP in cerebellum, pons, and occipital and temporal lobes fed by vertebrobasilar arteries predicted the occurrence of posterior ischemic stroke in VBD patients.

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Natural history of vertebrobasilar dolichoectasia

Abstract: The long-term prognosis of patients with vertebrobasilar dolichoectasia (VBD) depended mainly on the severity of the condition at diagnosis and on its evolutionary characteristics. Progression of VBD exposed patients to high risk of adverse events, especially stroke.

Cited by 188 publications

References 26 publications

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

The Pipeline Embolization Device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution

Vertebral Artery Dolichoectasia with Fusiform Aneursym Presented By Internuclear Ophthalmoplegia: A Case Report

Perfusion by delayed time to peak in vertebrobasilar dolichoectasia patients with vertigo

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