Serial Neuroimaging of a Growing Thrombosed Giant Aneurysm of the Distal Anterior Cerebral Artery. Case Report.

Kaneko, Takuro; Nomura, Motohiro; Yamashima, Tetsumori; Suzuki, Masayuki; Yamashita, Junkoh

doi:10.2176/nmc.41.33

Cited by 13 publications

(13 citation statements)

References 15 publications

(16 reference statements)

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“…perifocal edema and an onion skin appearance of the intramural hematoma suggesting blood of varying ages and subsequent growth over time) [20][21][22] (Figure 8). Treatment of these lesions is probably the greatest challenge of all dissecting processes since they may be regarded as a proliferative disease of the vessel wall with growth induced by extravascular activity.…”

Section: Dissections and "Giant Partially Thrombosed" Aneurysmsmentioning

confidence: 99%

The Many Faces of Intracranial Arterial Dissections

Krings

Choi

2010

Interv Neuroradiol

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Intracranial arterial dissecting diseases are rare and challenging diseases with a high associated morbidity and mortality. Their common pathomechanic origin is related to blood entering the vessel wall via an endothelial and intimal tear. Depending on the fate of the thus established intramural hematoma, different symptoms may ensue including mass effect, subarachnoid hemorrhage or ischemia. If the mural hematoma ruptures all vascular layers of the intradural artery, a subarachnoid hemorrhagic will occur. If the intramural hematoma reopens distally into the parent vessel on the other hand, ischemic embolic events may happen following intramural clot formation. If the mural hematoma does neither open itself into the parent vessel nor into the subarachnoid space, the vessel wall may dilate leading to occlusion of perforator branches and local ischemia. Organization of the mural hematoma may result in a chronic dissecting process which may eventually lead to formation of a “giant partially thrombosed” aneurysm with thrombus of varying ages within the vessel wall, ingrowth of vasa vasorum and recurrent dissections with subsequent growth of the aneurysm from the periphery. Treatment strategies of these diseases should take the underlying pathomechanism into consideration and include, depending on the presentation medical treatment, parent vessel occlusion, flow reversal or diversion, surgical options or a combined treatment protocol.

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Section: Dissections and "Giant Partially Thrombosed" Aneurysmsmentioning

confidence: 99%

The Many Faces of Intracranial Arterial Dissections

Krings

Choi

2010

Interv Neuroradiol

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“…Low thrombogenic nature of the embolic material, incomplete occlusion of the aneurysm due to loose filling and residual neck have been cited as the responsible factors in recanalization of the aneurysms treated by endovascular approach 20 . Regrowth of completely thrombosed giant aneurysm has been reported and various mechanisms have been proposed including accumulation of thrombotic material, recurrent intramural hemorrhage or development of intrathrombotic capillary channels [21][22][23][24] . However, the phenomenon of recanalization of spontaneously thrombosed aneurysm is less well understood with few such reports [25][26][27][28] .…”

Section: Discussionmentioning

confidence: 99%

Disappearing Saccular Intracranial Aneurysms: Do They Really Disappear?

et al. 2007

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Evolution and natural history of cerebral aneurysms is a dynamic process. Spontaneous regression in size or complete disappearance of an aneurysm is a known phenomenon, more commonly noted in giant intracranial aneurysms. However, reappearance or regrowth of such aneurysms is rare with few anecdotal reports. We report a series of four cases including one giant aneurysm, which either disappeared or regressed on sequential angiograms. Regrowth or reappearance of two of these previously disappeared or regressed aneurysms was noted and endovascularly treated while the other two cases are being followed up. The decision to follow up was crucial considering the nature of the aneurysms to change in morphology under the influence of various hemodynamic factors.

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“…1,5,12,13,16,17,19 Based on these reports, it was suggested that some PTAs may be caused by a chronic dissecting process. 7,16,19 According to this hypothesis, an intimal tear of an intradural artery leads to an intramural hematoma that neither dissects through the adventitia to cause an acute subarachnoid hemorrhage nor reopens into the parent vessel to be the cause of repeated embolic events.…”

Section: Operation and Postoperative Coursementioning

confidence: 99%

“…14 Multiple studies subsequently confirmed this speculation by using diagnostic imaging techniques, direct surgical inspection, or histopathological investigation. 1,5,12,13,16,17,19 It was suggested that certain PTAs arise from repeated hemorrhages of the vasa vasorum within the vessel wall, whereas other PTAs occur in relation to a chronic dissecting process with repeated intramural hemorrhages stemming from an incompletely healed acute dissection with intimal tearing. However, there has not yet been any serial imaging evidence to support the latter pathomechanism; i.e., the evolution of an acute dissecting aneurysm into a PTA, thereby rendering this pathomechanism hypothetical.…”

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confidence: 99%

Evolution of a chronic dissecting aneurysm on magnetic resonance imaging in a pediatric patient

Chen

Yau²,

deVeber³

et al. 2015

PED

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Clinical and imaging manifestations of the so-called partially thrombosed aneurysm (PTA) are different from those of the classic intracranial saccular aneurysm. Given some of their peculiar imaging features, it had been hypothesized that some PTAs occur due to repeated intramural hemorrhages. The authors present a case of PTA that evolved from an acute dissecting aneurysm as shown by serial imaging. A previously healthy 5-year-old boy had a sudden onset of left hemiparesis. Initial MRI sequences showed a perforating vessel infarction in the right basal ganglia area secondary to an acute distal middle cerebral artery (MCA) dissection as demonstrated on conventional angiography. Conservative management with close observation of this dissection was chosen, and serial MRI studies revealed layering of blood of various ages within the wall of an aneurysmal outpouching of the MCA, thereby leading to the imaging appearance of a PTA. The findings in this case indicate that some PTAs may be caused by repeated or chronic dissections, with blood entering the wall through an endothelial defect. Understanding the pathological mechanism underlying the formation of these aneurysms will help inform appropriate treatment strategies.

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Serial Neuroimaging of a Growing Thrombosed Giant Aneurysm of the Distal Anterior Cerebral Artery. Case Report.

Cited by 13 publications

References 15 publications

The Many Faces of Intracranial Arterial Dissections

The Many Faces of Intracranial Arterial Dissections

Disappearing Saccular Intracranial Aneurysms: Do They Really Disappear?

Evolution of a chronic dissecting aneurysm on magnetic resonance imaging in a pediatric patient

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