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Magnetic resonance (MR) angiogram (A) and basiparallel anatomic scanning-MR image (B) performed 6 years after onset showing no subsequent development of a dissection of the right vertebral artery. Source image of MR angiography (C) showing no recanalization of the aneurysm.
Source publication
A 34-year-old female presented with subarachnoid hemorrhage caused by the rupture of a right vertebral artery (VA) dissecting aneurysm. The affected site, including the aneurysm and parent artery, was successfully occluded with detachable coils. Follow-up angiography performed 28 days after the endovascular treatment revealed recanalization of the...
Context in source publication
Context 1
... with the angiography performed on Day 45. At the last clinical follow-up examination 6 years after onset, magnetic resonance (MR) angiography and basiparallel anatomic scanning (BPAS)-MR imaging showed no signs of right VA dissection or the recanalization of the aneurysm, although a minor luminal irregularity in the wall of the right VA was noted (Fig. ...
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Objective:
Intracranial ruptured vertebral artery dissecting aneurysms (VADAns) are associated with high morbidity and mortality when left untreated due to the high likelihood of rebleeding. The present study aimed to establish an endovascular therapeutic strategy that focuses specifically on the angioarchitecture of ruptured VADAns.
Methods:
Tw...
Double origin of the posterior inferior cerebellar artery (DOPICA) is rare but is associated with intracranial aneurysm formation. A 46-year-old man was brought to our hospital with severe subarachnoid hemorrhage (SAH). Digital subtraction angiography revealed right vertebral artery dissecting aneurysm (VADA) and DOPICA. The aneurysm involved the d...
Ruptured vertebral artery dissecting aneurysm (VADA) causes subarachnoid hemorrhage (SAH), and parent artery occlusion (PAO) with endovascular technique (EVT) has been the first-line treatment for ruptured VADA. In this study, we have extracted 530 ruptured VADA, treated through PAO with EVT, from a nationwide, retrospective, multi-center registrat...
Objective: A rare case of enlargement of asymptomatic dissecting aneurysm after its initial treatment with stent-assisted coiling with parent artery occlusion for the ruptured contra lateral side is reported.
Case Presentation: A 52-year-old male patient presented with a subarachnoid hemorrhage resulting from a bilateral vertebral artery dissecting...
Objective:We report the first case of a vertebral artery (VA) dissecting aneurysm involving the posterior inferior cerebellar artery (PICA) treated by placing a stent on the PICA from the contralateral VA and parent artery occlusion in the acute hemorrhagic phase.
Case Presentation: The patient was a 47-year-old man with World Federation of Neurosu...
Citations
... Of those, we acquired 112 reports with full text. Of the 112, 20 studies described the number of coils used and so were eligible for inclusion in the present study [2,3,[6][7][8][14][15][16][17][18][19][20][21]27,[32][33][34][35]38]. We performed a systematic review using the 20 studies, which comprised 33 cases. ...
Background: Parent Artery Occlusion (PAO) by simple coiling for Vertebral Artery Dissection (VAD) sometimes needs a large number of coils, increasing both operative time and medical costs. DELTA coils (Johnson and Johnson, USA) provide a homogenous coil distribution and high packing density due to their triangular shape. They have the potential to decrease the number of coils used in PAO. In this study, we retrospectively investigated the number of coils required for PAO using the simple coiling to treat VAD-induced Subarachnoid Hemorrhage (SAH).
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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]. ...
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.
... [2,3,8,12,13] Various methods are available for internal trapping, including occlusion of the dilated segment of the aneurysm and distal and proximal VA, occlusion of the dilated segment of the aneurysm and proximal VA, and occlusion of the dilated segment of the aneurysm only. [1,4,10,11,13] Which method is most appropriate for preventing recanalization of VA and procedural complications remains unclear. ...
... Recanalization of a coil-occluded VA is a well-known endovascular phenomenon. [1,2,4,8,10,11] In particular, coil compaction due to loose packing of the lesion frequently causes recanalization. [4,10,11] 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. ...
... [1,2,4,8,10,11] In particular, coil compaction due to loose packing of the lesion frequently causes recanalization. [4,10,11] 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. ...
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.
Introduction:
Previous 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.
Methods:
A 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.
Results:
Forty-five patients had ruptured VADs, and 28 had unruptured VADs. Clinical follow-up of at least 6 months data was 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 six patients (8.21 %), spinal cord infarction in two patients (2.74 %), and a perforating artery ischemia was diagnosed in seven patients (9.59 %); all patients with CNP and five of the patients with partial Wallenberg syndrome experienced only temporary symptoms; two 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.
Conclusions:
The 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 3 months after initial treatment without rupture. CNPs were observed in 8.21 %, perforating ischemia in 9.59 %, and spinal cord infarction in 2.74 %. The former two are temporary, while the last can be a factor that affects the modified Rankin Scale. 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.
Spontaneous occlusion is a rare manifestation of ruptured vertebral artery dissection (VAD). Its natural history and treatment strategy have yet to be established due to its rarity. Here, we report five lesions involving spontaneous occlusion of VAD after subarachnoid haemorrhage, among which three lesions showed recanalisation. Based on our experience and previous reports, spontaneous occlusion of ruptured VAD can be classified into two groups-one group with occlusion in the acute stage with a high incidence of recanalisation and another group with occlusion in the chronic stage with a relatively low incidence of recanalisation. The underlying mechanism is likely different in each group, and treatment strategies should also be tailored depending on the pathophysiology.
