Transcirculation balloon-assisted stent-supported coil embolization of a basilar tip aneurysm

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Vijay Agarwal ◽  
Ali Zomorodi ◽  
Cameron Mcdougal ◽  
Ranjith Babu ◽  
Adam Back ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Coil Embolization ◽  
Posterior Communicating Artery ◽  
Link Type ◽  
Left Posterior ◽  
Basilar Tip Aneurysm ◽  
The Right

We present the case of a balloon-assisted, stent-supported coil embolization of a basilar tip aneurysm. Initially, a balloon extending from the basilar artery into the right PCA was placed.3 However, even with a more proximal purchase, coils were found to impinge on the left PCA. Subsequently, a transcirculation approach was performed, where the left posterior communicating artery was utilized as a conduit for balloon support and the coils were embolized from the ipsilateral vertebral artery.1 However, after this transcirculation approach was completed, there was a coil tail extruding from the aneurysm. The balloon was then removed over an exchange wire and a horizontal stent advanced, spanning the entire neck of the aneurysm, eliminating the extruded coil.2The video can be found here: http://youtu.be/bMbtZoPnYvo.

Broad Neck Basilar Tip Aneurysm Treated by Neck Plastic Intra-Aneurysmal GDC Embolisation with Protective Balloon

1997 ◽  
Vol 3 (2) ◽  
pp. 167-170 ◽  
Author(s):  
A. Takahashi ◽  
M. Ezura ◽  
T. Yoshimoto
Keyword(s):  
Basilar Artery ◽  
Balloon Catheter ◽  
Artery Aneurysm ◽  
Detachable Coil ◽  
Guglielmi Detachable Coil ◽  
Left Posterior ◽  
Basilar Artery Aneurysm ◽  
Basilar Tip Aneurysm ◽  
Aneurysmal Neck ◽  
The Stability

A 56-year-old male was found to have a basilar artery aneurysm by magnetic resonance imaging. Angiography demonstrated a broad neck basilar tip aneurysm. He refused surgical clipping but accepted intravascular embolisation. Introducing catheters were inserted into each of the bilateral vertebral arteries. A microcatheter was introduced into the aneurysm through one of the introducing catheters and a double lumen balloon catheter was introduced into the left posterior cerebral artery (PCA) through the other. The balloon was located from the left PCA to the basilar artery across the aneurysmal neck with the aid of a guidewire passed through the inner lumen of the balloon catheter. The balloon was inflated, and a Guglielmi detachable coil (GDC) was inserted until the platinum part was placed inside the aneurysm. The balloon was deflated to confirm the stability of the GDC, and then the GDC was electrically detached. This procedure was repeated until nine GDCs were successfully inserted. The aneurysm was tightly embolised despite its broad neck. Angiography comfirmed complete neck closure and stable preservation of the basilar artery and bilateral PCAs immediately, 1 week, 3 months, 6 months, and 12 months after embolisation without evidence of thrombo-embolic complications. Neck plastic intra-aneurysmal GDC embolisation using a protective balloon can be used to treat broad-neck aneurysms.

scholarly journals Direct puncture of the V3 segment of the vertebral artery in acute basilar artery stroke: an alternative approach in desperate circumstances

2019 ◽  
Vol 12 (8) ◽  
pp. e231335 ◽  
Author(s):  
Sean Thomas O’Reilly ◽  
Ian Rennie ◽  
Jim McIlmoyle ◽  
Graham Smyth
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Posterior Inferior Cerebellar Artery ◽  
Left Vertebral Artery ◽  
Basilar Artery Thrombosis ◽  
Direct Puncture ◽  
Alternative Approach ◽  
Cerebellar Artery ◽  
First Pass ◽  
The Right

A patient in his mid-40s presented with acute basilar artery thrombosis 7 hours postsymptom onset. Initial attempts to perform mechanical thrombectomy (MT) via the femoral and radial arterial approaches were unsuccessful as the left vertebral artery (VA) was occluded at its origin and the right VA terminated in the posterior inferior cerebellar artery territory, without contribution to the basilar system. MT was thus performed following ultrasound-guided direct arterial puncture of the left VA in its V3 segment, with antegrade advancement of a 4 French radial access sheath. First pass thrombolyisis in cerebral infarction (TICI) 3 recanalisation achieved with a 6 mm Solitaire stent retriever and concurrent aspiration on the 4 French sheath. Vertebral closure achieved with manual compression.

Stent-assisted coil embolization for an unruptured vertebral artery–posterior inferior cerebellar artery aneurysm with retrograde access via type 1 persistent primitive proatlantal artery: A case report

2020 ◽  
pp. 159101992097384
Author(s):  
Yasuhiko Nariai ◽  
Tomoji Takigawa ◽  
Ryotaro Suzuki ◽  
Akio Hyodo ◽  
Kensuke Suzuki
Keyword(s):  
Carotid Artery ◽  
Vertebral Artery ◽  
Coil Embolization ◽  
Posterior Inferior Cerebellar Artery ◽  
External Carotid ◽  
Proatlantal Artery ◽  
Cerebellar Artery ◽  
The Right ◽  
Pica Aneurysms

Vertebral artery (VA)-posterior inferior cerebellar artery (PICA) aneurysms are rare lesions that are difficult to treat with both endovascular and surgical techniques. Tight angulation of the PICA from VA may make access to the PICA difficult from ipsilateral VA if adjunctive techniques are needed. Recently, the safety and efficacy of retrograde access have been reported. We report a case of endovascular treatment for a VA-PICA aneurysm with a stent-assisted technique using retrograde access via contralateral persistent primitive proatlantal artery (PPA). The patient was a 76-year-old woman with an unruptured VA-PICA aneurysm on the dominant VA side. Coil embolization with a stent-assisted technique using retrograde access seemed appropriate. However, the origin of the left VA was not confirmed. Left common carotid artery angiography demonstrated that the PPA (type 1) branching from external carotid artery joined the VA V4 segment. Retrograde access via the PPA for stenting was performed. A microcatheter for stenting was retrogradely advanced to the right PICA at ease. After deploying the stent, coil insertion was completed from the right VA, and the final angiogram showed adequate occlusion of the aneurysm with preservation of the PICA. Thus, PPA may be an approach route in the treatment of VA-PICA aneurysms with unconfirmed contralateral VA orifice and apparent PPA on angiography, when retrograde access is needed.

SUCCESSFUL STENTING BY COMBINATION TECHNIQUE OF REVERSE FLOW AND DOWNSTREAM FILTERING FOR LONG CHRONIC TOTAL OCCLUSION OF THE CERVICAL VERTEBRAL ARTERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (2) ◽  
pp. E378-E379 ◽  
Author(s):  
Tomonori Iwata ◽  
Takahisa Mori ◽  
Hiroyuki Tajiri ◽  
Masahito Nakazaki
Keyword(s):  
Vertebral Artery ◽  
Chronic Total Occlusion ◽  
Reverse Flow ◽  
Posterior Inferior Cerebellar Artery ◽  
Vertebrobasilar Insufficiency ◽  
Total Occlusion ◽  
Combination Technique ◽  
Left Posterior ◽  
The Right ◽  
Distal Filter

Abstract OBJECTIVE To report a case of successful recanalization using the combination technique of reverse flow and downstream filtering in chronic total occlusion of the bilateral vertebral artery (VA). Clinical Presentation A 59-year-old man had experienced attacks consisting of vertigo and/or dysarthria more than 1 year before presentation. He experienced symptoms despite the administration of antiplatelet drugs and presented to our institution. Diagnostic cerebral angiography demonstrated that the right VA was not occluded at the ostium but, rather, along its midcervical portion and that the left VA ended in the left posterior inferior cerebellar artery. Intervention Long chronic total occlusion of the right cervical VA was recanalized successfully and safely by reverse flow and downstream filtering with proximal flow blockade and a distal filter device positioned in the right brachial artery. Follow-up angiography at 1 year demonstrated no re-occlusion. The patient's symptoms disappeared after recanalization and did not recur. To our knowledge, there are no reports describing successful angioplasty and/or stenting for long chronic total occlusion of the cervical VA. CONCLUSION Stenting using the combination technique of reverse flow and downstream filtering can safely open even long chronic cervical VA occlusion and may be effective in the treatment of patients experiencing vertebrobasilar insufficiency due to bilateral chronic VA occlusion.

scholarly journals A Vertebral Artery Dissection with Basilar Artery Occlusion in a Child

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Katleen Devue ◽  
Annemie Van Ingelgem ◽  
Katrien De Keukeleire ◽  
Marc De Leeuw
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Vertebral Artery Dissection ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Left Vertebral Artery ◽  
Artery Dissection ◽  
Minor Trauma ◽  
Systemic Thrombolysis ◽  
The Right

This paper presents the case report of an 11-year-old boy with an acute dissection with thrombosis of the left vertebral artery and thrombosis of the basilar artery. The patient was treated with acute systemic thrombolysis, followed by intra-arterial thrombolysis, without any clinical improvement, showing left hemiplegia, bilateral clonus, hyperreflexia, and impaired consciousness. MRI indicated persistent thrombosis of the arteria basilaris with edema and ischemia of the right brainstem. Heparinization for 72 hours, followed by a two-week LMWH treatment and subsequent oral warfarin therapy, resulted in a lasting improvement of the symptoms. Vertebral artery dissection after minor trauma is rare in children. While acute basilar artery occlusion as a complication is even more infrequent, it is potentially fatal, which means that prompt diagnosis and treatment are imperative. The lack of class I recommendation guidelines for children regarding treatment of vertebral artery dissection and basilar artery occlusion means that initial and follow-up management both require a multidisciplinary approach to coordinate emergency, critical care, interventional radiology, and child neurology services.

scholarly journals Terminal Triplication of the Left Vertebral Artery: A Unique Variation

2007 ◽  
Vol 13 (4) ◽  
pp. 399-401
Author(s):  
P.H. Dissanayake ◽  
J.J. Bhattacharya ◽  
E.V. Teasdale
Keyword(s):  
Vertebral Artery ◽  
Ct Angiography ◽  
Subclavian Artery ◽  
Basilar Artery ◽  
Clinical Importance ◽  
Aberrant Right Subclavian Artery ◽  
Left Vertebral Artery ◽  
Unique Case ◽  
The Right ◽  
Unique Variation

This report describes a unique case of triplication of the terminal left vertebral artery, forming the basilar artery in a 75-year-old male. CT angiography of cranio-cervical vessels also demonstrated the right vertebral artery originating from the right common carotid and an aberrant right subclavian artery. To the best of our knowledge this is the first report of a variation of this nature. The embryology and the clinical importance are discussed.

scholarly journals Asymmetry of P1 and vertebral arteries is not related to basilar tip aneurysm development or rupture

2020 ◽  
Author(s):  
Lan Li ◽  
Björn B. Hofmann ◽  
Igor Fischer ◽  
Daniel M. Donaldson ◽  
Adrian Engel ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Basilar Artery ◽  
Morphological Parameters ◽  
Anterior Circulation ◽  
Vertebral Arteries ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Basilar Tip Aneurysm ◽  
The Asymmetry

Abstract Objective Lately, morphological parameters of the surrounding vasculature aside from aneurysm size, specific for the aneurysm location, e.g., posterior cerebral artery angle for basilar artery tip aneurysms, could be identified to correlate with the risk of rupture. We examined further image-based morphological parameters of the aneurysm surrounding vasculature that could correlate with the growth or the risk of rupture of basilar artery tip aneurysms. Methods Data from 83 patients with basilar tip aneurysms (27 not ruptured; 56 ruptured) and 100 control patients were assessed (50 without aneurysms and 50 with aneurysms of the anterior circle of Willis). Anatomical parameters of the aneurysms were assessed and analyzed, as well as of the surrounding vasculature, namely the asymmetry of P1 and the vertebral arteries. Results Patients with basilar tip aneurysm showed no significant increase in P1 or vertebral artery asymmetry compared with the control patients or patients with aneurysms of the anterior circulation, neither was there a significant difference in asymmetry between cases with ruptured and unruptured aneurysms. Furthermore, we observed no significant correlations between P1 asymmetry and the aneurysm size or number of lobuli in the aneurysms. Conclusion We observed no significant difference in aneurysm size, rupture, or lobulation associated with P1 or vertebral artery (surrounding vasculature) asymmetry. Therefore, the asymmetry of the surrounding vessels does not seem to be a promising morphological parameter for the evaluation of probability of rupture and growth in basilar tip aneurysms in future studies.

scholarly journals Acute Vertebral Artery Origin Occlusion Leading to Basilar Artery Thrombosis Successfully Treated by Angioplasty with Stenting and Thrombectomy

2014 ◽  
Vol 20 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Arata Abe ◽  
Seiji Okubo ◽  
Shiro Onozawa ◽  
Masataka Nakajima ◽  
Kentaro Suzuki ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Successful Treatment ◽  
Basilar Artery ◽  
Cerebral Angiography ◽  
Guide Wire ◽  
Endovascular Surgery ◽  
Basilar Artery Thrombosis ◽  
Artery Thrombosis ◽  
The Right ◽  
Guiding Catheter

Few reports have described the successful treatment of stroke caused by acute vertebral artery (VA) origin occlusion by endovascular surgery. We describe the case of a 68-year-old man who experienced stroke due to left acute VA origin occlusion. Cerebral angiography showed that the left VA was occluded at its origin, the right VA had hypoplastic and origin stenosis, and the basilar artery was occluded by a thrombus. The VA origin occlusion was initially passed through with a 0.035-inch guide wire. An angioplasty was performed, and a coronary stent was appropriately placed. The VA origin was successfully recanalized. A balloon-assisted guiding catheter was navigated through the stent and a thrombectomy was performed using the Penumbra system. The patient's symptoms gradually improved postoperatively. Balloon-assisted catheter guidance through a vertebral artery stent permitted a successful thrombectomy using the Penumbra system and may be useful for treating stroke due to VA origin occlusion.

Coil Embolization for Ruptured Basilar Tip Aneurysm After Mechanical Thrombectomy for Acute Basilar Artery Occlusion

2016 ◽  
Vol 93 ◽  
pp. 488.e9-488.e12
Author(s):  
Shuta Aketa ◽  
Daisuke Wajima ◽  
Taekyun Kim ◽  
Rinsei Tei ◽  
Taiji Yonezawa
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Mechanical Thrombectomy ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Basilar Tip Aneurysm
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