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ABSTRACT: BACKGROUND: Foramen magnum dural arteriovenous fistulas (DAVF) with perimedullary venous drainage represent a small minority of intracranial DAVF, and only a number of small series with limited cases have been reported. The purpose of this retrospective study is to summarize experience of transarterial Onyx embolisation in the treatment of these lesions, with emphasis on the balloon-augmented technique. METHODS: Five consecutive patients with DAVF at the foramen magnum were treated by transarterial embolisation using the Onyx system. Their symptoms included myelopathy (n=4) and SAH (n=1). Suppliers were from the vertebral artery (VA) (n=4), occipital artery (OA) (n=4), and ascending pharyngeal artery (APA) (n=2), with drainage to the perimedullary veins. After catheterization of the dilated supplier, the fistulous connections, proximal draining veins and appropriate distal segment of the feeders of these DAVF were transarterial embolized using Onyx-18. In three patients, balloon-augmented technique was used to assist embolisation. The technical feasibility of the procedure, angiographic results, and clinical outcome were evaluated. RESULTS: In every case, complete obliteration was achieved. Neither intraprocedural vessel rupture nor other procedure-related complications occurred. The results remained stable in all patients on follow-up angiograms (mean, 7.2 months). At the last clinical follow-up (mean, 17.6 months), two patients showed complete resolution of the initial symptoms, and three patients showed significant improvement. CONCLUSION: We found that Onyx embolisation is a feasible and safe alternative to open surgery in the treatment of selective DAVF at the foramen magnum. The balloon-augmented technique widens indications for transarterial Onyx packing of these lesions, and improved safety of the procedure.
Journal of Neuroradiology 02/2013; · 1.21 Impact Factor
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ABSTRACT: BACKGROUND AND PURPOSE: Cognard type IV anterior cranial fossa dural arteriovenous fistulas (DAVFs) are rare lesions with a high risk of intracranial hemorrhage. We present our experience with the use of Onyx via the arterial route in these aggressive lesions. MATERIALS AND METHODS: Between October 2009 and October 2011, six consecutive patients diagnosed with Cognard type IV anterior cranial fossa DAVFs were treated transarterially with Onyx in our department. All patients were male; mean age was 55 years (range 38-68). Four patients presented with intracranial hemorrhage as the initial manifestation; one patient presented with seizures at the time of diagnosis and experienced intracranial hemorrhage during the antiepileptic therapy; and the other patient was asymptomatic. RESULTS: In five patients, complete obliteration was achieved with transarterial Onyx injection in a single treatment session; in the remaining patient, subtotal occlusion was achieved and gamma knife treatment was followed. The average time of injection was 19 min (range 5-28) for every pedicle catheterized and the average amount of Onyx was 3.2 ml (range 0.4-6.3) for each lesion. All patients recovered uneventfully after embolization. No mortality or permanent morbidity was observed in this series. Follow-up digital subtraction or MR angiography confirmed durable obliteration of the fistulas in five cured cases. No patients suffered intracranial hemorrhage during the follow-up period. CONCLUSIONS: In this small series, our experience with the use of Onyx for arterial embolization of Cognard type IV DAVFs is encouraging, with durable complete cure in most lesions without severe complications.
Journal of neurointerventional surgery 02/2013; · 0.92 Impact Factor
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ABSTRACT: The term trepanation describes the removal of sections of bone from the cranium. Although others may have made earlier reference to trepanation, Chinese archeologists have made aware of a skull discovered at the Early Neolithic site Dawenko from approximately 4300 to 2500 BC, Taian, Shandong, China, in 1995, and, after careful examination of the specimen, suggested that the procedure had been performed on a living patient who subsequently survived. Archeological evidence supports that the practice was indeed widespread.
World Neurosurgery 09/2012; · 0.68 Impact Factor
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ABSTRACT: To estimate for hemorrhage risk of partially endovascularly embolized brain arteriovenous malformation (BAVM).
We retrospectively reviewed 147 consecutive patients with BAVM-treated mainly with endovascular N-butyl cyanoacrylate (NBCA) and ONYX embolization. In Kaplan-Meier survival analysis, the index date was the dated of initial endovascular embolization; cases were censored at time of subsequent intracranial hemorrhage (ICH), or loss to follow-up, and multivariate proportional-hazards regression models included age of presentation (≤30 years old), clinical presentations, and other potential confounders.
We reviewed 147 patients with BAVM (58.8% male; mean age±SD at treatment: 27.5±11.1 years) treated with endovascular embolization. One hundred and forty-four NBCA and 76 ONYX embolizations were performed. Complete obliteration of BAVMs was achieved in 29 patients (19.7%). Thirty-two (21.8%) patients were treated with additional Gamma-knife radiosurgery. During 499.5 years of follow-up, 15 partially treated patients suffered a further hemorrhage, which caused four deaths. The crude annual risk of hemorrhage was 3.0% and the annual death rate was 0.8%. Among partially treated patients with hemorrhage at initial presentation, the risk of hemorrhage was 3.8%, while the risk of hemorrhage for patients without hemorrhage at initial presentation was 2.5%. The annual rate of subsequent hemorrhage was 2.6% for non-ICH and 4.2% for ICH in the partial NBCA embolization group compared with 2.4% for non-ICH and 2.4% for ICH in the partial ONYX embolization group.
The effect of partial AVM embolization with liquid embolic agents may still be unclear as for risk reduction of annual hemorrhage rate of cerebral AVM.
Neurological Research 05/2012; 34(6):552-6. · 1.52 Impact Factor
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ABSTRACT: The purpose of this study was to report the potential proneness of a fetal-type posterior cerebral artery (PCA) to develop vascular insufficiency in parent vessel occlusion of distal PCA aneurysms.
Between January 2005 and January 2011, 19 patients (9 females and 10 males) with 20 distal PCA aneurysms (16 dissecting and 4 saccular) were treated with endovascular parent vessel occlusion. The ages of the patients ranged from 5 to 71 years, with a mean age of 40.2 years. Of the 20 aneurysms, 4 were ruptured and 16 were unruptured. One of the unruptured aneurysms was additional to another ruptured aneurysm, and 15 were incidentally discovered. Five aneurysms were smaller than 10 mm, and the other 15 were 10 mm or larger.
All aneurysms were successfully treated with simultaneous coil occlusion of the aneurysm and the parent PCA. One patient had hemianopia at the initial presentation, and 2 patients had new persistent hemianopia due to insufficient leptomeningeal collateral circulation; in 16 patients with an intact visual field, no hemianopia developed because there was sufficient leptomeningeal collateral circulation. A fetal-type PCA was involved in all 3 patients with hemianopia, which was initially presented or caused by parent vessel occlusion. However, in the patients without hemianopia, an adult-type PCA was involved in all cases.
Endovascular treatment via coil occlusion of the aneurysm as well as the parent artery can be used to cure distal PCA aneurysms. A fetal-type PCA could be an important predictive factor for vascular insufficiency in parent vessel occlusion treatment.
Journal of Neurosurgery 05/2012; 117(2):284-7. · 2.96 Impact Factor
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ABSTRACT: OBJECTIVE: To identify the specific angioarchitectural characteristics of arteriovenous malformations AVMs that are associated with a clinical presentation of nonhemorrhagic neurologic deficits. METHODS: Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution. Twenty-four patients (7.9%) presented with neurologic deficits without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and neurological deficits at presentation. RESULTS: When we compared the 24 (7.9%) patients with nonhemorrhagic neurological deficits with the 278 patients who did not experience neurologic deficits initially (total of 302 patients), female sex (P = 0.002), deep AVM location (P = 0.015), AVM size greater than 3 cm (P = 0.001), more than three arterial feeders present (P = 0.004), only perforating feeding artery (P = 0.007), the presence of more than three draining veins (P = 0.016), the presence of varices in the venous drainage (P = 0.013), and a Spetzler-Martin grade of III to V (P = 0.004) were statistically associated with neurological deficits. Patient age, eloquent location, deep venous drainage, venous drainage restriction, and coexisting aneurysms were not statistically associated with neurological deficits without hemorrhage. CONCLUSION: The characteristics of AVM associated with nonhemorrhagic neurological deficits include female sex, deep AVM location, more than three arterial feeders, only perforating feeding artery, more than three draining veins, the presence of varices in the venous drainage, and a Spetzler-Martin grade of III to V.
World Neurosurgery 04/2012; · 0.68 Impact Factor
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ABSTRACT: BACKGROUND: Direct surgical exposure and cannulation (DSEC) of the superior ophthalmic vein (SOV) can be used as an alternative approach for the endovascular treatment of cavernous sinus dural fistulas (CSDF) that fail conventional endovascular access. The aim of this study was to report the techniques, effectiveness and safety of DSEC of the SOV in these cases. METHODS: Between June 2007 and June 2011, nine CSDF in nine patients who presented with ocular signs and symptoms were embolized using DSEC of the SOV when the CSDF could not be treated via the transarterial or transfemoral venous route. RESULTS: All nine patients were successfully treated by introduction of Onyx in conjunction with detachable coils through the catheterized SOV to the affected cavernous sinus. No exposure or catheterization of the SOV proved difficult. Symptoms and signs resolved completely in all patients after successful occlusion of the CSDF. There were no intraoperative complications. All patients underwent follow-up cerebral angiography at least 3 months after treatment, and none showed recurrence of the fistula. CONCLUSION: DSEC of the SOV for embolization of a CSDF is a good alternative treatment when conventional venous routes are inaccessible. Surgical access to the SOV is direct and can be performed safely. The use of Onyx in conjunction with detachable coils is safe and effective for symptomatic CSDF.
Journal of neurointerventional surgery 03/2012; · 0.92 Impact Factor
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ABSTRACT: Embolization of grade III-V intracranial DAVFs using Onyx is feasible with promising results, indicating stability at the time of mid-term follow-up. This article is to evaluate the role of transarterial Onyx embolization in the treatment of grade I and II intracranial dural arteriovenous fistulas (DAVFs), including its limitations and risks.
We retrospectively studied consecutive 26 patients (8 women and 18 men) treated for an grade I and II intracranial DAVF since 2006 in whom a transarterial approach was attempted with Onyx-18 embolization. There were 18 transverse-sigmoid sinus, 4 cavernous sinus, 2 superior sagittal sinus, 1 inferior petrosal sinus and 1 intradiploic fistulas. Five fistulas were Type I, 8 were Type IIa, and 13 were Type IIa+b, according to the Cognard classification. The mean clinical follow-up period was 15.6 months.
Anatomic cure was proven in 13 patients (50%) and clinical cure was obtained in 17 cases (65.4%). These 13 cures were achieved after a single procedure. All these 13 patients underwent a follow-up angiography, which has confirmed the complete cure. Partial occlusion was obtained in 13 patients. Complications were as follows: 2 cardiac Onyx migration, 2 reflexive bradyarrythmia, 1 transient visual hallucination, 2 transient fifth nerve palsies and 1 permanent seventh nerve palsy in inferior petrosal sinus DAVF.
Based on this experience, grade I and II intracranial DAVFs may be treated with transarterial Onyx embolization to reduce the shunted blood flow and to facilitate subsequent transvenous embolization or surgery.
European journal of radiology 12/2011; 80(3):e385-8. · 2.65 Impact Factor
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ABSTRACT: To evaluate the characteristics of brain arteriovenous malformations (AVMs) with coexisting flow-related and Willis circle aneurysms.
The 302 consecutive retrospectively reviewed patients from the Beijing Tiantan Hospital were analyzed in this study. The presence of cerebral aneurysms was confirmed by pretreatment selective and superselective angiography. Univariate and multivariate analyses were performed for patient age, sex, history of rupture, associated aneurysms, AVM size, and deep and superficial venous drainage.
Of the 302 patients, 41 (13.6%) had AVMs associated with intranidal aneurysms, and 33 (10.9%) had AVMs associated with extranidal aneurysms. Of the 33 patients, 24 (72.7%) had a flow-related and 9 (27.3%) had a Willis circle aneurysm. Flow-related and Willis circle aneurysms correlated positively with intracranial hemorrhage (P = 0.003), patient age (P = 0.003), and infratentorial AVMs (P = 0.040) in multiple univariate analysis.
Flow-related and Willis circle aneurysms coexisting with cerebral AVMs frequently are associated with initial hemorrhage presentation, patient age, and infratentorial AVM location.
World Neurosurgery 11/2011; 76(5):455-8. · 0.68 Impact Factor
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ABSTRACT: The Leo self-expandable stent is a new retractable stent that is delivered via a conventional catheter. The aim of this study was to evaluate the use of this stent for endovascular treatment of complex aneurysms.
Twenty-eight complex cerebral aneurysms (27 saccular and 1 fusiform) in 28 patients were treated electively. They were located at the internal carotid artery (17), basilar trunk (3), anterior cerebral artery (1), anterior communicating artery (3), vertebral artery (2) and middle cerebral artery (2). One aneurysm exhibited recanalization after primary endovascular treatment without stent. Clinical outcome was assessed with the modified Glasgow Outcome Scale.
Deployment of Leo stent was successful in 26 lesions, and difficulties in stent positioning due to tortuous cerebral circulation in 2 cases, which were treated with Neuroform stent. Additional coil embolization was performed in 26 lesions. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in all aneurysms. There was no immediate coil embolization was chosen in 3 cases because of subsequent reduced filling of the aneurysms with contrast agent on angiograms. There were 3 asymptomatic parent artery occlusion related to the deployment of the Leo stent, one stent migration. Follow-up revealed patent stents in the remaining cases. No angiographic recurrences arose.
The Leo stent is very useful for endovascular treatment of complex cerebral aneurysms because it is easy to navigate and place precisely. A drawback is that in-stent thrombosis caused by stent placement and stiffer delivery catheters to place larger stents.
European journal of radiology 08/2011; 79(2):317-22. · 2.65 Impact Factor
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ABSTRACT: Cerebral perforating artery (CPA) aneurysms are rarely reported in the literature, making management decisions challenging. This study is to report neurological outcomes in a single institution experience of perforating artery aneurysms treated endovascularly.
All cases involving patients with CPA aneurysms who presented to Beijing Tiantan Hospital between September 2006 and September 2009 were reviewed retrospectively.
Over 3 years, four patients with four CPA aneurysms were treated. The Hunt and Hess grade on admission ranged from 0 to IV, with intracranial hemorrhage in three of the four patients. Conventional angiography confirmed the presence of the aneurysms, and all patients underwent endovascular embolization using liquid embolic materials with parent artery sacrifice. Associated risk factor in our series of patients was brain arteriovenous malformation. The locations of aneurysm were lenticulostriate artery, anterior choroidal artery and medial posterior choroidal artery. The mean size of the aneurysms was 2.5 mm. The mean modified Rankin scale score at follow-up was 1.25. Three patients in whom the perforating artery was sacrificed had good outcomes, suggesting that loss of the artery is clinically well tolerated.
This case series reveals that endovascular treatment of CPA aneurysms may be an appropriate, effective, and safe therapy.
Neurological Research 06/2011; 33(5):553-7. · 1.52 Impact Factor
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ABSTRACT: Perimedullary arteriovenous fistula (AVF) has shunt on the spinal cord surface and it can be treated with surgery, or endovascular embolization. Intramedullary arteriovenous malformation (AVM) has its nidus in the cord and is difficult to treat either by surgery or endovascular technique. We report our experience with endovascular embolization in the treatment of perimedullary AVF and intramedullary AVM.
Four consecutive cases of spinal perimedullary AVF and six intramedullary AVM were retrospectively reviewed. These cases were evaluated and treated at Beijing Tiantan Hospital, China, over a 2-year period. A review of previously reported cases was also performed.
There was no significant difference in the presentations (P = 0.348), level of lesions (P = 0.350), arterial suppliers (P = 0.801), and associated vascular anomalies between perimedullary AVF and intramedullary AVM, except for age (P = 0.014) and treatment modalities (P = 0.003). The patients with perimedullary AVFs were younger in our cases; the age at onset of symptoms averaged 25.8 years compared to 31.7 years for intramedullary AVMs. There was a significant male predominance for both lesions, and a significantly higher incidence of subarachnoid hemorrhage than in spinal dural AVFs. Regarding treatment, endovascular coil embolization is frequently used in perimedullary AVF and liquid embolic agent is an effective therapeutic choice in intramedullary AVM.
Perimedullary AVF and intramedullary AVM are dissimilar with dural AVF in clinical characteristics. Our experience suggests that the endovascular treatment of spine perimedullary AVFs and intramedullary AVMs is feasible and effective. Endovascular treatment for intramedullary AVMs is still challenging, the main problem is acute ischemia injury of the spinal cord.
Neuroradiology 05/2011; 54(4):349-59. · 2.82 Impact Factor
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ABSTRACT: The aim of the present retrospective study is to compare outcome of the endovascular treatment using the Enterprise stent in intracranial wide-necked saccular and dissecting aneurysms.
Forty-six patients with 50 complex intracranial aneurysms admitted between June 2009 and November 2010 were treated using Enterprise stents. Thirty-one aneurysms were wide-necked saccular, 19 aneurysms dissecting. In 48 cases, aneurysms were occluded by stent-assisted coiling; in 2 cases, by stent alone.
Among the aneurysms treated with the Enterprise stent, patient sex, aneurysm location, hypertension history and the immediate angiographic results differed significantly between the saccular and dissecting aneurysm groups. However, recurrence rate, clinical follow-up outcomes did not differ significantly between the saccular and dissecting groups. There was 1 (2%) procedure-related complication, which caused death in the saccular group. At mean 9.1-month follow-up, the result was good in all dissecting cases and good in 30 saccular cases. There was 1 recurrence in each group.
Enterprise stent is very useful for endovascular embolization of intracranial wide-necked saccular and dissecting aneurysms because it is easy to navigate and place precisely. The overall morbidity and mortality rates were low.
European journal of radiology 05/2011; 81(6):1179-83. · 2.65 Impact Factor
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ABSTRACT: In univariate survival analysis, coexisting aneurysms was associated with a significantly increased risk of hemorrhage in AVMs. We report here on our clinical experience with AVMs associated with arterial aneurysms that were managed by endovascular treatment.
To determine the incidence of associated aneurysms, the authors reviewed 366 consecutive patients with AVMs managed between 1999 and 2009. In 86 (23.5%) of these 366 patients, 55 intranidal aneurysms and 40 proximal aneurysms were observed. Targeted endovascular treatment with coils, n-butylcyanoacrylate(NBCA) and Onyx was performed for patients in this series, using a standard protocol. We reviewed the treatment plans, radiological findings and clinical courses of 86 patients suffering AVM associated with aneurysm.
Ninety-five aneurysms in 86 patients with AVMs were enrolled in this study. Hemorrhage was the most frequent presenting symptom (69 patients, 80.2%). Bleeding was caused by an AVM nidus in 44 cases, aneurysm rupture in 20 and an undetermined origin in 5. Four patients were treated for associated aneurysm with coils followed by AVM embolization and 82 patients were treated with NBCA or Onyx embolization. There were total of 3 complications (3.5%) clinically significant complications in this series. Excellent or good outcomes (Glasgow Outcome Scale ≥ 4) were observed in 63 (73.3%) patients at discharge. Neurological deficits (Glasgow Outcome Scale 1-4) were 16.6% at discharge.
Endovascular treatment can be adequately used for cerebral aneurysms associated with AVMs as an adjunct to microsurgery and radiosurgery.
European journal of radiology 04/2011; 81(6):1296-8. · 2.65 Impact Factor
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ABSTRACT: To explore angioarchitectural features of brain arteriovenous malformations (BAVMs) in ages.
302 Consecutive patients with BAVMs between 1999 and 2008 were retrospectively reviewed. Univariate analysis was used to test initial presentation and BAVM characteristics in different ages.
Patients ranged in age from 5 to 65 years (mean±SD, 28.3±12.8). One hundred and eighty-eight were male and 113 female. Clinical presentations were hemorrhage (52.6%), seizure (24.5% of patients), headache (12.6%), focal neurological deficit (6.3%), or other clinical events, including incidental BAVM diagnoses (4.0%). Increasing age correlated positively with coexisting arterial aneurysms (P=0.044). No differences were found for sex, initial presentation, BAVM size, BAVM location, arterial feeders and venous drainage pattern between each age groups.
Increasing age correlated positively with coexisting arterial aneurysms. No statistical significance was observed for clinical presentations, and BAVM characteristics among age groups.
European journal of radiology 02/2011; 81(4):780-3. · 2.65 Impact Factor
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ABSTRACT: The laterocavernous sinus system is best defined as the entire territory served by the laterocavernous and the superior petrosal sinuses (SPS).
The laterocavernous sinus is a small but important venous structure located between the two dural layers forming the lateral wall of the cavernous sinus and has been described as one of the principal drainage pathways of the deep and superficial middle cerebral veins.
Several disease processes in the head involve the laterocavernous sinus. To evaluate and treat these diseases it is necessary for neuroradiologists not only to know selective angiography and embolization techniques, but also the territory of the laterocavernous sinus and venous watershed between the deep and superficial venous systems.
In the present report the normal angiographic anatomy of the laterocavernous sinus system, its relationship with the deep and superficial venous systems, and its importance in clinical situations are outlined.
World Neurosurgery 01/2011; 75(1):90-3; discussion 34-5. · 0.68 Impact Factor
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ABSTRACT: The embolic agents currently used for the treatment of AVMs are n-butyl cyanoacrylate (NBCA) and ethylene-vinyl alcohol copolymer (ONYX). The purpose of this study was to examine the overall NBCA and ONYX embolization-related complication rate.
We retrospectively reviewed 147 consecutive patients with cerebral AVMs treated mainly with endovascular NBCA and ONYX embolization. Demographics, including age, sex, presenting symptoms, and angiographic factors including AVM size, deep venous drainage, and involvement of eloquent cortex were recorded. Number of pedicles embolized, the obliteration rate, and any complications were recorded. Complications were classified as the following: bleeding and ischemic complications. The ischemic complications were also classified as transient neurologic deficit, and permanent deficits. Modified Rankin Scale (mRS) scores were collected pre- and postembolization on all patients. Univariate regression analysis of determinants of complications was performed.
We reviewed 147 patients with BAVM (58.5% male; mean age±SD at treatment: 27.5±11.1 years) treated with endovascular embolization. Two hundred twenty embolization, 144 NBCA and 76 ONYX embolizations were performed. Complete obliteration of BAVMs were achieved in 29 patients (19.7%). Additional gamma-knife radiosurgery were performed for 32 (21.8%) patients. There were 5 Spetzler-Martin grade I (3.4%), 20 grade II (13.6%), 54 grade III (36.7%), 44 grade IV (30%), and 24 grade V (16.3%) AVMs. There were a total of 7 (4.8% per patient, 3.2% per procedure) complications. There were bleeding complications in 2 patients (1.4% per patient, 0.9% per procedure), transient neurologic deficits in 4 (2.7% per patient, 1.8% per procedure) and 1 permanent deficit (0.7% per patient, 0.5% per procedure). Of the 147 patients, 141 (95.9%) were mRS 0-2, 6 (4.1%) were mRS=3 at discharge. Univariate analysis of risk factors for embolic agent showed that ONYX was not significantly associated with complications (X2=0.3, P>0.5).
Embolization of brain AVMs is safe, 95.9% of patients had excellent or good outcomes at discharge after AVM embolization using liquid embolic agents, with a complication rate of 4.8%. ONYX embolization was not associated a higher rate of complications comparing with NBCA embolization.
European journal of radiology 10/2010; 80(3):776-9. · 2.65 Impact Factor
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ABSTRACT: To report transarterial Onyx packing of the transverse-sigmoid sinus for dural arteriovenous fistulae (DAVFs).
We retrospectively studied consecutive 5 patients (2 female and 3 male) treated for a transverse-sigmoid sinus DAVF since 2008 in whom transverse sinus packing was attempted with a transarterial approach Onyx embolization. The mean clinical follow-up period was 6.2 months.
Of the five lesions, 2 fistulas were type IIa, 3 were type IIb, according to the Cognard classification. Five Onyx embolizations were all performed via the middle meningeal artery. Cure was obtained in all cases after completion of direct sinus packing. No complications were revealed.
Transarterial Onyx packing of transverse-sigmoid sinus for DAVFs via the meningeal arterial system is a safe therapeutic alternative in selected cases.
European journal of radiology 10/2010; 80(3):767-70. · 2.65 Impact Factor
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ABSTRACT: Surgical treatment of VA-PICA dissecting aneurysms is difficult and complication of LCNP is common. These lesions can be approached easily with endovascular technique, but complete obliteration can only be achieved in a small number of cases. Our aim was to report the clinical outcomes of VA-PICA dissecting aneurysms treated by endovascular embolization.
Between 2001 and 2007, the authors treated 22 consecutive patients (15 men and 7 women; ranging in age from 12 to 59 years; mean age, 43 years) with VA-PICA dissecting aneurysms. Diagnosis of VA-PICA dissecting aneurysm was based on clinical, MR imaging, and cerebral angiography studies.
Of the 22 patients, 6 had unruptured aneurysms. One patient presented with headaches, whereas the remaining 5 patients showed brain stem ischemia. Four were treated with stent-only or stent-coil embolization, and 2 were treated with unilateral VA occlusion. Among 16 patients presenting with SAH, 10 were treated with stent-only or stent-coil embolization. The other 6 patients with SAH were treated by using unilateral endovascular VA occlusion. One patient could not return to his previous daily activities.
VA-PICA aneurysms are rare lesions associated with significant morbidity, and endovascular treatment strategies for these lesions were stent deployment with or without coil embolization and VA occlusion. Favorable clinical outcomes can be achieved with endovascular techniques.
American Journal of Neuroradiology 08/2010; 31(7):1232-5. · 2.93 Impact Factor
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ABSTRACT: To report our experience with 12 ruptured and 12 unruptured vertebral artery (VA) fusiform aneurysms treated endovascularly using stents.
Three patients were female and 20 patients were male; their mean age was 43·7 (17-77) years. Altogether, 25 stents were placed in 23 patients for 24 fusiform VA aneurysms.
All patients were successfully treated using stents; in 19 patients, we also coil-embolized the aneurysmal lumen. One aneurysm was treated by the placement of two stents covering the dissection site. No technical complications were encountered. According to the Glasgow outcome scale, at follow-up after treatment, 22 patients (95·7%) made a good recovery and one (4·3%) died due to rebleeding during the procedure.
Endovascular therapy using stents may be a useful treatment in patients with fusiform VA aneurysms involving the posterior inferior cerebellar artery or hypoplasia of the contralateral VA or unruptured VA aneurysms.
Neurological Research 05/2010; 32(8):792-5. · 1.52 Impact Factor
