365体育网站

Advertisement

Basilar Artery Trunk Aneurysm: Large Transitional Vertebrobasilar Artery Aneurysm Causing Severe Ischemic Cerebellar Stroke; Treatment with a Surpass Flow Diverter with Growing Thrombus, Increasing Mass Effect and Continued Contrast Medium Pooling in the Thrombus despite Angiographic Remodeling

  • Ivan LylykEmail author
  • Rene Viso
  • Carlos Bleise
  • Pedro Lylyk
Living reference work entry
  • 82 Downloads

Abstract

This chapter describes the treatment of a vertebrobasilar fusiform aneurysm, which was found in a 57-year-old male patient who presented with an acute ischemic stroke causing ataxia, dysarthria, and gait disturbance due to an infarct involving the SCA, AICA/PICA, and pontine perforator supply territories. The patient was treated by deploying a single long Surpass (Stryker) flow diverter from the basilar artery trunk to the right-hand V4 segment. During the same session, the distal V4 segment on the left-hand side was occluded with coils in order to prevent competing flow from this artery, creating an endoleak-like phenomenon. The procedure was well tolerated. An MRI/MRA follow-up examination showed a growing thrombus in the fusiform aneurysm with persistent contrast pooling. The main topics discussed in this chapter will be the evolution of this vicious disease with or without treatment and the different strategies and options available for treatment.

Keywords

Basilar artery Fusiform aneurysm Ischemic stroke Surpass flow diverter Deconstructive vertebral artery occlusion 

References

  1. Awad AJ, Mascitelli JR, Haroun RR, De Leacy RA, Fifi JT, Mocco J. Endovascular management of fusiform aneurysms in the posterior circulation: the era of flow diversion. Neurosurg Focus. 2017 Jun;42(6):E14.  .
  2. Bhogal P, Pérez MA, Ganslandt O, Bäzner H, Henkes H, Fischer S. Treatment of posterior circulation non-saccular aneurysms with flow diverters: a single-center experience and review of 56 patients. J Neurointerv Surg. 2017 May;9(5):471–81.  .
  3. Chen YA, Drake BJ, Chiu AH, Marotta TR. Pipeline embolization device induced collateral channels in elective flow diversion treatment. J Neurointerv Surg. 2016.  .
  4. Chiu AH, Marotta TR. Pipeline embolization device thrombosis induced peri-construct collateral channels. J Neurointerv Surg. 2016 Nov;8(11):e47.  .
  5. Coert BA, Chang SD, Do HM, Marks MP, Steinberg GK. Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms. J Neurosurg. 2007 May;106(5):855–65.  .
  6. Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Nakatomi H, Huston J 3rd, McClelland R, Christianson TJ. Prospective risk of hemorrhage in patients with vertebrobasilar nonsaccular intracranial aneurysm. J Neurosurg. 2004;101(1):82–7.  
  7. Flemming KD, Wiebers DO, Brown RD Jr, Link MJ, Huston J 3rd, McClelland RL, Christianson TJ. The natural history of radiographically defined vertebrobasilar nonsaccular intracranial aneurysms. Cerebrovasc Dis. 2005;20(4):270–9.  
  8. Mangrum WI, Huston J 3rd, Link MJ, Wiebers DO, McClelland RL, Christianson TJ, Flemming KD. Enlarging vertebrobasilar nonsaccular intracranial aneurysms: frequency, predictors, and clinical outcome of growth. J Neurosurg. 2005 Jan;102(1):72–9.  .
  9. Munich SA, Tan LA, Keigher KM, Chen M, Moftakhar R, Lopes DK. The pipeline embolization device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution. J Neurosurg. 2014 Nov;121(5):1077–84.  .
  10. Nasr DM, Flemming KD, Lanzino G, Cloft HJ, Kallmes DF, Murad MH, Brinjikji W. Natural history of vertebrobasilar dolichoectatic and fusiform aneurysms: a systematic review and meta-analysis. Cerebrovasc Dis. 2018;45(1-2):68–77.  .
  11. Passero SG, Rossi S. Natural history of vertebrobasilar dolichoectasia. Neurology. 2008 Jan 1;70(1):66–72.  .
  12. Raphaeli G, Collignon L, De Witte O, Lubicz B. Endovascular treatment of posterior circulation fusiform aneurysms: single-center experience in 31 patients. Neurosurgery. 2011 Aug;69(2):274–83.  .
  13. Rigante L, Moudrous W, de Vries J, de Korte AM, Boogaarts HD. Gradual remodelling of the vertebrobasilar circulation with reconstructive treatment of a symptomatic fusiform basilar artery aneurysm. Acta Neurol Belg. 2017 Dec;117(4):961–4.  .
  14. Sacho RH, Saliou G, Kostynskyy A, Menezes R, Tymianski M, Krings T, Radovanovic I, Terbrugge K, Rinkel GJ, Willinsky R. Natural history and outcome after treatment of unruptured intradural fusiform aneurysms. Stroke. 2014 Nov;45(11):3251–6.  .
  15. Saliou G, Sacho RH, Power S, Kostynskyy A, Willinsky RA, Tymianski M, terBrugge KG, Rawal S, Krings T. Natural history and management of basilar trunk artery aneurysms. Stroke. 2015 Apr;46(4):948–53.  .
  16. Serrone JC, Gozal YM, Grossman AW, Andaluz N, Abruzzo T, Zuccarello M, Ringer A. Vertebrobasilar fusiform aneurysms. Neurosurg Clin N Am. 2014 Jul;25(3):471–84.  .
  17. Shapiro M, Becske T, Riina HA, Raz E, Zumofen D, Nelson PK. Non-saccular vertebrobasilar aneurysms and dolichoectasia: a systematic literature review. J Neurointerv Surg. 2014 Jun;6(5):389–93.  .
  18. van Oel LI, van Rooij WJ, Sluzewski M, Beute GN, Lohle PN, Peluso JP. Reconstructive endovascular treatment of fusiform and dissecting basilar trunk aneurysms with flow diverters, stents, and coils. AJNR Am J Neuroradiol. 2013 Mar;34(3):589–95.  .
  19. Yu YL, Moseley IF, Pullicino P, McDonald WI. The clinical picture of ectasia of the intracerebral arteries. J Neurol Neurosurg Psychiatry. 1982 Jan;45(1):29–36.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Ivan Lylyk
    • 1
    Email author
  • Rene Viso
    • 1
  • Carlos Bleise
    • 1
  • Pedro Lylyk
    • 1
  1. 1.Clinica Sagrada Familia, ENERIBuenos AiresArgentina

Personalised recommendations