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Embolization, TherapeuticIntracranial AneurysmAneurysmCerebral AngiographyParentsAneurysm, InfectedAngiography, Digital SubtractionVertebral ArteryAneurysm, RupturedArteriesAortic AneurysmPosterior Cerebral ArteryAneurysm, DissectingCarotid Artery, InternalAneurysm, FalseBasilar ArteryTreatment OutcomeAortic Aneurysm, ThoracicTomography, X-Ray ComputedCerebral ArteriesSubarachnoid HemorrhageHeart AneurysmCarotid Artery DiseasesBalloon OcclusionCavernous SinusStentsRadiography, InterventionalEnbucrilateEndovascular ProceduresCarotid-Cavernous Sinus FistulaAnterior Cerebral ArteryVertebral Artery DissectionIliac AneurysmBlood Vessel Prosthesis ImplantationRenal ArterySurgical InstrumentsAngiographySplenic ArteryCerebral RevascularizationPulmonary ArteryCoronary AneurysmRetreatmentFollow-Up StudiesIliac ArteryPolyvinylsFemoral ArteryIntracranial Arteriovenous MalformationsCarotid ArteriesEmbolismBlood Vessel ProsthesisNeurosurgical ProceduresRetrospective StudiesEquipment and SuppliesMagnetic Resonance AngiographyUterine Artery EmbolizationEquipment DesignHepatic ArteryPolyvinyl AlcoholAortic RuptureAorta, AbdominalCerebellumImaging, Three-DimensionalArteriovenous FistulaVascular Surgical ProceduresMesenteric ArteriesArteriovenous MalformationsSubclavian ArteryGelatin Sponge, AbsorbableAortographyBronchial ArteriesMesenteric Artery, SuperiorCeliac ArteryCoronary Artery BypassKaolinPostoperative ComplicationsAutomatismMammary ArteriesRadial ArteryOphthalmic ArteryTime FactorsCarotid Artery, CommonCerebrovascular CirculationCyanoacrylatesMagnetic Resonance ImagingPlatinumCentral Nervous System Vascular MalformationsForeign-Body MigrationCarotid Artery, ExternalCatheterizationPopliteal ArteryProsthesis DesignMiddle Cerebral ArteryAngioplastyTissue AdhesivesIntracranial EmbolismBrachial ArteryButtocksCoronary VesselsImage Processing, Computer-AssistedMaxillary Artery
IntracranialSubarachnoid hemorrhageVertebral arteryProximalCoil embolizationCerebral angiographySaccular aneurysmsAcuteArterialOcclusionVertebrobasilarEtiologyPosterior circulationJunctionAntegradeEndovascular treatmentIschemic strokeAnterior circulationSegmentAngiographicIpsilateralHemodynamicBrainSegmentsLumenConsecutive patientsVesselTreatmentUnderwentOccurOriginBloodCompletePatients
Intracranial20
  • Posterior inferior cerebellar artery (PICA) aneurysms account for approximately 0.5% to 3.0% of all intracranial aneurysms, 1 , 2 and most are located right at the origin or in the first anteromedullary segment of the vessel. (ajnr.org)
  • The cases were collected from the data base containing all of the patients who had undergone endovascular treatment for their intracranial aneurysm since the start of the endovascular coiling activity in our hospital on December 1993 until March 2008. (ajnr.org)
  • Ten of the aneurysms presented with an acute intracranial hemorrhage, and 2 were incidental imaging findings. (ajnr.org)
  • Only 8-12% of intracranial aneurysms and 5-15% of arterial venous malformations (AVMs) occur in the posterior circulation. (surgicalneurologyint.com)
  • Pipeline embolization device (PED) has proved its safety and efficacy in the treatment of intracranial large and giant side-wall aneurysms. (biomedcentral.com)
  • Since its approval by FDA in 2011, PED (ev3, USA) has proved its safety and efficacy in the treatment of large and giant intracranial aneurysms from the petrous to the superior hypophyseal segment of the internal carotid artery [ 1 , 2 ]. (biomedcentral.com)
  • BackgroundSelection of appropriate surgical strategy for the treatment of intracranial aneurysms (IA) during pregnancy requires careful consideration of the potential risks to the mother and fetus. (journaltocs.ac.uk)
  • Although genetic conditions are associated with increased risk of aneurysm development (see below), most intracranial aneurysms probably result from hemodynamically induced degenerative vascular injury. (medscape.com)
  • The occurrence, growth, thrombosis, and even rupture of intracranial saccular aneurysms can be explained by abnormal hemodynamic shear stresses on the walls of large cerebral arteries, particularly at bifurcation points. (medscape.com)
  • The incidence of intracranial aneurysms is not known with certainty but is estimated to be in the range of 1-6% of the population. (medscape.com)
  • Familial intracranial aneurysms have been reported. (medscape.com)
  • Autosomal dominant polycystic kidney disease (ADPKD) is by far the most common genetic abnormality associated with intracranial aneurysms, with an estimated 5-40% of ADPKD patients harboring such lesions. (medscape.com)
  • This study aimed to evaluate the effectiveness, safety, and technical considerations of flow diverter (FD) treatment using a Flow Re-direction Endoluminal Device (FRED) for unruptured intracranial vertebral artery dissecting aneurysms (VADAs). (neurointervention.org)
  • The rate of intracranial artery involvement from dissection is exceptionally high in Asia [ 3 - 5 ]. (neurointervention.org)
  • As compared to patients in Western countries, intracranial arterial dissections in Koreans occur most commonly in the posterior circulation, particularly in the vertebral artery (VA) [ 1 , 6 ]. (neurointervention.org)
  • The 3 major types of true intracranial aneurysms are saccular, fusiform, and dissecting. (medscape.com)
  • The common causes of intracranial aneurysm include hemodynamically induced or degenerative vascular injury, atherosclerosis (typically leading to fusiform aneurysms), underlying vasculopathy (eg, fibromuscular dysplasia), and high-flow states, as in arteriovenous malformation (AVM) and fistula. (medscape.com)
  • Most saccular or intracranial berry aneurysms were once thought to be congenital in origin, arising from focal defects in the media and gradually developing over a period of years as arterial pressure first weakens and subsequently balloons out the vessel wall. (medscape.com)
  • The true incidence of intracranial aneurysms is unknown but is estimated at 1-6% of the population. (medscape.com)
  • In one series of patients undergoing coronary angiography, incidental intracranial aneurysms were found in 5.6% of cases, and another series found aneurysms in 1% of patients undergoing 4-vessel cerebral angiography for indications other than subarachnoid hemorrhage (SAH). (medscape.com)
Subarachnoid hemorrhage8
Vertebral artery5
  • Proximal PICA aneurysms located at the vertebral artery-PICA junction or at anteromedullary segment and flow-related aneurysms associated with brain arteriovenous malformations were excluded. (ajnr.org)
  • Internal trapping in which the dissecting aneurysm is occluded represents reliable treatment to prevent rebleeding of ruptured vertebral artery (VA) dissecting aneurysms. (surgicalneurologyint.com)
  • Especially, if dissecting aneurysm of proximal PICA is associated with small caliber PICA and stenosis of ipsilateral vertebral artery orifice (VAO), endovascular coiling with saving of PICA is not always easy. (koreamed.org)
  • We performed bifemoral puncture and chose additional route from right vertebral artery to left vertebrobasilar junction for retrograde approach and deployment of LVIS Jr. intraluminal support at proximal PICA. (koreamed.org)
  • 5) The authors present a successful but challenging case of stent-assisted coil embolization of a ruptured left proximal PICA dissecting fusiform aneurysm with left vertebral artery orifice (VAO) stenosis using the contralateral vertebral artery (VA) approach for stenting and the ipsilateral VA approach for coil embolization. (koreamed.org)
Proximal11
  • 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. (surgicalneurologyint.com)
  • 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. (surgicalneurologyint.com)
  • 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. (surgicalneurologyint.com)
  • 2 3 8 13 ] Proximal occlusion of the VA carries a risk of rebleeding due to the presence of retrograde flow through the contralateral VA. Internal trapping in which the dissecting aneurysm is occluded represents a reliable treatment for preventing rebleeding of ruptured VA dissecting aneurysms. (surgicalneurologyint.com)
  • 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. (surgicalneurologyint.com)
  • 20 , 24 , 33 ] In this context, we present the operative management of two CPAc AVMs - pontine artery aneurysms, both supplied by the same feeder artery, characterized by a small AVM nidus and a proximal ruptured aneurysm. (surgicalneurologyint.com)
  • Aneurysms of the proximal posterior inferior cerebellar artery (PICA) are rare. (koreamed.org)
  • However, the results of endovascular repair of proximal PICA aneurysms are not well reported. (koreamed.org)
  • 7) Furthermore, the safety and feasibility of stent assist coil embolization of proximal PICA aneurysms with narrow caliber are not precisely known, including their radiologic and clinical results. (koreamed.org)
  • A left proximal PICA fusiform dissecting aneurysm with a lacerated PICA orifice was found on cerebral angiography with 3D reconstruction ( Fig. 1B-D ). The shape of this fusiform aneurysm was triangular and irregular, and the size of the aneurysm was 3.95 mm (anterior/posterior diameter) × 3.12 mm (height) × 4.75 mm (length) with a shallow PICA orifice (1.3 mm). (koreamed.org)
  • The diameter of the left PICA just proximal and distal to the dissecting aneurysm was 1.2 mm and 0.9 mm and acute angulation PICA with ipsilateral VA, respectively ( Fig. 1E ). (koreamed.org)
Coil embolization3
  • Only the dilated segment of the aneurysm was occluded by coil embolization. (surgicalneurologyint.com)
  • The safety and feasibility of simple coil embolization and stent deployment for the treatment of posterior inferior cerebellar artery (PICA) aneurysms, as well as their radiologic and clinical results, have not been adequately understood. (koreamed.org)
  • Our endovascular team decided to perform a stent-assisted coil embolization with a bilateral VA approach through bilateral femoral puncture. (koreamed.org)
Cerebral angiography1
Saccular aneurysms4
  • BackgroundIntracranial fusiform aneurysms are less common than saccular aneurysms, but are associated with higher mortality and morbidity. (journaltocs.ac.uk)
  • Saccular aneurysms are rounded berrylike outpouchings that arise from arterial bifurcation points, most commonly in the circle of Willis (see the image below). (medscape.com)
  • Common locations of cerebral saccular aneurysms. (medscape.com)
  • Less common causes of saccular aneurysms include trauma, infection, tumor, drug abuse (cocaine), and high-flow states associated with AVMs or fistulae. (medscape.com)
Acute2
  • We report herein a case of antegrade VA recanalization without obvious coil compaction after internal trapping for acute-phase occlusion of only a dilated segment of the aneurysm. (surgicalneurologyint.com)
  • The acute origin angle of the vessel from the basilar artery made both malformations unsuitable for endovascular treatment. (surgicalneurologyint.com)
Arterial2
  • In this series, most peripheral PICA aneurysms were secondary to arterial dissection. (ajnr.org)
  • The coexistence of hyper-inflow aneurysms and cerebellopontine angle cistern (CPAc) arterial venous malformations (AVMs) have been rarely reported and most commonly associated with high risk of bleeding. (surgicalneurologyint.com)
Occlusion5
  • Four aneurysms were treated by endosaccular coiling, 6 (all dissecting) by parent artery occlusion, and in 2 cases endovascular treatment failed. (ajnr.org)
  • Angiographic outcome was complete aneurysm and/or parent artery occlusion in 9 cases and neck remnant in 1 case. (ajnr.org)
  • 3 aneurysms located at V-B junction, angiographic follow up on 3 months demonstrated no complete occlusion of both the aneurysms, the other patients were still on follow up. (biomedcentral.com)
  • PED for aneurysms incorporated the fetal PCA and V-B junction might meet a high propensity for incomplete occlusion during short term follow up. (biomedcentral.com)
  • Aneurysm with ipsilateral AVM is not suitable for PED treatment due to the risk of hemorrhage and incomplete occlusion during midterm follow up. (biomedcentral.com)
Vertebrobasilar1
  • 2 - 4 Approximately 28% of all aneurysms located in the vertebrobasilar arteries, including PICA, have been estimated to be of dissecting origin. (ajnr.org)
Etiology2
  • The purpose of this study was to assess the etiology and clinical characteristics of peripheral PICA aneurysms and to evaluate the angiographic and clinical results of the patients who underwent endovascular treatment for a peripheral PICA aneurysm in a single center. (ajnr.org)
  • 5 Among peripheral PICA aneurysms, dissecting etiology has been found in 0%-80% of the cases. (ajnr.org)
Posterior circulation1
  • We adopted routinely a triaxial system in the deployment of PED for anterior circulation aneurysm, however for aneurysms located on posterior circulation, a biaxial system consisting of 6Fr guiding catheter and Marksman microcatheter was sufficient. (biomedcentral.com)
Junction4
  • Except for aneurysm, those patients also presented with special angioarchitecture: Fetal PCA, AVM, V-B junction and DAVF. (biomedcentral.com)
  • Here, we report the outcomes of 9 patients with 10 aneurysms that incorporated at least one of the following special angioarchitecture: fetal PCA, AVM, V-B junction and DAVF. (biomedcentral.com)
  • Among those patients, 9 patients were identified with a special angioarchitecture that were qualified for the study, namely the aneurysm was related to fetal PCA, ipsilateral AVM, V-B junction and DAVF. (biomedcentral.com)
  • The internal elastic membrane is reduced or absent, and the media ends at the junction of the aneurysm neck with the parent vessel. (medscape.com)
Antegrade1
Endovascular treatment5
  • Peripheral aneurysms of the posterior inferior cerebellar artery (PICA) are rare, and pre-existing literature concerning their endovascular treatment is limited. (ajnr.org)
  • Three dissecting aneurysms reruptured before endovascular treatment, and another 3 demonstrated angiographic progress. (ajnr.org)
  • Despite the recently increased number of publications, the pre-existing literature concerning endovascular treatment of peripheral PICA aneurysms is limited and controversial. (ajnr.org)
  • 6 - 9 , 11 - 21 In the present study, a consecutive series of 12 patients harboring a peripheral PICA aneurysm allocated for endovascular treatment in a single center was retrospectively analyzed. (ajnr.org)
  • Endovascular treatment has been widely applied to VA dissecting aneurysms, because these procedures are quicker and less invasive than direct surgery. (surgicalneurologyint.com)
Ischemic stroke1
  • The outcomes were statistically comparable between EC and NC for both ruptured and unruptured IA, except for a lower incidence of ischemic stroke in patients undergoing EC for ruptured aneurysms (OR 0.12, 95% CI 0.02 to 0.84).ConclusionsMost pregnant and postpartum patients are treated with EC for both ruptured and unruptured IA. (journaltocs.ac.uk)
Anterior circulation1
  • 25 ] Posterior fossa AVMs also have a documented tendency to develop aneurysms compared to their anterior circulation counterparts. (surgicalneurologyint.com)
Segment1
  • From the 25 angiographically verified PICA aneurysms, 12 were located distally to the anteromedullary segment of the PICA and composed the case material of this study. (ajnr.org)
Angiographic1
  • [ 1 ] Published data vary according to the definition of what constitutes an aneurysm and whether the series is based on autopsy data or angiographic studies. (medscape.com)
Ipsilateral1
  • For preservation of narrow PICA with ipsilateral VAO stenosis, the contralateral approach and deployment of LVIS Jr. intraluminal support may be considered. (koreamed.org)
Hemodynamic1
  • 2 , 6 ] Other suggested hypotheses may implicate either the decreased resistance inside AVM nidus[ 23 ] or the increased hemodynamic turbulence in feeding arteries,[ 36 ] though the contribution of both factors remains unclear. (surgicalneurologyint.com)
Brain2
  • Due to anatomic location of the PICAs (proximity to brain stem and lower cranial nerves), their surgical treatment is associated with significant risk of neurologic complications. (ajnr.org)
  • For patient education resources, see the Headache Center , as well as Aneurysm, Brain . (medscape.com)
Segments1
  • 2 - 4 Roughly, only a fifth of the PICA aneurysms are thought to arise from more distal segments of the PICA. (ajnr.org)
Lumen1
  • These are true aneurysms-that is, they are dilatations of a vascular lumen caused by weakness of all vessel-wall layers. (medscape.com)
Consecutive patients2
  • Twelve consecutive patients with 12 peripheral PICA aneurysms (10 ruptured) included in an internal data base were retrospectively reviewed. (ajnr.org)
  • We performed a retrospective analysis of 210 consecutive patients treated by PED for intracerebral aneurysms in our center. (biomedcentral.com)
Vessel3
  • An aneurysm is an abnormal local dilatation in the wall of a blood vessel. (medscape.com)
  • Atherosclerotic changes in the parent vessel are also common. (medscape.com)
  • Aneurysm is an abnormal local dilatation in the wall of a blood vessel, usually an artery, due to a defect, disease, or injury. (medscape.com)
Treatment3
  • With the accumulation of treatment experience, it is an inevitable trend to expand its off-label use on aneurysms. (biomedcentral.com)
  • For aneurysm with concurrent DAVF, PED treatment is safe and efficient relatively in one session or by staged operation. (biomedcentral.com)
  • The treatment effect of PED is accredited to the flow diversion effect, and aneurysms with concomitant complex angioarchitecture might result in disturbed flow. (biomedcentral.com)
Underwent1
  • whereas among 180 patients treated for unruptured aneurysms, 140 (77.8%) underwent EC and 40 (22.2%) underwent NC. (journaltocs.ac.uk)
Occur1
  • The categorization of these aneurysms is based on their relationship with the nidus, extranidal ones more frequently occur on the pedicle of the feeding artery and are considered the leading cause of bleeding in about 37% of cases. (surgicalneurologyint.com)
Origin1
Blood3
Complete1
  • Aneurysm exclusion and AVM size reduction were obtained in the first case, while complete AVM removal and later aneurysm disappearance were obtained in the second one. (surgicalneurologyint.com)
Patients1
  • There were no statistically significant differences in the baseline characteristics between patients undergoing EC versus NC for either ruptured or unruptured aneurysm groups. (journaltocs.ac.uk)