Cerebellar hemorrhage after embolization of ruptured vertebral dissecting aneurysm proximal to PICA including parent artery

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Abstract

Background:

Some complications related to vertebral artery occlusion by endovascular technique have been reported. However, cerebellar hemorrhage after vertebral artery occlusion in subacute phase is rare. In this report, we describe a patient who showed cerebellar hemorrhage during hypertensive therapy for vasospasm after embolization of a vertebral dissecting aneurysm.

Case Description:

A 56-year-old female with a ruptured vertebral dissecting aneurysm proximal to the posterior inferior cerebellar artery developed cerebellar hemorrhage 15 days after embolization of the vertebral artery, including the dissected site. In this patient, the preserved posterior inferior cerebellar artery fed by retrograde blood flow might have been hemodynamically stressed during hypertensive and antiplatelet therapies for subarachnoid hemorrhage, resulting in cerebellar hemorrhage.

Conclusion:

Although cerebellar hemorrhage is not prone to occur in the nonacute stage of embolization of the vertebral artery, it should be taken into consideration that cerebellar hemorrhage may occur during hypertensive treatment.

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Most cited references 8

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Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling.

Yeon-Soo Seo, J D Joo, Brian J. Lee … (2006)

Endovascular treatment with stent placement or stent-assisted coiling was recently introduced as an alternative to parent artery occlusion in intracranial vertebral artery dissections. We describe the efficacy and limitations of this method. Fourteen patients with intracranial vertebral artery dissection were treated with stent placement (10 patients) or stent-assisted coiling (4 patients). Double overlapping stents were deployed in 4 of 10 patients with stent placement alone. Angiographic follow-up at 6 to 12 months was available in 13 patients. In 13 patients with dissecting aneurysm, immediate angiographic outcomes were complete occlusion (1 patient), nearly complete (2 patients), and incomplete (10 patients). Follow-up angiograms of 12 of these patients showed complete occlusion (6 patients) and incomplete (6 patients; 1 unstable and 5 stable). Complete occlusion rates in follow-up angiograms were superior in double stent placement (75%) or stent-assisted Guglielmi detachable coil (GDC) embolization to stent placement alone (0%). There were no instances of postprocedural ischemic attacks, new neurologic deficits, and no new minor or major strokes before patient discharge. On the modified Rankin scale applied in follow-up, all patients were assessed as functionally improved or of stable clinical status. Intracranial vertebral artery dissections were acceptably treated with stent placement or stent-assisted coiling, and the patency could be preserved at follow-up. However, the efficiency of stent placement alone for intracranial vertebral artery dissecting aneurysm was limited. Stent-assisted coil embolization or double stent placements are a viable alternative for complete occlusion of dissecting aneurysms.

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Endovascular treatment of ruptured dissecting vertebral artery aneurysms--long-term follow-up results, benefits of early embolization, and predictors of outcome.

Jong-Myong Lee, Tae-Sun Kim, Sung-Pil Joo … (2010)

The purpose of this study was to evaluate the effect of endovascular treatment of ruptured dissecting aneurysms of the vertebral artery, the benefits of early embolization, and the predictors of outcomes. Between September, 2001 and May, 2009, 25 patients with ruptured vertebral dissecting aneurysms were treated by internal coil trapping (n = 23) or stents (n = 2) in our hospital. There were 14 males and 11 females with a mean age of 45 years (age range, 22-66 years). Dissecting aneurysms were supra-posterior inferior cerebellar artery lesions (n = 16), infra-posterior inferior cerebellar artery lesions (n = 6), or involved the posterior inferior cerebellar artery (n = 3). Complete occlusion of dissected arterial and aneurysm segments (internal trapping) was achieved in 21 (91.3%) of 23 patients. The two patients with posterior inferior cerebellar artery involvement underwent double stent only placement. Clinical outcomes were favorable in 17 (68%) of 25 patients, 2 (8%) had severe disability, and 6 (24%) patients died. Risk factors that varied with favorable versus unfavorable outcomes were: preoperative Hunt-Hess, World Federation of Neurological Surgeons scale, presence of hydrocephalus, presence of lateral medullary syndrome, presence of low cranial nerve palsy, rebleeding, time of endovascular procedures, and time from admission to procedure. However, univariate Cox analysis confirmed that only low preoperative Hunt-Hess grade predicted favorable clinical outcome. Early embolization did not affect clinical outcome, but reduced the risk of rebleeding and inpatient stay. In our experience, internal trapping of the dissected segment with a coil was straightforward, applicable to most patients, prevented rebleeding safely and effectively without significant procedural complications, and had a good follow-up outcome. The low Hunt-Hess grade remained predictors of favorable clinical outcomes. The timing of embolization did not significantly affect clinical outcome but early embolization reduces inpatient stay.

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Rebleeding from vertebral artery dissection after proximal clipping. Case report.

C Kitanaka, T Morimoto, T Sasaki … (1992)

The authors present the case of a patient with vertebral artery dissection that rebled after being treated by proximal clipping. This is the second report of such a case. The results indicated that proximal clipping is not free from the risk of rebleeding, and a better alternative surgical technique should always be sought when treating vertebral artery dissections.

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Author and article information

Contributors

Akira Tamase

Tomoya Kamide

Kentaro Mori

Hiroshi Shima

Shunsuke Seki

Motohiro Nomura

Journal

Journal ID (nlm-ta): Surg Neurol Int

Journal ID (iso-abbrev): Surg Neurol Int

Journal ID (publisher-id): SNI

Title: Surgical Neurology International

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2229-5097

ISSN (Electronic): 2152-7806

Publication date Collection: 2014

Publication date (Electronic): 21 April 2014

Volume: 5

Electronic Location Identifier: 59

Affiliations

[1]Department of Neurosurgery, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama 247-8581, Japan

Author notes

[* ]Corresponding author

Article

Publisher ID: SNI-5-59

DOI: 10.4103/2152-7806.131187

PMC ID: 4033783

SO-VID: 4193bebc-625c-4b61-91a8-93aa212f22a3

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 12 November 2013

Date accepted : 20 February 2014

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Cerebellar hemorrhage after embolization of ruptured vertebral dissecting aneurysm proximal to PICA including parent artery

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Abstract

Background:

Case Description:

Conclusion:

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Chinese Journal of General Practice

Most cited references 8

Endovascular treatment of intracranial vertebral artery dissections with stent placement or stent-assisted coiling.

Endovascular treatment of ruptured dissecting vertebral artery aneurysms--long-term follow-up results, benefits of early embolization, and predictors of outcome.

Rebleeding from vertebral artery dissection after proximal clipping. Case report.

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