Giant Saccular Aneurysm Research Articles

Surgery for a giant atherosclerotic left main trifurcation saccular coronary artery aneurysm.

Aneurysms of the left main coronary artery are rare clinical entities with an incidence of 0.1%. We herein report a case of left main trifurcation aneurysm in a 57-year-old woman whose coronary angiography demonstrated a giant saccular aneurysm of trifurcation of the left main coronary artery, measuring 32 × 21mm with tight post-aneurysmal stenosis in the intermediate artery. The patient underwent coronary artery bypass grafting following the resection of CAA and reconstruction with saphenous vein roof-plasty, which ensured the preservation of the native coronary vasculature. At the 6-month follow-up, she remained asymptomatic and preserved preoperative left ventricular function.

Microsurgical Clipping of Giant Saccular Middle Cerebral Artery Aneurysm: A Case Report

Giant saccular middle cerebral artery aneurysm is rare vascular lesion and few cases have been reported in the literature. Microsurgical clipping is applied to treat a giant middle cerebral artery aneurysm .A 26 year-male presented with complain severe headache, multiple episodes of vomiting and one episode of sudden loss conscious since few hours prior to admission at emergency department. Cerebral Angiography showed a giant saccular middle cerebral artery (MCA) aneurysm. A standard right pterional approach applied to expose MCA and microsurgical clipping was performed. No any serious neurological complication was noted after surgery except right facial palsy. Patient was discharged at the 12th day of surgery.Endovascular therapy as well as STA-MCA bypass surgery plus clipping are usually applied to manage the giant MCA aneurysm. However, alone microsurgical clipping is also effective and has better result.

Giant Posterior Inferior Cerebellar Artery Aneurysm Mimicking a Brainstem Tumor

Aneurysms from the vertebrobasilar system are rare, accounting for only 5%-10% of all intracranial aneurysms. The most common sites in which these lesions occur are the bifurcation of the basilar artery and the origin of the posterior inferior cerebellar artery (PICA). When the aneurysms present in the distal portion of the PICA, they represent from 0.5% to 6%. These aneurysms are called giant when they exceed 25 mm in diameter. We present a case of a 49-year-old male who presented with acute obstructive hydrocephalus, which required ventriculoperitoneal shunting and left hemispheric cerebellar syndrome. The magnetic resonance imaging study revealed an occupative mass located in the fourth ventricle, and diagnostic angiography showed a partially thrombosed giant saccular aneurysm in the posterior inferior cerebellar artery. He underwent surgical management via a lateral suboccipital approach. The aneurysm was remodeled and clipped successfully without complications, with an uneventful postoperative course.Although rare, PICA aneurysms should always be considered when posterior fossa syndrome occurs, including brainstem and cranial nerve compression symptoms. It can easily be misdiagnosed as a neoplastic lesion, especially when the aneurysm reaches big or giant size. Therefore, complete diagnostic studies, such as cerebral angiography, must be performed. Surgical clipping must be offered as the first line of treatment. It provides occlusion of the aneurysm and relieves compressive symptoms.

Giant Saccular Aneurysm of the Right Coronary Artery.

Coronary artery aneurysm (CAA) is defined as a segmental coronary dilation that exceeds the diameter of the adjacent normal coronary artery 1.5 times. Its incidence in the general population is between 1.5% and 5%. However, CAAs over 10 mm are extremely rare. The cause of CAA in this patient with diffuse coronary artery disease was evaluated as atherosclerosis. CAA lesion was not the cause of acute coronary syndrome in our patient. Therefore, CAAS can remain asymptomatic for many years. Individuals with systemic diseases, such as Kawasaki's disease and Behçet's disease, should be followed up for CAAS.

Giant unruptured intracranial aneurysm manifesting as ischemic stroke

A 75-year-old hypertensive woman presented with 2-day history of right sided weakness and speech disturbances. Neurologic examination revealed right hemiparesis, anosmia and dysfunction of the left third and sixth cranial nerves. Brain computed tomography scan (A,B) followed by magnetic resonance angiography (C,D) discovered an unruptured cavernous carotid aneurysm measuring 40 × 39 mm in diameter (stars) on the left side with a concomitant acute ipsilateral frontal infarction (arrows). The giant calcified saccular aneurysm contained a dense, structured, and intraluminal thrombus. Laboratory studies were within normal range. Based on these findings, the patient was diagnosed with a thrombosed unruptured carotid-cavernous aneurysm with homolateral anterior cerebral artery ischemic stroke. Exploration of the supra-aortic arteries was normal. No other sources of brain infarction were found on electrocardiogram, transthoracic echocardiography and Holter monitoring. The patient was referred to interventional neuroradiology for endovascular coiling of the aneurysm.

Tętniak gigant pojedynczego pnia tętniczego segmentu A2 tętnicy przedniej mózgu. Trudności w postępowaniu chirurgicznym

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Andrychowski J. Giant saccular aneurysm of the distal A2 segment of the azygos anterior cerebral artery. Difficulties in surgery. Medical Studies/Studia Medyczne. 2019;35(4):327-330. doi:10.5114/ms.2019.91252. APA Andrychowski, J. (2019). Giant saccular aneurysm of the distal A2 segment of the azygos anterior cerebral artery. Difficulties in surgery. Medical Studies/Studia Medyczne, 35(4), 327-330. https://doi.org/10.5114/ms.2019.91252 Chicago Andrychowski, Jarosław. 2019. "Giant saccular aneurysm of the distal A2 segment of the azygos anterior cerebral artery. Difficulties in surgery". Medical Studies/Studia Medyczne 35 (4): 327-330. doi:10.5114/ms.2019.91252. Harvard Andrychowski, J. (2019). Giant saccular aneurysm of the distal A2 segment of the azygos anterior cerebral artery. Difficulties in surgery. Medical Studies/Studia Medyczne, 35(4), pp.327-330. https://doi.org/10.5114/ms.2019.91252 MLA Andrychowski, Jarosław. "Giant saccular aneurysm of the distal A2 segment of the azygos anterior cerebral artery. Difficulties in surgery." Medical Studies/Studia Medyczne, vol. 35, no. 4, 2019, pp. 327-330. doi:10.5114/ms.2019.91252. Vancouver Andrychowski J. Giant saccular aneurysm of the distal A2 segment of the azygos anterior cerebral artery. Difficulties in surgery. Medical Studies/Studia Medyczne. 2019;35(4):327-330. doi:10.5114/ms.2019.91252.

Giant saccular aneurysm of the descending aorta in an infant

Giant saccular aneurysm of the descending aorta in an infant

Випадок комбінованого хірургічного лікування нерозірваної гігантської мішкоподібної аневризми супракліноїдного відділу правої внутрішньої сонної артерії

We tried to determine the optimal tactics of endovascular occlusion of a giant saccular aneurysm supraclinoid part of the right internal carotid artery, which moves right middle cerebral artery on the background of hypoplasia and stenosis of the right internal carotid artery (ICA) in petrous segment in conjunction with stenosis in the M1-segment of right middle cerebral artery (MCA) and deconstruction clinoid part of the right ICA using coils with maintaining adequate perfusion in right MCA. We analyzed the results of surgical treatment endovascular embolization of giant intracranial unruptured aneurysms, on the background of concomitant stenosis of the ICA (2 similar cases in my own practice). In all cases, regardless of the degree of ICA stenosis performed a stand-alone coiling of aneurysms occlusion. Stenting of the stenotic part of the ICA was not performed. The results of the combined 3-stage of surgical treatment (bypass, endovascular coiling-aneurysm occlusion of the ICA, deconstruction ICA) patient with a giant saccular aneurysm supraclinoid part of right ICA, from which departs right MCA, against the background of hypoplasia and stenosis of right ICA in the petrous segment in conjunction with stenosis in the M1-segment of right MCA. After 3 months the patient's condition by somatic satisfactory. Neurologically: remained moderate paresis of the abducens nerve on the right. The patient is recommended dynamic observation with conducting magnetic resonance imaging of the brain and cerebral angiography at 6 and 12 months. The analysis of the result of combined surgical treatment in the combined pathology of the cerebral vessels (saccular aneurysm, stenosis of right ICA, stenosis of right MCA). Showed that surgical tactics was justified and can be used as a method of treating this pathology.

Long-Term Effect of Flow Diversion on Large and Giant Aneurysms: MRI-DSA Clinical Correlation Study

The long-term effect of flow diversion (FD) on aneurysms has not been well studied. We aimed to assess the effect of the Pipeline embolization device (Covidien, Irvine, California, USA) on large and giant intracranial aneurysms with magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) and then correlate with clinical follow-up. We conducted a retrospective analysis of aneurysms treated solely with Pipeline without adjunctive therapy. The largest aneurysm diameters were compared with pretreatment and post treatment MRI and correlated with DSA and clinical symptoms. Twelve patients harboring large and giant saccular unruptured aneurysms, treated with Pipeline, were included. Mean follow-up times were as follows: MRI 22.8 months (range 1-57), DSA 18.2 months (range 1-33), and clinical 29 months (range 1-48). Ten (83%) of 12 treated aneurysms decreased in size on MRI, which was first seen at an average of 17 months (range 4-57). In 70% of patients the change was noted on MRI ≤1 year after treatment, at an average of 9.1 months (range 4-12). MRI reduction was more likely in angiographically occluded aneurysms. Five aneurysms with complete occlusion on early angiogram showed size reduction on MRI only at ≥12 months. Mean aneurysm size reduction was 57% (range 19.6-94.2), which correlated well with improvement of cranial neuropathies in 75% and headaches in 100% of patients. Most aneurysms treated with Pipeline decreased in size, correlating with clinical improvement. Some aneurysms remained unchanged on MRI until a later time point despite early DSA occlusion. It may be reasonable to eliminate early postprocedural imaging and start follow-up only as late as 1 year after FD treatment in clinically stable, asymptomatic patients.

Haemodynamics of giant cerebral aneurysm: A comparison between the rigid-wall, one-way and two-way FSI models

In this paper a computer simulation of a blood flow in cerebral vessels with a giant saccular aneurysm at the bifurcation of the basilar artery is performed. The modelling is based on patient-specific clinical data (both flow domain geometry and boundary conditions for the inlets and outlets). The hydrodynamic and mechanical parameters are calculated in the frameworks of three models: rigid-wall assumption, one-way FSI approach, and full (two-way) hydroelastic model. A comparison of the numerical solutions shows that mutual fluid- solid interaction can result in qualitative changes in the structure of the fluid flow. Other characteristics of the flow (pressure, stress, strain and displacement) qualitatively agree with each other in different approaches. However, the quantitative comparison shows that accounting for the flow-vessel interaction, in general, decreases the absolute values of these parameters. Solving of the hydroelasticity problem gives a more detailed solution at a cost of highly increased computational time.

Corkscrew axillary artery with giant saccular aneurysm formation

Axillary artery aneurysms are rare, with limited cases reported.1Rose J.F. Lucas L.C. Bui T.D. Mills Sr., J.L. Endovascular treatment of ruptured axillary and large internal mammary artery aneurysms in a patient with Marfan syndrome.J Vasc Surg. 2011; 53: 478-482Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 2Lind R.C. de Vries M. Rolink R. Oskam J. Pierie M.E. Surgical management of an isolated symptomatic true axillary artery aneurysm.Vasc Med. 2013; 18: 145-146Crossref PubMed Scopus (4) Google Scholar Coiling of the axillary arteries with formations of aneurysms are extremely uncommon.3Ortiz-Pomales Y. Smith J. Weiss J. Casey K. Tortuous axillary artery aneurysm causing median nerve compression.Ann Vasc Surg. 2014; 28: 122.e1-122.e3Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Symptoms can include acute vascular insufficiency and neurologic deficits. Treatment should address the coiling vessels and the aneurysms. An 86-year-old woman complaining of increasing right shoulder pain and swelling was transferred to our hospital’s Department of Vascular Surgery. She had been diagnosed with advanced liver cancer, with multiple systemic metastases, and had been hospitalized 7 days earlier in the oncology department for support therapy. The physical examination revealed a pulsatile mass on her right upper extremity. She had no history of trauma or connective tissue disorders and denied long-term use of crutches. A contrast-enhanced computed tomography angiogram showed a corkscrew axillary artery with giant saccular aneurysm formation, reaching 35 mm by 62 mm in size (A and B). Considering its corkscrew course, an endovascular intervention using stent grafts was not suitable. Resection of the coiled part of the axillary artery and an end-to-end anastomosis were planed. However, the patient’s general condition was not ideal either, with liver function grade classified as Child C, which placed her at extremely high-risk for an open operation. The patient died of hepatic failure 10 days later during the hospitalization.

A challenging entity of unruptured giant saccular aneurysms of vertebrobasilar artery

PurposeGiant intracranial aneurysms commonly cause poor clinical outcome and few studies focus on them. This study is to retrospectively report the angiographic and clinical presentations in unruptured giant saccular vertebrobasilar aneurysms with and without endovascular treatment. MethodsOut of 400 patients who had unruptured posterior circulation aneurysms in a single center, we found 10 unruptured giant (>25mm) saccular vertebrobasilar aneurysms. Clinical and angiographic presentations as well as their clinical outcomes were assessed. ResultsOf the 10 giant aneurysms in 10 patients, three were left untreated. During 6 months follow-up, all 3 of these patients died from aneurysm rupture. The remaining 7 patients were treated by endovascular procedure, 5 received stent-assisted coiling, 1 was treated by parent artery occlusion (PAO), and 1 was treated by conventional coiling. Of these treated patients, only one survived during a 22 month period of follow-up. ConclusionsPatients with giant saccular aneurysms of vertebrobasilar artery presenting mass effect may have extremely poor clinical outcomes and may not benefit from endovascular treatment.

TCTAP C-114 A Hybrid Approach for Giant Coronary Artery Saccular Aneurysm with Stent Migration

### Patient initials or identifier number 46 years female ### Relevant clinical history and physical exam A 46 yrs old female who is a known case of T2 DM, old Anterior wall Myocardial Infarction, S/P PTCA to LAD in 2012 had presented with unstable angina.She had Anterior wall MI in 2012, Single

Pituitary Insufficiency and Hyperprolactinemia Associated with Giant Intra- and Suprasellar Carotid Artery Aneurysm.

Pituitary insufficiency secondary to internal carotid artery (ICA) aneurysm is a very rare condition. Its prevalence is reported as 0.17% (Heshmati et al., 2001). We present a case of pituitary insufficiency and hyperprolactinemia secondary to suprasellar giant intracranial aneurysm. A 71-year-old man was admitted to our clinic with symptoms of hypopituitarism, hyperprolactinemia, and visual field defect. His pituitary MRI and cerebral angiography revealed a giant saccular aneurysm filling suprasellar cistern arising from the ophthalmic segment of the right ICA. Endovascular treatment was performed on the patient to decrease the mass effect of aneurysm and improve the hypophysis dysfunction. After treatment, his one-year follow-up showed the persistence of hypophysis insufficiency, decrease of prolactin (PRL) level, and normal visual field. An intracranial aneurysm can mimic the appearance and behavior of a pituitary adenoma. Intracranial aneurysms should be taken into consideration in the situation of hypopituitarism and hyperprolactinemia. It is important to distinguish them because their treatment approach is different from the others.

Giant saccular aneurysm of the left main coronary artery.

Coronary aneurysms represent anomalies identified in 0.15%–4.9% of patients undergoing coronary angiography. At present, there is no uniform definition of this pathology. Aneurysms of the left main coronary artery (LMCA) are extremely uncommon, with an incidence of 0.1%. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. Other causes include connective tissue disorders, trauma, vasculitis, congenital, mycotic, and idiopathic. These dilated sections of the coronary artery are not benign pathology because they are subject to spasm, thrombosis, and subsequent distal embolism, spontaneous dissection and rupture. Treatment options include anticoagulation, custom-made covered stents, reconstruction, resection, and exclusion with bypass. Our report on an old case illustrates the giant saccular LMCA aneurysm leading to myocardial ischemia due to coronary steal phenomenon.

Giant Congenital Left Atrial Appendage Aneurysm

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 10-year-old girl presented with a 2-month history of atrial fibrillation. Chest x-ray film showed marked cardiomegaly (A) . Transthoracic echocardiography showed a giant (13 × 10 cm) saccular aneurysm

Giant thrombosed saccular aneurysm of the ascending aorta

A 74-year-old woman with a history of hypertension, heart failure, asthma, and amputated right arm (secondary to arterial thromboemboli) was admitted to the emergency department with complaints of chest distress and dyspnea. She was normotensive and her heart rate was 76 bpm. On the physical examination, bilateral rales up to the mid zones of the lungs and grade III systolic murmur at the left sternal border and apex were heard. Electrocardiography showed QS pattern in anterior precordial derivations, and troponinI level was 1.0 ng/ml (reference range: 0-0.6 ng/ml). Transthoracic echocardiography revealed valvular insufficiencies (moderate-to-severe tricuspid regurgitation, moderate mitral regurgitation and mild aortic regurgitation), biatrial dilatation, left ventricular hypertrophy, and systolic dysfunction (ejection fraction [EF] was 40%, with segmental wall motion abnormalities at the apex and apical segments). On chest X-ray, congested lungs, increased cardiothoracic ratio, and dilated-calcified ascending and arcus aorta were detected. After admission to the coronary care unit, coronary angiography was performed, and a giant thrombosed saccular aneurysm of 120x50 mm was visualized (Fig. A, B). The aneurysm was limited to the ascending aorta (Video*). In addition, we detected several critical stenoses in coronary arteries. Although this giant aneurysm was detected incidentally, it is the most likely cause of her previous thromboemboli to the right arm that resulted in amputation. This giant aneurysm went undetected because the patient did not undergo computed tomography or conventional angiography during the first event. Because of the giant saccular aneurysm and multivessel disease of the coronary arteries, surgery was decided for the patient. As the patient refused surgery, no tomographic imaging was performed and she was discharged with medical therapy. 781

RETRACTED: Successful treatment for a giant coronary saccular aneurysm complicated with myocardial infarction in a patient with Behcet's disease: Case report

We report on a 35-year-old man, with known Behcet's disease, who was admitted with the diagnosis of subacute anterior myocardial infarction. Coronary angiography revealed an isolated giant saccular aneurysm at the mid segment of left anterior descending coronary artery with a tight stenosis. The patient was successfully treated with covered stent on the first day of admission.

Surgical treatment of giant saccular coronary artery aneurysm: a case report

Aneurysm of coronary arteries is rare and diagnosis is usually made accidentally during coronary angiography. Atherosclerosis, Kawasaki disease, autoimmune diseases and syphilis are among common etiologic factors. Spontaneous rupture of the aneurysmal sac, thrombosis and distal emboli are the major causes for mortality and morbidity. Treatment options vary from surgical intervention to conservative drug therapy such as antithrombotic treatment, depending on the localization and the dimensions of the lesion and the clinical outcome of the patient. In this article, we report a patient who underwent operation for giant saccular coronary artery aneurysm in the left anterior descending artery.

Interrupted aortic arch accompanied by a giant saccular aneurysm in a 53-year-old man

A 53-year-old man with history of polyarteritis was admitted for chest distress and breathlessness. PhysicaI examination showed the blood pressure was significantly greater in the right arm than in the left arm (right 180/90 mmHg vs. left 140/80 mmHg). Grade …