Trunk Aneurysm Research Articles

Results of the Endovascular Treatment and Classification of the Coeliac Trunk Aneurysms

To propose a classification for the endovascular treatment of the aneurysms of the coeliac trunk (CTa), discussing the results of our center in this pathology.

Cerebral Mycotic Aneurysm and Infective Endocarditis: A Case Study

Mycotic aneurysms resulting from endocarditis are uncommon, and patients having aneurysms in multiple locations are rare. We report on a case of a patient having both infrapopliteal and cerebral mycotic aneurysms as a result of endocarditis. A patient was referred to the vascular lab for a lower extremity venous duplex, which incidentally demonstrated an infrapopliteal aneurysm of the right tibio-peroneal trunk. Computed tomography (CT) demonstrated two separate aneurysms: one at the origin of the anterior tibial artery and another involving the peroneal artery. The anterior tibial artery aneurysm was treated surgically. A transesophageal echocardiogram was performed on the patient and identified vegetation on the prosthetic aortic valve. The patient was then transferred to another facility for replacement of the prosthetic aortic valve. The patient suffered a cerebrovascular accident (CVA) postoperatively and subsequently had two cerebral mycotic aneurysms identified and treated.

Assessment of the endoscopic endonasal approach to the basilar apex region for aneurysm clipping.

The expanded endoscopic endonasal approach (EEA) has shown promising results in treatment of midline skull base lesions. Several case reports exist on the utilization of the EEA for treatment of aneurysms. However, a comparison of this approach with the classic transcranial orbitozygomatic approach to the basilar apex (BAX) region is missing.The present study summarizes the results of a series of cadaveric surgical simulations for assessment of the EEA to the BAX region for aneurysm clipping and its comparison with the transcranial orbitozygomatic approach as one of the most common approaches used to treat BAX aneurysms. Fifteen cadaveric specimens underwent bilateral orbitozygomatic craniotomies as well as an EEA (first without a pituitary transposition [PT] and then with a PT) to expose the BAX. The following variables were measured, recorded, and compared between the orbitozygomatic approach and the EEA: 1) number of perforating arteries counted on bilateral posterior cerebral arteries (PCAs); 2) exposure and clipping lengths of the PCAs, superior cerebellar arteries (SCAs), and proximal basilar artery; and 3) surgical area of exposure in the BAX region. Except for the proximal basilar artery exposure and clipping, the orbitozygomatic approach provided statistically significantly greater values for vascular exposure and control in the BAX region (i.e., exposure and clipping of ipsilateral and contralateral SCAs and PCAs). The EEA with PT was significantly better in exposing and clipping bilateral PCAs compared to EEA without a PT, but not in terms of other measured variables. The surgical area of exposure and PCA perforator counts were not significantly different between the 3 approaches. The EEA provided better exposure and control if the BAX was located ≥ 4 mm inferior to the dorsum sellae. For BAX aneurysms located in the retrosellar area, PT is usually required to obtain improved exposure and control for the bilateral PCAs. However, the transcranial approach is generally superior to both endoscopic approaches for accessing the BAX region. Considering the superior exposure of the proximal basilar artery obtained with the EEA, it could be a viable option when surgical treatment is considered for a low-lying BAX or mid-basilar trunk aneurysms (≥ 4 mm inferior to dorsum sellae).

IP119. Early and Long-Term Results of Viabahn Endograft for Treatment of Supra-Aortic Trunk Aneurysm∗

IP119. Early and Long-Term Results of Viabahn Endograft for Treatment of Supra-Aortic Trunk Aneurysm∗

IP179. Delayed Tibioperoneal Trunk Aneurysm After Atherectomy and Balloon Angioplasty

IP179. Delayed Tibioperoneal Trunk Aneurysm After Atherectomy and Balloon Angioplasty

Evaluation of Microsurgery for Managing Giant or Complex Cerebral Aneurysms: A Retrospective Study

Surgical or endovascular treatment for giant or complex aneurysms is challenging. The aims of this study were to evaluate clinical outcomes and factors affecting the prognosis of giant or complex aneurysms and to better establish the role of microsurgery in the management strategy. One hundred fifty-nine patients with surgically treated complex aneurysms were included. Thirty-two patients (20.1%) had giant aneurysms (≥25 mm) and 57 (35.8%) had large aneurysms (≥15 mm). Poor outcome was defined as modified Rankin Scale scores of 3-6. The mean aneurysm size was 17.0 mm (range, 1.6-47.5 mm). One hundred and sixteen aneurysms (80.0%) were in the anterior circulation and 43 (27.0%) were in the posterior circulation. One hundred and thirty-eight (86.8%) aneurysms were completely occluded without residual aneurysms. Nineteen (11.9%) had minor aneurysm remnants; 2 (1.3%) had incomplete occlusion. Two patients (1.3%) with giant basilar artery (BA) trunk aneurysms experienced rupture of the treated aneurysm and died. Bypass surgery was combined with microsurgery in 148 patients (93.1%). Perforating artery infarction was observed postoperatively in 42 patients (26.4%), and poor outcome was observed in 29 (18.2%). Male sex (P= 0.016; adjusted odds ratio [OR], 4.524 [1.949-10.500]), perforating artery infarction (P < 0.001; adjusted OR, 13.625 [5.329-34.837]), and BA aneurysm location (P= 0.003; adjusted OR, 56.333 [6.830-464.657]) were significantly related to poor outcome. The aneurysm size (P= 0.017; adjusted OR, 1.064 [1.021-1.107]), C1 aneurysm location (P= 0.042; adjusted OR, 2.591 [0.986-6.811]), and BA aneurysm location (P=0.033; adjusted OR, 12.956 [3.197-52.505]) were significantly related to perforating artery infarction. Microsurgery with bypass is effective for many different complex aneurysms, except BA aneurysms.

Correção endovascular de pseudoaneurisma de tronco tibiofibular secundário a endocardite – relato de caso

Tibioperoneal trunk aneurysms are rare and the majority of them are pseudoaneurysms This report describes an unusual case of a pseudoaneurysm secondary to bacterial endocarditis diagnosed and treated several years previously. After ruling out ongoing infection, the patient was successfully treated by percutaneous covered stent implantation. In this scenario, the use of endovascular techniques offered a safe and effective alternative treatment.

Saccular aneurysm of the left main trunk

Alexopoulou, Magdalinia; Violo, Caterinaa; Santini, Claudiaa; De Carlo, Marcob; Faggioni, Lorenzoc; Bortolotti, Ubertod; Balbarini, Albertoa Author Information

The Interlenticulostriate Approach to Very High-Riding Distal Basilar Trunk Aneurysms.

Most high-riding distal basilar trunk aneurysms can be surgically approached via the transsylvian route and its orbitozygomatic variant. However, on rare occasions, the basilar bifurcation may be unusually high and an approach above the carotid terminus may be required. In this cadaveric study, we sought to determine the feasibility and exposure limits of the interlenticulostriate approach (ILSA). A standard transsylvian approach was performed in 10 cerebral hemispheres of 5 formalin-fixed, silicone-injected cadaver heads. The interpeduncular cistern was exposed via the opticocarotid window, carotid-oculomotor window, and supracarotid ILSA window. The latter was measured and an aneurysm clip or ventriculostomy stylet was placed as high as possible through each corridor. Using noncontrast 3-D rotational angiography, clip/stylet positions were measured relative to the dorsum sellae. ILSA provided a 9.4 × 4.6 mm mean surgical corridor, just enough room for a standard clip applier. This space was limited by the carotid bifurcation inferiorly, the lenticulostriate arteries medially and laterally, and the optic tract superiorly. There was no difference between opticocarotid and carotid-oculomotor windows, in terms of clip position (+8.9 vs +8.6 mm, respectively; P = .78). In contrast, ILSA provided significantly improved superior exposure, compared with either approaches (mean stylet position: +14.3 mm; P = .005). The exposure benefit afforded by ILSA was consistent across all 10 hemispheres, ranging from +2.5 to +8 mm. For high-riding distal basilar trunk aneurysms that cannot be reached via the frontotemporal orbitozygomatic approach, ILSA can provide a viable route of access. Vascular neurosurgeons should be familiarized with this approach.

Acute Abdomen Caused by a Dissecting Celiac Trunk Aneurysm

Acute Abdomen Caused by a Dissecting Celiac Trunk Aneurysm

P1_163 Aneurysm of the Left Main Coronary Trunk in Cogan's Syndrome

P1_163 Aneurysm of the Left Main Coronary Trunk in Cogan's Syndrome

脳底動脈本幹部破裂動脈瘤に対する急性期コイル塞栓術

Basilar artery trunk aneurysm (BATA) is an aneurysm that occurs between the union of the bilateral vertebral arteries and the superior cerebellar artery. Dissection, in addition to the formation of an aneurysm itself, has been considered a cause of BATA. Direct surgery is difficult in many cases; however, recently, endovascular treatment (EVT) has been used for BATA rupture.Between November 2007 and October 2015, acute-phase EVT was performed in five cases of ruptured BATA in our hospital. The male-to-female ratio and mean age of the patients were 1:4 and 63.6 years, respectively. The mean (range) maximum diameter of the aneurysm was 9.24 mm (3.2-17.8 mm). Four aneurysms were multilocular and irregular in shape, while two were partially thrombosed. During EVT, the balloon remodeling technique was used in four cases and a stent was used in one case as an adjunctive technique. We encountered two technical problems, namely failure during the delivery of the stent system and in-stent thrombosis. Three cases were exacerbated during the perioperative period and resulted in a modified Rankin score of 6.In our cases, EVT did not contribute adequately to improving the prognosis of BATA. This study suggests that to perform coil embolization safely and effectively for ruptured BATA, establishing not only the appropriate procedural strategies, including perioperative antiplatelet drugs management, but also a treatment plan that considers disease severity and systemic condition is important.

Case of successful diagnosis and surgical treatment of aneurysms with atypical origin splenic artery

The article describes a case of successful diagnosis and surgical treatment of patients with aneurysm of the splenic artery (ASA) with atypical origin from the abdominal aorta. For a long time, ASA had symptoms like chronic pancreatitis. Due to the discharge of an atypical splenic artery computed tomography of its aneurysmal expansion was evaluated as an aneurysm of the celiac trunk. A decisive role in the topical diagnosis of aneurysm played angiography of the abdominal aorta and its visceral branches. The blood circulation of the spleen was compensated and authors preferred to preserve spleen with resection of the aneurysm. In the immediate postoperative period, signs of splenic ischemia and other complications are not logged in.

血管攣縮像を経時的に捉えた典型的可逆性脳血管攣縮症候群の1例(Serial imaging of reversible cerebral vasoconstriction syndrome: a case report)

要旨可逆性脳血管攣縮症候群（reversible cerebral vasoconstriction syndrome: RCVS）は雷鳴頭痛を主徴とし，画像上の脳血管攣縮を認める症候群である。本疾患に関する認識は救急医療の現場において十分とはいえず，早期診断に至らない場合も少なくない。今回我々は，血管攣縮の継時的変化を捉えられたRCVS症例を経験した。本症例を通じてRCVSの診断，治療および臨床上の問題点について報告する。症例は20歳の男性。運動中に激しい後頭部痛を認めた。第5病日に近医を受診し頭部MRIおよびMRAを施行されるも異常を指摘されなかった。症状が改善しないため第8病日にMRAを再度施行されるも異常を指摘されず，第16病日に当院へ救急搬送となった。神経脱落所見を認めなかったが，CTで右前頭葉円蓋部にくも膜下出血を認めた。MRAで動脈瘤や血管解離所見を認めず，両側中大脳動脈末梢に多発性の血管攣縮像を認めた。第5，8病日のMRAでも同部位の血管攣縮を後方視的に指摘し得た。RCVSと診断し保存的に加療した。第21病日のMRAで血管攣縮所見は正常化した。神経脱落所見を後遺せず第23病日に退院となった。本疾患の自然歴は不明であり標準的な治療法が確立されておらず，治療介入により重症化を回避し得るか否かは不明である。病態把握と治療法確立のために，さらなる症例の蓄積と統合的な検討が望まれる。

Three-Dimensional Angiographic Evaluation of Middle Cerebral Artery Trunk Aneurysms: Demonstration of the Close Relationship Between the Early Frontal Cortical Branches and Lateral Lenticulostriate Arteries

For the treatment planning of a patient with a middle cerebral artery (MCA) trunk aneurysm, understanding the anatomic relationship among the aneurysm, branching vessels, and lenticulostriate arteries (LSAs) is important. We aimed to demonstrate the branching-vessel anatomy related to an MCA trunk aneurysm using 3-dimensional (3D) angiography. We retrospectively reviewed 3D angiographic findings of 64 cases of MCA trunk aneurysms using a 3D workstation with various postprocessing conditions. We classified the aneurysms into 4 groups (early frontal cortical branch [EFCB], early temporal cortical branch [ETCB], LSA, and nonbranching aneurysms) and analyzed the relationship between the branching vessels and the LSAs. There were 30 EFCB aneurysms, 25 ETCB aneurysms, 7 LSA aneurysms, and 2 nonbranching aneurysms. Twenty-six (86.7%) of the 30 EFCB aneurysms shared common origins and were associated with the LSAs, but none of the 25 ETCB aneurysms were. Three of 24 patients who received clipping for an EFCB aneurysm experienced a postoperative infarction in the LSA territory. In these 3patients, the LSA originated from the EFCB and was closely related with the aneurysm. We have identified a clinically important anatomic relationship between the MCA trunk aneurysm and branching vessels, including the LSAs. EFCB aneurysms show a close relationship with the LSAs. Pretreatment identification of the origin of the LSAs is important to obviate any perforator injury in EFCB aneurysms.

Characteristic analysis of hemodynamics for trunk aneurysm of posterior communicating artery

Objective To study the hemodynamic characteristics of the difference between the trunk aneurysm of posterior communicating artery (PCoA) and the internal carotid artery (ICA)-PCoA aneurysm. Methods A total of 15 patients with trunk aneurysm of PCoA (11 ruptured aneurysms, 4 unruptured aneurysms, for short PCoA trunk group) treated at the Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University from January 2014 to June 2015 were studied retrospectively. The 15 patients with ICA-PCoA aneurysm with approximately the same size and the same rupture state at the same time were used as a matched control group. A numerical simulation analysis was conducted for individual three-dimensional digital subtraction angiography (DSA) images of the patients using the method of computational fluid dynamics. The differences of hemodynamic parameters of the aneurysms were compared between the 2 groups. Results The PCoA trunk aneurysms were in accordance with the blood flow pattern of the lateral aneurysms, and the ICA-PCoA aneurysms were in accordance with the flow blood pattern of the aneurysms at the bifurcations. The hemodynamic parameters in the PCoA trunk group vs. the control group: The wall shear stress (WSS) of the PCoA trunk group and the control group was 0.48±0.08 and 0.63±0.07 respectively. The percentage of the low WSS area (LSA) was 23.20±6.94% and 4.50±2.29% respectively. There were significant differences (P=0.022, P=0.008). The oscillatory shear index (OSI) of the two groups was 0.0233±0.0071 and 0.0158±0.0044 respectively. There was no significant difference (P=0.411). The WSS of the ruptured group (n=22) and the unruptured group (n=8) was 0.45±0.05 and 0.84±0.08 respectively, and LSA was 18.22±5.11% and 1.84±1.76% respectively. There was significant difference (P<0.001, P=0.006). The OSI of the two groups was 0.0234±0.0054 and 0.0091±0.0027 respectively. There was no significant difference (P=0.132). Conclusion The low WSS may be one of the reasons for the high risk of PCoA trunk aneurysm rupture. Key words: Intracranial aneurysms; Aneurysm, ruptured; Hemodynamics; Posterior communicating artery; Computational fluid dynamics

Spontaneous Isolated Dissecting Aneurysm of Distal Celiac Artery- A Rare and Lethal Incidental Finding

Aneurysm of celiac artery is an uncommon occurrence with nearly 180 cases being reported in the literature so far [1]. These have been attributed to traumatic, iatrogenic and inflammatory being amongst few associated etiological factors. Spontaneous isolated dissecting aneurysm of celiac trunk is a rare occurrence with very few cases being mentioned in the published literature. Although the rate of rupture was 72% to 87% during the 1st half of the 20th century, advances in diagnostic imaging and early surgical intervention have reduced the rupture rate to 7% in recent years [1]. Early recognition and urgent intervention is required to prevent fatal complications like intraperitoneal rupture. Authors present a case of isolated spontaneous dissecting aneurysm of distal celiac artery in a fifty five year old male patient with alcoholic cirrhosis.

True Aneurysm of the Superficial Temporal Artery

True aneurysms of the superficial temporal artery are extremely rare. The majority of these aneurysms are a consequence of trauma. A 56-year-old male noticed a swelling in front of his left ear, which had slowly increased in size. There was no history of trauma. Computed tomography revealed an aneurysm of the main trunk of the superficial temporal artery. A ligation and excision was performed. The postoperative period was uneventful. Histology revealed a true aneurysm.

脳底動脈本幹部大型広頚動脈瘤に対するステントを併用したmultiple catheterでのコイル塞栓術

脳底動脈本幹部大型広頚動脈瘤に対するステントを併用したmultiple catheterでのコイル塞栓術

Bypass Surgery for the Treatment of Dolichoectatic Basilar Trunk Aneurysms: A Work in Progress.

The treatment of dolichoectatic basilar trunk aneurysms has been ineffectual or morbid due to nonsaccular morphology, deep location, and involvement of brainstem perforators. Treatment with bypass surgery has been advocated to eliminate malignant hemodynamics and to stabilize aneurysm growth. To validate that flow alteration with bypass and parent artery occlusion favorably impacts aneurysm progression. Surgical management evolved in 3 phases, each with different hemodynamic alterations. During a 17-year period, 37 patients with dolichoectatic basilar trunk aneurysms were retrospectively identified, of whom 21 patients were observed, 12 treated immediately, and 4 selected for treatment after clinical progression. In phase 1, flow reversal was overly thrombogenic, despite heparin (N = 5, final mortality, 100%). In phase 2, flow reduction with intracranial-to-intracranial bypass was safer than flow reversal, but did not prevent progressive aneurysm enlargement (N = 3, final mortality 67%). In phase 3, distal clip occlusion of the basilar trunk aneurysm preserved anterograde flow in the aneurysm without rupture, but reduced flow threatened perforator patency, despite treatment with clopidogrel (N = 8, final mortality 62%). Shifting treatment strategy for dolichoectatic basilar trunk aneurysms improved surgical (80% to 50%) and final mortalities (100% to 62%), with stabilization of aneurysms in the phase 3 survivors. Good outcomes are determined by perforator preservation and mitigating aneurysm thrombosis. Occlusion techniques with increased distal run-off seem to benefit perforators. The treatment of dolichoectatic basilar trunk aneurysms can advance through concentrated management in dedicated centers, concerted efforts to study morphology and hemodynamics with computational methods, and widespread collection of registry data. 4D PC-MRI, time-resolved phase-contrast MRIAICA, anterior inferior cerebellar arteryCE-MRA, high-resolution contrast-enhanced MR angiographyEC-IC, extracranial-to-intracranial bypassMCA, middle cerebral arteryMR, magnetic resonancemRS, modified Rankin ScalePCA, posterior cerebral arteryPICA, posterior inferior cerebellar arterySCA, superior cerebellar arterySTA, superficial temporal arteryVA, vertebral artery.