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Mitsuishi A, Nakamura H, Miura Y, Miyata T, Orihashi K, Yoshida K, Araki K. Significant thrombus in saccular aneurysm in a patient with polycythemia: a case report. J Cardiothorac Surg 2024; 19:134. [PMID: 38491494 PMCID: PMC10941378 DOI: 10.1186/s13019-024-02645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Morphologically, the risk of aortic aneurysm rupture is mainly evaluated based on its type (e.g., fusiform or saccular) and diameter. Based on the finite element analysis, peak wall stress has been identified as a more sensitive and specific predictor of rupture in recent years. Moreover, in finite analysis, the neck of aneurysm is the highest peak wall stress and is associated with the rupture point. CASE PRESENTATION A saccular aortic aneurysm (84 mm) was incidentally detected during preoperative examination for chronic empyema in a 74-year-old male patient with a history of polycythemia. Aortic arch graft replacement using an open stent was performed. CONCLUSIONS Morphologically, this case was associated with a very high risk of rupture; nevertheless, it did not rupture. In this case, a mural thrombus (likely formed due to polycythemia) covered the neck of aneurysm that is experiencing the highest peak wall stress and is associated with the rupture point. The mural thrombus decreased peak wall stress and could reduce the risk of rupture even for huge saccular aneurysms. Furthermore, the mural thrombus was fully occupied in aneurysms, such as during coil embolization. Thus, polycythemia could decrease the risk of rupture of huge saccular aneurysms.
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Affiliation(s)
- Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan.
- Department of Cardiovascular Surgery School of Medicine, Kochi University, 185-1, Kohasu, Nankoku-shi, 783- 8505,, Okohmachi, Kochi Prefecture, Japan.
| | - Hiromasa Nakamura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
| | - Tsuyoshi Miyata
- Liaison Healthcare Engineering Section Medicine, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
| | - Kazumasa Orihashi
- Department of Anesthesiology and intensive Care Medicine, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505, Okohcho, Kochi Prefecture, Japan
| | - Keisuke Yoshida
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
| | - Kouhei Araki
- Department of Surgery, Kochi Medical School Hospital, 185-1, Kohasu, Nankoku-shi, 783-8505,, Okohcho, Kochi Prefecture, Japan
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2
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Karagöz U, Bilen Ç, Karaçelik M. Large saccular aneurysm of the ascending aorta in a 5-year-old patient. Cardiol Young 2023; 33:2463-2465. [PMID: 37544938 DOI: 10.1017/s1047951123003001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
Saccular aneurysms of the aorta in childhood are rare, and the low incidence of aortic aneurysms among children limits our understanding of their aetiology and surgical indications. In this case report, we describe the successful surgical treatment of a 5-year-old boy with severe aortic valvular stenosis, supra-valvular aortic stenosis, and a large saccular aneurysm in the anterior wall of the ascending aorta, without any connective tissue disorder.
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Affiliation(s)
- Uğur Karagöz
- Pediatric Cardiac Surgery, Van Training and Research Hospital, Edremit, Turkey
| | - Çağatay Bilen
- Department of Pediatric Cardiac Surgery, Adnan Menderes University School of Medicine, Aydin, Turkey
| | - Mustafa Karaçelik
- Pediatric Cardiac Surgery, SBÜ Dr Behçet Uz Çocuk Hastalıkları Ve Cerrahisi Eğitim Ve Araştırma Hastanesi, Izmir, Turkey
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3
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Chan SM, Chen JF, Setia O, Nassiri N. Inferior Mesenteric Artery Snorkel for Endovascular Treatment of a Large Degenerating Saccular Aneurysm. EJVES Vasc Forum 2023; 59:36-40. [PMID: 37396439 PMCID: PMC10310467 DOI: 10.1016/j.ejvsvf.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 07/04/2023] Open
Abstract
Objective Preservation of the inferior mesenteric artery (IMA) during endovascular aortic aneurysm repair (EVAR) is necessary for prevention of mesenteric ischaemia in the case of chronically occluded coeliac and superior mesenteric arteries (SMA). This case report presents an approach in a complex patient. Methods A 74 year old man with hepatitis C cirrhosis and recent non-ST elevation myocardial infarction presented with an infrarenal degenerating saccular aneurysm (58 mm), chronically occluded SMA and coeliac artery, and 9 mm IMA with high grade ostial stenosis. He also had concomitant atherosclerosis of the aorta with a narrow distal aortic lumen of 14 mm, which tapered to 11 mm at the aortic bifurcation. Endovascular attempts to cross long segment occlusions of the SMA and coeliac artery were unsuccessful. Thus, EVAR was performed using the unibody AFX2 endograft and chimney revascularisation of the IMA using a VBX stent graft. One year follow up demonstrated regression of the aneurysm sac to 53 mm with patent IMA graft and no endoleak. Conclusion Few reports have described techniques for endovascular preservation of the IMA, which is a necessary consideration in the context of coeliac and SMA occlusion. Because open surgery was not a good option for this patient, available endovascular options had to be weighed up. An added challenge was the exceptionally narrow aortic lumen in the context of aortic and iliac atherosclerotic disease. It was decided that the anatomy was prohibitive for a fenestrated design and extensive calcification was too limiting for gate cannulation of a modular graft. Thus a bifurcated unibody aortic endograft with chimney stent grafting of the IMA was successfully used as a definitive solution.
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Affiliation(s)
- Shin Mei Chan
- Yale University School of Medicine, New Haven, CT, USA
| | - Julia Fayanne Chen
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ocean Setia
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Naiem Nassiri
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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4
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Ando M, Maki Y, Hojo M, Hatano T. Ruptured saccular aneurysm of the lenticulostriate artery embolized without parent artery occlusion in a case of moyamoya disease. Neuroradiol J 2023; 36:108-111. [PMID: 35545931 PMCID: PMC9893168 DOI: 10.1177/19714009221101307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In cases of moyamoya disease, an aneurysm of the lenticulostriate artery (LSA) is a rare finding. Preventive management of rebleeding from a ruptured aneurysm of the LSA is important to avoid poor outcomes. Endovascular embolization of a ruptured LSA aneurysm with parent artery occlusion has been reported in previous cases of moyamoya disease; however, to the best of our knowledge, a ruptured aneurysm treated only with coil embolization has not been described. A 42-year-old woman presented with sudden onset of dysarthria and right hemiparesis. Putaminal hemorrhage from a ruptured aneurysm in the left LSA was detected. Angiographically, moyamoya vessels were revealed. The aneurysm in the left LSA was saccular type and seemed to be related to moyamoya disease. As the aneurysm was successfully approached with a microcatheter, coil embolization without parent artery occlusion was performed. Rebleeding from the embolized aneurysm in the LSA did not occur. This is the first report of a ruptured LSA aneurysm embolized using coils through a flow-guiding microcatheter without parent artery occlusion in a case of moyamoya disease.
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Affiliation(s)
- Mitsushige Ando
- Department of Neurosurgery, Shiga General Hospital, Japan
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Japan
| | - Yoshinori Maki
- Department of Rehabilitation, Hikari Hospital, Japan
- Department of Neurosurgery, Hikone Chuo Hospital, Japan
| | - Masato Hojo
- Department of Neurosurgery, Shiga General Hospital, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Stroke Center, Kokura Memorial Hospital, Japan
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5
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Lee YH, Hong JH, Shin HK. Gasserian ganglion radiofrequency thermoablation in a patient with aneurysm of the anterior communicating artery -A case report. Anesth Pain Med (Seoul) 2022; 16:382-386. [PMID: 35139620 PMCID: PMC8828629 DOI: 10.17085/apm.21019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Gasserian ganglion radiofrequency thermoablation is a good treatment option for the management of pain in trigeminal neuralgia. We report a case in which the patient of trigeminal neuralgia combined with anterior cerebral artery aneurysm was treated successfully by gasserian ganglion thermoablation without any complication. Case An 85-year-old female presenting with electric shock like sensation in the gum and molar teeth was diagnosed as trigeminal neuralgia. Carbamazepine medication and trigeminal nerve blockade relieved her pain partially, but severe side effects of carbamazepine occurred. Magnetic resonance angiography of the brain showed saccular aneurysm in inferior aspect of the anterior communicating artery. Gasserian ganglion thermoablation under sedation anesthesia using nicardipine was performed carefully without any rupture of the cerebral aneurysm. Conclusions Gasserian ganglion thermoablation could be performed safely in a patient with cerebral aneurysm without any inadvertent event.
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Affiliation(s)
- Yong Ho Lee
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Ji Hee Hong
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hye Kyung Shin
- Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
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6
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Dubey A, B V, Bég OA, Gorla RSR. Finite element computation of magneto-hemodynamic flow and heat transfer in a bifurcated artery with saccular aneurysm using the Carreau-Yasuda biorheological model. Microvasc Res 2021; 138:104221. [PMID: 34271062 DOI: 10.1016/j.mvr.2021.104221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/19/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022]
Abstract
"Existing computational fluid dynamics studies of blood flows have demonstrated that the lower wall stress and higher oscillatory shear index might be the cause of acceleration in atherogenesis of vascular walls in hemodynamics. To prevent the chances of aneurysm wall rupture in the saccular aneurysm at distal aortic bifurcation, clinical biomagnetic studies have shown that extra-corporeal magnetic fields can be deployed to regulate the blood flow. Motivated by these developments, in the current study a finite element computational fluid dynamics simulation has been conducted of unsteady two-dimensional non-Newtonian magneto-hemodynamic heat transfer in electrically conducting blood flow in a bifurcated artery featuring a saccular aneurysm. The fluid flow is assumed to be pulsatile, non-Newtonian and incompressible. The Carreau-Yasuda model is adopted for blood to mimic non-Newtonian characteristics. The transformed equations with appropriate boundary conditions are solved numerically by employing the finite element method with the variational approach in the FreeFEM++ code. Hydrodynamic and thermal characteristics are elucidated in detail for the effects of key non-dimensional parameters i.e. Reynolds number (Re = 14, 21, 100, 200), Prandtl number (Pr = 14, 21) and magnetic body force parameter (Hartmann number) (M = 0.6, 1.2, 1.5) at the aneurysm and throughout the arterial domain. The influence of vessel geometry on blood flow characteristics i.e. velocity, pressure and temperature fields are also visualized through instantaneous contour patterns. It is found that an increase in the magnetic parameter reduces the pressure but increases the skin-friction coefficient in the domain. The temperature decreases at the parent artery (inlet) and both the distant and prior artery with the increment in the Prandtl number. A higher Reynolds number also causes a reduction in velocity as well as in pressure. The blood flow shows different characteristic contours with time variation at the aneurysm as well as in the arterial segment. The novelty of the current research is therefore to present a combined approach amalgamating the Carreau-Yasuda model, heat transfer and magnetohydrodynamics with complex geometric features in realistic arterial hemodynamics with extensive visualization and interpretation, in order to generalize and extend previous studies. In previous studies these features have been considered separately and not simultaneously as in the current study. The present simulations reveal some novel features of biomagnetic hemodynamics in bifurcated arterial transport featuring a saccular aneurysm which are envisaged to be of relevance in furnishing improved characterization of the rheological biomagnetic hemodynamics of realistic aneurysmic bifurcations in clinical assessment, diagnosis and magnetic-assisted treatment of cardiovascular disease."
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Affiliation(s)
- Ankita Dubey
- Department of Mathematics, Motilal Nehru National Institute of Technology, Allahabad, Prayagraj 211004, India
| | - Vasu B
- Department of Mathematics, Motilal Nehru National Institute of Technology, Allahabad, Prayagraj 211004, India.
| | - O Anwar Bég
- Multi-Physical Engineering Sciences, Aeronautical/Mechanical Engineering, Salford University, M54WT, UK
| | - R S R Gorla
- Department of Aeronautics and Astronautics, Air force Institute of Technology, Wright Patterson Air Force Base, Dayton, OH, USA
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7
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Papageorgopoulou CP, Nikolakopoulos KM. Eccentric saccular aneurysm formation of the infrarenal aorta from an arterial wall tear. Radiol Case Rep 2021; 16:1854-6. [PMID: 34040688 DOI: 10.1016/j.radcr.2021.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022] Open
Abstract
Eccentric saccular aneurysms result from a focal weakness of the arterial wall that may be due to a focal tear or a partial disruption of the arterial wall. Saccular morphology itself is often used as a factor for immediate intervention, because the risk of rupture is higher than that of the common fusiform aneurysms. We present a case of a 72-year-old female patient with a huge saccular aneurysm of the infrarenal aorta. In this case report, we discuss the algorithm that can be used for the differential diagnosis of any saccular shape aneurysm and that the main parameter that needs to be clarified before the endovascular treatment of any saccular aneurysm is the presence or absence of infection of the arterial wall.
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8
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Nakashima M, Kobayashi M. Open Repair of a Giant Popliteal Artery Aneurysm Presenting with Nerve Compression Symptoms. Vasc Specialist Int 2021; 37:37-40. [PMID: 33795552 PMCID: PMC8021490 DOI: 10.5758/vsi.200077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/12/2021] [Accepted: 02/21/2021] [Indexed: 11/26/2022] Open
Abstract
Popliteal artery aneurysm (PAA) is a rare vascular disease, especially in women, and presents with various symptoms, ranging from being asymptomatic to rupture or acute life-threatening ischemia. We have presented a case of PAA in an 81-year-old woman complaining of tingling sensations in her leg. Computed tomography revealed a large 10-cm sized PAA. Because of the compression related symptoms, an open repair approach was selected and performed successfully via a posterior approach, including partial aneurysm resection and interposition graft with a reversed saphenous vein.
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Affiliation(s)
- Masaya Nakashima
- Department of Vascular Surgery, Tokoname Municipal Hospital, Tokoname, Japan
| | - Masayoshi Kobayashi
- Department of Cardiovascular surgery, Fujita Health University Graduate School of Medicine, Toyoake, Japan
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9
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Korotkikh AV, Nekrasov DA, Khilchuk AA, Scherbak SG, Sarana AM. Simultaneous internal carotid artery stenosis and ipsilateral anterior communicating artery saccular aneurysm treatment: a case report. Radiol Case Rep 2020; 15:1083-1086. [PMID: 32461781 PMCID: PMC7243056 DOI: 10.1016/j.radcr.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/03/2020] [Accepted: 05/03/2020] [Indexed: 10/29/2022] Open
Abstract
The presence of ipsilateral aneurysm in the stenosis of the internal carotid artery is determined by computed tomography angiography in 1.8%-3.2% of cases. The literature describes the most varied options for treating this pathology: isolated or alternate, and now the method of simultaneous endovascular treatment - carotid stenting and endovascular embolization of aneurysm - is gaining popularity. We presented a clinical case of treatment of 61 women with critical stenosis (90%) and tortuosity of the internal carotid artery in combination with ipsilateral saccular aneurysm of the anterior connecting artery. The uniqueness of this case lies in the fact that a hybrid approach has been applied in the treatment of pathology, not previously described in the literature. The case is highlighting the potential complexity of concomitant vascular cervical and cerebral pathology and the necessity of surgical and endovascular team interactions to choose the appropriate methods of treatment.
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Affiliation(s)
- Alexander V Korotkikh
- Regional vascular center, Regional Clinical Hospital №2, 625039, Mel'nikaite str. 75, Tyumen', Russian Federation
| | - Dmitriy A Nekrasov
- Regional vascular center, Regional Clinical Hospital №2, 625039, Mel'nikaite str. 75, Tyumen', Russian Federation
| | - Anton A Khilchuk
- Department of Interventional Radiology, City Hospital, Saint-Petersburg, Russian Federation.,Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Sergey G Scherbak
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
| | - Andrey M Sarana
- Medical Faculty, Saint-Petersburg State University, Saint-Petersburg, Russian Federation
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10
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Al-Abdulwahhab AH, Al-Sharydah AM, Al-Suhibani SS, Almulhim AS, Al-Dhafeeri OM, Al-Jubran SA. A ruptured posterior communicating artery aneurysm presenting as tentorial and spinal isolated subdural hemorrhage: a case report and literature review. BMC Neurol 2020; 20:102. [PMID: 32188416 PMCID: PMC7081678 DOI: 10.1186/s12883-020-01682-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background Ruptured intracranial aneurysms are often associated with subarachnoid or intraparenchymal hemorrhage. However, the prevalence of subdural hemorrhage post aneurysmal rupture is low and rarely reported in scientific studies. Here, we report an unusual case of a ruptured posterior communicating artery aneurysm resulting in an isolated subdural hematoma located in the tentorial and spinal canal without subarachnoid or intraparenchymal hemorrhage. Case presentation In this case, a 34-year-old woman with no history of trauma or coagulopathy was diagnosed with a subdural hematoma in the tentorium cerebellum tracing to the subdural space of the spinal column. Computed tomography angiography was used to identify the source of the bleeding, which revealed a ruptured left-sided posterior communicating artery saccular aneurysm. The aneurysm was clipped, and the hematoma was evacuated. The patient recovered without any neurological complications. Conclusions Our results suggest that a diagnosis of ruptured intracranial aneurysm should be considered in patients with nontraumatic subdural hematoma. Prompt diagnostic imaging and interventional diagnostic procedures are required to ensure proper management of these patients and to avoid unnecessary complications.
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Affiliation(s)
- Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia
| | - Abdulaziz Mohammad Al-Sharydah
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia
| | - Sari Saleh Al-Suhibani
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia.
| | | | - Obaied M Al-Dhafeeri
- Diagnostic Imaging Radiology department, Royal Commission Health Services, Jubail, Saudi Arabia
| | - Saeed A Al-Jubran
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, P.O. Box: 4398, Al-Khobar City, Eastern Province, 31952, Saudi Arabia
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11
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Hendricks BK, Spetzler RF. Lenticulostriate Artery Aneurysm: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 18:E39. [PMID: 31758188 DOI: 10.1093/ons/opz370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 11/01/2019] [Indexed: 11/15/2022] Open
Abstract
Saccular aneurysms that arise from the origin of or along a lenticulostriate artery are rarely observed. In general, occlusion of the lenticulostriate artery is discouraged because of the risk of a capsular infarction. This patient was a woman with moyamoya disease who demonstrated a fusiform aneurysm of a lenticulostriate artery. Image guidance was critical to correctly identify the location of the aneurysm. The lenticulostriate artery was occluded by a surgical clip to obliterate the aneurysm and consequently the flow through the artery. However, the patient tolerated the procedure well and did not experience an ischemic stroke from the vessel occlusion. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
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Affiliation(s)
- Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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12
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Abstract
Superior vena cava saccular aneurysms are a rare clinical entity. Diagnosis of superior vena cava aneurysm includes multiple advanced imaging modalities. Management options for venolymphatic malformations. Symptoms were reduced following surgical resection and treatment with sirolimus.
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13
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Sultan S, Elkady R, Barrett N, Hynes N. Endovascular management of saccular extracranial internal carotid artery aneurysm using transcervical carotid approach and flow reversal. J Vasc Surg Cases Innov Tech 2019; 5:273-277. [PMID: 31304440 PMCID: PMC6600588 DOI: 10.1016/j.jvscit.2019.03.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/23/2019] [Indexed: 11/30/2022]
Abstract
Transcervical endovascular management of saccular aneurysms of the extracranial internal carotid artery is an evolving treatment option. We report our experience during two decades in managing such a complex vascular scenario. Patients in this case series were symptomatic and had Eagle syndrome (elongated styloid processes in two cases and a calcified stylohyoid ligament in one case). All patients underwent endovascular stenting for expanding extracranial internal carotid artery saccular aneurysm using self-expandable covered stent grafts reinforced with a self-expanding nitinol stent. The approach was transcervical in all cases with cerebral protection by manual flow reversal.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland.,Galway Clinic, Royal College of Surgeons of Ireland Affiliated Teaching Hospital, Doughiska, Galway, Ireland
| | - Ramy Elkady
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland
| | - Nora Barrett
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland.,Galway Clinic, Royal College of Surgeons of Ireland Affiliated Teaching Hospital, Doughiska, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland, Galway, Ireland.,Galway Clinic, Royal College of Surgeons of Ireland Affiliated Teaching Hospital, Doughiska, Galway, Ireland
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14
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Liu X, Zhang Z, Zhu C, Feng J, Liu P, Kong Q, Zhang X, Zhang Q, Jin H, Ge H, Jiang Y, Saloner D, Li Y. Wall enhancement of intracranial saccular and fusiform aneurysms may differ in intensity and extension: a pilot study using 7-T high-resolution black-blood MRI. Eur Radiol 2019; 30:301-307. [PMID: 31218429 DOI: 10.1007/s00330-019-06275-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/18/2019] [Accepted: 05/14/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate and compare wall enhancement patterns in saccular and fusiform intracranial aneurysms using high-resolution black-blood MRI at 7 T. METHODS Thirty-one patients with 32 unruptured intracranial aneurysms (21 saccular and 11 fusiform) underwent 7-T black-blood MRI. Aneurysm wall enhancement (AWE) was categorized as follows: no wall enhancement (NWE), focal wall enhancement (FWE), and uniform wall enhancement (UWE). The degree of enhancement was scored as follows: 0 (no enhancement), 1 (signal intensity (SI) of the aneurysm wall less than that of the pituitary infundibulum), and 2 (equal to that of the pituitary infundibulum). The chi-squared test was used to compare the AWE pattern and degree between saccular and fusiform aneurysms. RESULTS In saccular aneurysms, 12/21 (57%) enhanced. Of these, 9 showed FWE (5 grade 1 and 4 grade 2), and 3 showed UWE (2 grade 1 and 1 grade 2). In fusiform aneurysms, 11/11 (100%) enhanced. Of these, 1 showed FWE and 10 showed UWE. All fusiform aneurysms had grade-2 enhancement. Fusiform aneurysms had more extensive and higher SI AWE than saccular aneurysms (p < 0.01) despite having a similar size (6.9 ± 3.0 mm vs. 8.0 ± 2.9, p = 0.23). For saccular aneurysm, larger aneurysm size was correlated with higher degree of enhancement with Pearson's r = 0.64 (p = 0.002). CONCLUSION Intracranial fusiform aneurysms had enhancement of higher SI and that covered a more extensive area than saccular aneurysms, which might indicate differences in vessel wall pathology. KEY POINTS • Intracranial aneurysm wall enhancement can be reliably characterized by 7-T black-blood MRI. • AWE in intracranial fusiform aneurysms presents over a larger surface area and with greater signal intensity as compared with that in saccular aneurysms, which might indicate differences in pathology. • Stronger signal intensity of AWE correlates with the aneurysm size in saccular aneurysms.
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Affiliation(s)
- Xinke Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,The Innovation Center of Excellence on Brain Science, Chinese Academy of Sciences, Beijing, China
| | - Chengcheng Zhu
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Junqiang Feng
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qingle Kong
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xianchang Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qiang Zhang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - David Saloner
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, USA
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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15
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Scheer N, Ghaznawi R, van Walderveen MAA, Koot RW, Willems PWA. Evaluation of the yield of post-clipping angiography and nationwide current practice. Acta Neurochir (Wien) 2019; 161:783-90. [PMID: 30783804 DOI: 10.1007/s00701-019-03834-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Surgical treatment of intracranial saccular aneurysms aims to prevent (re)hemorrhage by complete occlusion of the aneurysmal lumen. It is unclear whether routine postoperative imaging, to assess aneurysmal occlusion, is necessary since intraoperative assessment by the neurosurgeon may be sufficient. We assessed routine clinical protocols for post-clipping imaging in the Netherlands and determined whether intraoperative assessment of aneurysm clippings sufficiently predicts aneurysm residuals. METHODS A survey was conducted to assess postoperative imaging protocols in centers performing clipping of intracranial aneurysms in the Netherlands (n = 9). Furthermore, a retrospective single-center cohort study was performed to determine the predictive value of intraoperative assessment of aneurysm occlusion in relation to postoperative digital subtraction angiography (DSA) findings, between 2009 and 2017. RESULTS No center performed intraoperative DSA in a hybrid OR, routinely. Respectively, four (44.4%), seven (77.8%), and three (33.3%) centers did not routinely perform early postoperative imaging, late follow-up imaging, or any routine imaging at all. Regarding our retrospective study, 106 patients with 132 clipped aneurysms were included. There were 23 residuals ≥ 1 mm (17.4%), of which 10 (43.5%) were unexpected. For the presence of these residuals, intraoperative assessment showed a sensitivity of 56.5%, a specificity of 86.2%, a positive predictive value of 46.4%, and a negative predictive value of 90.4%. CONCLUSIONS There is lack of consensus regarding the post-clipping imaging strategy in the Netherlands. Since intraoperative assessment is shown to be insufficient to predict postoperative aneurysm residuals, we advocate routine postoperative imaging after aneurysm clipping unless this is not warranted on the basis of patient age, clinical condition, and/or comorbidity.
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16
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Iwakura T, Toguchi K, Kato I, Asakawa N. Internal thoracic artery patch repair of a saccular left main coronary artery aneurysm. J Cardiothorac Surg 2019; 14:38. [PMID: 30808396 PMCID: PMC6390321 DOI: 10.1186/s13019-019-0868-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/17/2019] [Indexed: 11/21/2022] Open
Abstract
Background A saccular aneurysm located at the bifurcation of the left main coronary artery (LMCA) is an extremely rare condition. A major cause of left main coronary aneurysm is atherosclerosis, and common complications include thrombosis, embolism, and rupture. Despite the serious nature of this condition, the ideal operative approach to LMCA aneurysm (LMCAA) has not been established. Furthermore, little is known about resection of the saccular aneurysm and closure using a small internal thoracic artery patch. Case presentation Here, we present the case of a 66-year-old woman who had significant stenosis in the left anterior descending artery and a saccular aneurysm at the bifurcation of the LMCAA, which was repaired using a small internal thoracic artery patch during coronary artery bypass grafting. Postoperative multislice computed tomography revealed the complete disappearance of the aneurysm and a successful repair with no luminal stenosis of the internal thoracic artery patch. In addition, the left internal thoracic artery graft was found to be patent. Conclusions Resection of the saccular LMCA aneurysm and closure using a small internal thoracic artery patch is safe and offer excellent results.
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Affiliation(s)
- Tomohiro Iwakura
- Department of Cardiovascular Surgery, Meirikai Chuo General Hospital, 114-0001 Higashi-jyujo Kita-ku, Tokyo, Japan.
| | - Kouji Toguchi
- Department of Cardiovascular Surgery, Meirikai Chuo General Hospital, 114-0001 Higashi-jyujo Kita-ku, Tokyo, Japan
| | - Ippei Kato
- Department of Cardiovascular Surgery, Meirikai Chuo General Hospital, 114-0001 Higashi-jyujo Kita-ku, Tokyo, Japan
| | - Noriko Asakawa
- Department of Cardiovascular Surgery, Meirikai Chuo General Hospital, 114-0001 Higashi-jyujo Kita-ku, Tokyo, Japan
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17
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Foster MT, Herwadkar A, Patel HC. Posterior Inferior Cerebellar Artery/Vertebral Artery Subarachnoid Hemorrhage: A Comparison of Saccular vs Dissecting Aneurysms. Neurosurgery 2018; 82:93-98. [PMID: 28402517 DOI: 10.1093/neuros/nyx155if:5.315q1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/11/2017] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Two distinct categories of aneurysms are described in relation to the posterior inferior cerebellar artery (PICA) and vertebral artery (VA): saccular (SA) and dissecting (DA) types. This distinction is often unrecognized because abnormalities here are uncommon and most studies are small. OBJECTIVE To determine if there are any differences in the clinical presentation, in-hospital course, or outcomes in patients with DA vs SA of the PICA or VA. METHODS Thirty-eight patients with a VA or PICA aneurysm were identified from a departmental subarachnoid hemorrhage database and categorized into DA or SA types. Prospectively collected demographic and outcome data (length of stay, discharge Glasgow Outcome Score) were supplemented by abstracting records for procedural data (extraventricular drain [EVD], ventriculoperitoneal [VP] shunt, tracheostomy, and nasogastric feeding). Univariate, binary logistic regression, and Cox regression analysis was used to compare patients with SA vs DA. RESULTS Three aneurysms related to arteriovenous malformation were excluded. Five patients were conservatively managed. Of the 30 treated cases, more patients with a DA presented in poor grade (6/13 vs 2/17 SA; P = .035). More DA patients required an EVD (85% vs 29%; P = .003), VP shunt (54% vs 6%; P = .003), tracheostomy (46% vs 6%; P < .01), and nasogastric feeding (85% vs 35%; P = .007). The median length of stay (41 vs 17 d, P < .001) was longer, and the age and injury severity adjusted odds of discharge home were significantly lower in the DA group (P = .008). Thirty-day mortality was not significantly different (23% of DA vs 24% of SA; P = .2). CONCLUSION The presentation, clinical course, and outcomes differ in patients with DA vs SA of the PICA and VA.
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Affiliation(s)
- Mitchell T Foster
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, UK
| | - Amit Herwadkar
- Department of Neuroradiology, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, UK
| | - Hiren C Patel
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Stott Lane, Manchester, UK
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18
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Lee CH, Liao CH, Chen WH, Lee HT, Tsuei YS. Angiographic doughnut-shaped aneurysm of intracranial internal carotid artery. Acta Neurochir (Wien) 2017; 159:721-4. [PMID: 28188419 DOI: 10.1007/s00701-017-3110-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/01/2017] [Indexed: 11/27/2022]
Abstract
Morphologic characteristics of angiographic doughnut-shaped aneurysms of the intracranial internal carotid artery (ICA) have been rarely reported in the literature and were discussed only radiologically. In this case, surgical clipping was performed, and the specimen from the aneurysm was examined to correlate the pathologic findings and morphologic characteristics. A 59-year-old male presented with diffuse subarachnoid hemorrhage secondary to a ruptured vascular lesion originating from the intracranial portion of the right ICA. Digital subtraction angiography showed a 1.5-cm doughnut-shaped aneurysm at the junction of the ICA and the posterior communicating artery. The aneurysm was successfully clipped in a neurosurgical hybrid operating room. The pathologic findings of the content inside the aneurysm revealed only fibrinoid exudates, materials from thrombosis. This is the first report to prove that the mechanism of a doughnut-shaped aneurysm formation is central thrombosis inside the aneurysm, possibly related to its complex hemodynamic flow.
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19
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Peruvumba JN, Paul D, Verghese R. Growth and subsequent disappearance of a ruptured small saccular intracranial aneurysm: A morphometric and flow-dynamic analysis. Neuroradiol J 2016; 29:340-6. [PMID: 27470928 DOI: 10.1177/1971400916658305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The growth of a ruptured small saccular aneurysm has rarely been documented. Also rare are reports of spontaneous thrombosis of ruptured small intracranial saccular aneurysms. However, there are no reported instances of ruptured small saccular aneurysms that have demonstrated an increase in size after rupture, subsequently thrombosed and disappeared from circulation. We report one such aneurysm in a patient who presented with subarachnoid hemorrhage from a ruptured small saccular aneurysm of the anterior communicating artery. The possible reasons for the initial growth and subsequent thrombosis of the aneurysm from morphometric and flow dynamic points of view are discussed.
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Affiliation(s)
| | - Divyan Paul
- Department of Radiology, Khoula Hospital, Oman
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20
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Matsukawa H, Kamiyama H, Tsuboi T, Noda K, Ota N, Miyata S, Takahashi O, Tokuda S, Tanikawa R. Is Age a Risk Factor for Poor Outcome of Surgical Treatment of Unruptured Intracranial Aneurysms? World Neurosurg 2016; 94:222-228. [PMID: 27392889 DOI: 10.1016/j.wneu.2016.06.118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Advanced age is known to be a significant risk factor for the rupture of intracranial aneurysms. The impact of age on outcomes of surgically treated patients with unruptured intracranial aneurysms (UIAs) is less clear. METHODS A total of 663 consecutive patients with 823 surgically treated UIAs were evaluated. UIAs, which need bypass surgery including low-flow or high-flow bypass, were defined as complex aneurysms. Aneurysm size was categorized as small (<15 mm), large (15-24 mm), and giant (≥25 mm). In patients without symptoms, a poor outcome is defined as a modified Rankin Scale (mRS) score of 2-6. In those with mRS score higher than 1 as a result of UIA-related symptoms or other comorbidities, a poor outcome is defined as an increase of 1 or more on the mRS. Outcomes were evaluated at the 6-month and 12-month follow-up examinations. RESULTS The mean age was 62 ± 12 years and 650 UIAs (78%) were observed in women. Previously treated aneurysm (P = 0.009), posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.011), and perforator territory infarction (P < 0.0001) were related to poor outcome at 6 months, and posterior circulation aneurysm (P < 0.0001), complex aneurysm (P < 0.0001), a larger size (P = 0.035), and perforator territory infarction (P = 0.013) were related to poor outcome at 12 months. Age was not associated with poor outcome in patients with UIAs who undertook direct surgery. CONCLUSIONS Although risks and benefits of aneurysm treatment in older patients should be carefully considered, surgical treatment of UIAs in the elderly should be considered positively.
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Affiliation(s)
- Hidetoshi Matsukawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan.
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Kosumo Noda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Shiro Miyata
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Teishinkai Hospital, Sapporo, Japan
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21
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See AP, Gross BA, Penn DL, Du R, Frerichs KU. Hemodynamic Impact of a Spontaneous Cervical Dissection on an Ipsilateral Saccular Aneurysm. J Cerebrovasc Endovasc Neurosurg 2016; 18:110-114. [PMID: 27790401 PMCID: PMC5081495 DOI: 10.7461/jcen.2016.18.2.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 08/29/2015] [Accepted: 12/27/2015] [Indexed: 11/23/2022] Open
Abstract
The dynamic, hemodynamic impact of a cervical dissection on an ipsilateral, intracranial saccular aneurysm has not been well illustrated. This 45-year-old female was found to have a small, supraclinoid aneurysm ipsilateral to a spontaneous cervical internal carotid artery dissection. With healing of the dissection, the aneurysm appeared to have significantly enlarged. Retrospective review of the magnetic resonance imaging (MRI) at the time of the initial dissection demonstrated thrombus, similar in overall morphology to the angiographic appearance of the "enlarged" aneurysm. As the dissection healed far proximal to the intradural portion of the internal carotid artery, this suggested that the aneurysm was likely a typical, saccular posterior communicating artery aneurysm that had thrombosed and then recanalized secondary to flow changes from the dissection. The aneurysm was coiled uneventfully, in distinction from more complex treatment approaches such as flow diversion or proximal occlusion to treat an enlarging, dissecting pseudoaneurysm. This case illustrates that flow changes from cervical dissections may result in thrombosis of downstream saccular aneurysms. With healing, these aneurysms may recanalize and be misidentified as enlarging dissecting pseudoaneurysms. Review of an MRI from the time of the dissection facilitated the conclusion that the aneurysm was a saccular posterior communicating artery aneurysm, influencing treatment approach.
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Affiliation(s)
- Alfred P See
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Bradley A Gross
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
| | - David L Penn
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Kai U Frerichs
- Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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22
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Sharma J, Kapoor A, Kumar S, Gaharwar S, Phadke RV. An Ascending Aortic Rent with a Saccular Aneurysm: Role of Multimodality Imaging. Aorta (Stamford) 2013; 1:231-232. [PMID: 26798699 PMCID: PMC4682748 DOI: 10.12945/j.aorta.2013.13-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/20/2013] [Indexed: 06/05/2023]
Abstract
We report an unusual case of 26 year old previously healthy man who presented with exertional breathlessness of 6 months duration with clinical findings suggestive of moderate aortic regurgitation (AR). There was no previous history suggestive of trauma or chest pain. Trans-thoracic and trans-esophageal echocardiography showed an ascending aortic aneurysm compressing the Left atrium and presence of moderate AR. A 64 slice cardiac CT with intraaortic endoscopic reconstruction further clarified the anatomy. This revealed an ascending aortic aneurysm, extending into the middle mediastinum with a clear rent in the ascending aorta, communicating with the aneurysm. More importantly, CT imaging also confirmed the absence of a dissection flap. The case demonstrates the usefulness of multimodality imaging in defining the morpho-anatomic features in such unusual situations.
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Affiliation(s)
| | | | | | - Saurabh Gaharwar
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra V. Phadke
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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23
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Khouzam RN, Soufi MK, Whitted A. Saccular aneurysm and stenosis of the left anterior descending artery presenting with acute coronary syndrome. What is the best treatment: CABG or PCI? J Cardiol Cases 2013; 8:129-130. [PMID: 30546763 DOI: 10.1016/j.jccase.2013.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/02/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022] Open
Abstract
Treatment of coronary artery aneurysms (CAAs) can either take the way of a close regular follow up with antiplatelet and anticoagulation therapy, percutaneous coronary intervention with possible stenting, or reach the extent of doing coronary artery bypass grafting. The severity of coexistent coronary artery stenosis, symptomatology, embolization to distal coronary beds, and increasing measurements over time are key players to decide whether to proceed with surgery in patients with CAAs. <Learning objective: (i) Coronary artery aneurysms (CAAs) are defined as luminal dilation 50% larger than that of the adjacent reference segment. They are found in 1.4% of patients and could have multiple shapes and forms. (ii) Up to one-third of CAAs are associated with obstructive coronary artery disease and have been associated with myocardial infarction, arrhythmias, or sudden cardiac death. (iii) Treatment of CAAs can be medical, or invasive by performing percutaneous coronary intervention, or surgical using coronary artery bypass grafting. (iv) The severity of coexistent coronary artery stenosis, symptomatology, and embolization to distal coronary beds are important in the final decision on treatment modality.>.
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Affiliation(s)
- Rami N Khouzam
- Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 6283 Common Oaks Crt # 106, Memphis, TN 38120, USA
| | | | - Anthony Whitted
- Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, 6283 Common Oaks Crt # 106, Memphis, TN 38120, USA
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24
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Verma RK, Kaushal D, Panda NK. External jugular vein aneurysm with thrombus presenting as painful neck mass: a case report. Oman Med J 2013; 28:278-80. [PMID: 23904923 PMCID: PMC3725242 DOI: 10.5001/omj.2013.77] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/29/2013] [Indexed: 11/03/2022] Open
Abstract
External jugular vein aneurysm with thrombosis presenting as neck swelling is a rare clinical entity and rarely encountered in routine clinical practice. We present a case of a 45-year-old female with external jugular vein aneurysm presenting as a painful lump in the neck. Ultrasound of the neck and CT angiography showed saccular dilation of the lower end of the external jugular vein with thrombosis within the aneurysm. Saccular aneurysm of the external jugular vein is very uncommon and can lead to thrombotic complications with serious consequence.
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Affiliation(s)
- Roshan Kumar Verma
- Department of Otolaryngology and Head & Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India
| | - Darwin Kaushal
- Department of Otolaryngology and Head & Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India
| | - Naresh K. Panda
- Department of Otolaryngology and Head & Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India
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25
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Huh JS, Park SK, Shin JJ, Kim TH. Saccular aneurysm of the azygos anterior cerebral artery: three case reports. J Korean Neurosurg Soc 2007; 42:342-5. [PMID: 19096567 DOI: 10.3340/jkns.2007.42.4.342] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 08/29/2007] [Indexed: 12/14/2022] Open
Abstract
The azygos anterior cerebral artery, a rare anomaly in the circle of Willis in which only a single vessel supplies the medial aspects of both anterior cerebral hemispheres, is closely associated with saccular aneurysms. We present three cases of azygos anterior cerebral artery aneurysms among the 781 cerebral aneurysms surgically treated at our institution in an 11-year period. These three cases all involved elderly women who presented with subarachnoid hemorrhage. Conventional cerebral angiography and CT angiography revealed small saccular aneurysms at the distal ends of the azygos anterior cerebral arteries. These aneurysms were clipped successfully using a bifrontal interhemispheric approach. Hence, the pathogenesis of these particular aneurysms relating to hemodynamic change, associated anomalies, and surgical pitfalls is discussed with review of literature.
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Affiliation(s)
- Jun Suk Huh
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University, College of Medicine, Seoul, Korea
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