Anzeige
Erschienen in:
12.04.2018 | Correspondence
Ruptured Fusiform Aneurysm of the Anterior Spinal Artery
Successful Treatment with Flow Diverter Stent Placed in the Feeding Vertebral Artery
Erschienen in: Clinical Neuroradiology | Ausgabe 4/2018
Einloggen, um Zugang zu erhaltenExcerpt
Reports of anterior spinal artery (ASA) aneurysms are sparse in the English literature with only 10 cases of angiographically confirmed ruptured craniocervical ASA aneurysms (Table 1; [1‐10]). In this location they usually present with symptoms of intracranial subarachnoid hemorrhage (SAH). There is no general consensus on the optimal treatment strategy of ASA aneurysms. Management carries a significant risk and different strategies (e.g. surgical trapping, resection, endovascular occlusion and conservative wait and see) have been proposed in case reports or mini-series [5, 6, 10]. Flow diverter stents (FDS) are usually used for treatment of large or giant wide-necked sidewall or fusiform aneurysms where the aneurysm is directly covered by the FDS. Here, we describe the successful endovascular treatment of a ruptured fusiform ASA aneurysm by hemodynamic remodeling with a FDS placed in the ipsilateral vertebral artery (VA).
Table 1
Summary of ruptured craniocervical ASA aneurysms in the literature
|
Author (Year)
|
Age (years)/sex
|
Aneurysm
|
Treatment
|
Angiographic outcome
|
Clinical outcome
|
|||
|---|---|---|---|---|---|---|---|---|
|
Level
|
Shape
|
Size
(mm)
|
Presumed etiology
|
|||||
|
Vincent et al. (1981) [1]
|
30/F
|
C1
|
Sac
|
4
|
Unknown
|
Clip
|
CO; patent ASA
|
Mild hemiparesis due to vasospasm
|
|
Kawamura et al. (1999) [2]
|
42/M
|
Clivus
|
Sac
|
4 × 7
|
Hemodynamic stress: bilateral VA occlusion
|
Clip
|
CO; patent ASA
|
CR w/o FND
|
|
Jiarakongmun et al. (2002) [3]
|
39/M
|
C5/6
|
Sac
|
12.3 × 13
|
Hemodynamic stress: coarctation of aorta
|
Clip
|
NA
|
Partial recovery
|
|
Pollock et al. (2009) [4]
|
55/F
|
C1/2
|
Fus
|
3
|
Repetitive microtrauma: Chiari 1 + degenerative calcification
|
Surgical trapping
|
NA
|
CR w/o FND
|
|
Karakama et al. (2010) [5]
|
51/M
|
C1
|
Sac
|
2.5 × 1.3
|
Unknown
|
Cons
|
CO; patent ASA
|
CR w/o FND
|
|
Pahl et al. (2014) [6]
|
48/F
|
C1/2
|
Sac
|
2
|
Unknown
|
Cons
|
CO; patent ASA
|
NA
|
|
Nakagawa et al. (2014) [7]
|
54/M
|
C1/2
|
Sac
|
5 × 4
|
Hemodynamic stress: ASA feeding epidural AVF
|
Transarterial AVF-embolization
|
CO; patent ASA
|
CR w/o FND
|
|
Ashour et al. (2015) [8]
|
72/M
|
C2
|
Fus
|
3
|
Hemodynamic stress: bilateral VA occlusion
|
Clip + circumferential wrapping
|
CO; patent ASA
|
Return to baseline
|
|
Nakhla et al. (2016) [9]
|
88/F
|
C5/6
|
Sac
|
NA
|
Repetitive microtrauma: herniated cervical disc
|
Cons
|
NA
|
CR w/o FND
|
|
Dabus et al. (2017) [10]
|
Mid 60 s/NA
|
C0
|
Fus
|
NA
|
Unknown
|
Cons
|
CO
|
CR w/o FND
|
|
Present case
|
65/M
|
Clivus
|
Fus
|
2 × 1.9
|
Hemodynamic stress: collateral to isolated VA segment
|
FDS at ASA origin
|
CO; patent ASA
|
CR w/o FND
|