Basilar artery fenestration associated with aneurysms treated by endovascular approach

Introduction: Arterial fenestrations are associated with saccular aneurysms that are often difficult to treat with open surgical techniques. Basilar artery fenestration reported in the literature is highly variable depending on the technique used. Typically fenestration occurs at the lower end of the basilar artery just at the vertebral arteries join. For basilar artery fenestrations associated with aneurysms endovascular embolization could be the first treatment choice.Methods: This study presented three cases of patients having basilar artery fenestration associated with aneurysm that were treated endovascularly. All patients underwent endovascular embolization by femoral approach, under general anesthesia.Results: In all three cases, no new neurological deficits were reported. Balloon remodeling technique was necessary in one patient that presented kissing aneurysms. The length of the follow-up was 3 years for 2 patients, and 1 year for one patient. All the aneurysms, except one, presented a small recanalization at four vessels digital subtraction angiography (DSA) control, but it remained stable even at the three years control.Conclusions: Endovascular treatment of basilar artery aneurysms associated with fenestrations is a safe and durable option. No second embolization procedure was necessary in our cases. No limb of the fenestration was necessary to be sacrificed. Larger series of patients treated with this method are needed to support our evidence

Surgical treatment of a dissecting aneurysm of the superior cerebellar artery: Case report

Dissecting aneurysm located in the peripheral region of the superior cerebellar artery is very rare. There is little experience regarding their surgical or endovascular treatment. We present the case of a peripheral dissecting superior cerebellar artery aneurysm treated by surgical clipping

Cerebral Vasospasm – A serious obstacle in a successful aneurysm surgery

Background: Cerebral vasospasm that occurs after subarachnoid hemorrhage (SAH) can be an important cause of mortality and morbidity for patients successfully operated for a cerebral aneurysm. Methods: Five cases of prompt diagnostic and surgical treatment of a cerebral aneurysm, with important SAH on cerebral computed tomography (CT) at onset, are presented. All patients were admitted in a poor neurological state and developed severe vasospasm. Both, the correct clipping of the aneurysm and the cerebral vasospasm were angiographic demonstrated in all cases. Two patients showed complete obliteration of one carotid artery. Results: Postoperatory, four of the patients were treated with intrathecally administered nimodipine (10mg/50ml). In three cases, the procedure caused the reverse of the vasospasm and clinical improvement of the patients. Their clinical outcomes were very good and were discharged with minimal neurological deficits. In one case, repeated intraarterial administration of nimodipine, showed no reduction of the vasospasm, and no improvement of patient’s clinical status. The patient was conscious, but presented focal neurological deficits (hemiplegia and aphasia). One patient did not benefit from this treatment and had a poor clinical outcome, remaining in a vegetative state. Conclusions: Cerebral vasoconstriction after SAH could be an important obstacle in obtaining very good results in aneurysm surgery. Intra-arterial administration of nimodipine is an important and useful treatment, but good results in reversal severe cerebral vasospasm are not always mandatory

Diversion-p64: results from an international, prospective, multicenter, single-arm post-market study to assess the safety and effectiveness of the p64 flow modulation device

International audienceBackground: The use of flow diversion to treat intracranial aneurysms has increased in recent years.Objective: To assess the safety and angiographic efficacy of the p64 flow modulation device.Methods: Diversion-p64 is an international, prospective, multicenter, single-arm, study conducted at 26 centers. The p64 flow modulation device was used to treat anterior circulation aneurysms between December 2015 and January 2019. The primary safety endpoint was the incidence of major stroke or neurologic death at 3-6 months, with the primary efficacy endpoint being complete aneurysm occlusion (Raymond-Roy Occlusion Classification 1) on follow-up angiography.Results: A total of 420 patients met the eligibility criteria and underwent treatment with the p64 flow modulation device (mean age 55±12.0 years, 86.2% female). Mean aneurysm dome width was 6.99±5.28 mm and neck width 4.47±2.28 mm. Mean number of devices implanted per patient was 1.06±0.47, with adjunctive coiling performed in 14.0% of the cases. At the second angiographic follow-up (mean 375±73 days), available for 343 patients (81.7%), complete aneurysm occlusion was seen in 287 (83.7%) patients. Safety data were available for 413 patients (98.3%) at the first follow-up (mean 145±43 days) with a composite morbidity/mortality rate of 2.42% (n=10).Conclusions: Diversion-p64 is the largest prospective study using the p64 flow modulation device. The results of this study demonstrate that the device has a high efficacy and carries a low rate of mortality and permanent morbidity