Top

Neuroradiology

Published in:

01-01-2014 | Interventional Neuroradiology

First demonstration of resolution of an infundibulum by direct treatment of the arterial wall with Pipeline flow-diverting stent

Authors: M. M. Kameda-Smith, J. C. Du Plessis, J. J. Bhattacharya

Published in: Neuroradiology | Issue 1/2014

Abstract

Introduction

Infundibula are symmetrical funnel-shaped widening, measuring more than 3 mm at its base with the branch artery arising from its apex. The pathological significance of this entity remains controversial. Although a relatively common appearance in otherwise normal angiograms, they have occasionally been described to progress into saccular aneurysms or directly rupture.

Methods/Results

We describe the first case of a disappearing infundibulum after a flow diverting stent was deployed across the infundibulum during the treatment of an adjacent aneurysm.

Conclusions

We concur in the view that infundibula are at least pre-pathological lesions that may in certain circumstances require consideration for treatment. Our case for the first time offers a potential treatment option for such situations.

Marshman LA, Ward PJ, Walter PH, Dossetor RS (1998) The progression of an infundibulum to aneurysm formation and rupture: case report and literature review. Neurosurgery 43:1445–1448PubMed

Martins C, Macanovic M, Silva IE C, Griz F, Azevedo-Filho HR (2002) Progression of an arterial infundibulum to aneurysm: case report. Arq Neuropsiquiatr 60:478–480PubMedCrossRef

Fischer S, Hopf N, Henkes H (2011) Evolution from an infundibulum of the posterior communicating artery to a saccular aneurysm. Clin Neuroradiol 21:87–90PubMedCrossRef

Saltzmann GF (1959) Infundibular widening of the posterior communicating artery studied by carotid angiography. Acta Radiol 51:415–421CrossRef

Wollschlaeeger G, Wollschlaeger PB, Lucas FV, Lopez VF (1967) Experience and result with postmortem cerebral angiography performed as a routine procedure of the autopsy. Am J Roent 101:68–87CrossRef

Ebina K, Ohkuma H, Iwabuchi T (1986) An angiographic study of incidence and morphology of infundibular dilatation of the posterior communicating artery. Neuroradiology 28:23–29PubMedCrossRef

Ohyama T, Ohara S, Momma F (1994) Fatal subarachnoid hemorrhage due to ruptured infundibular widening of the posterior communicating artery: access report. Neurol Med Chir (Tokyo) 34:172–175CrossRef

Edelsohn L, Caplan L, Rosenbaum AE (1972) Familial aneurysms and infundibular widening. Neurology 22:1056–1060PubMedCrossRef

Leblanc R, Worsley KJ, Melanson D, Tampieri D (1994) Angiographic screening and elective surgery of familial cerebral aneurysms: a decision analysis. Neurosurgery 35:9–18PubMedCrossRef

10.

Miyasaka K, Wolpert SM, Prager RJ (1982) The association of cerebral aneurysms, indundibula, and intracranial arteriovenous malformations. Stroke 13:196–203PubMedCrossRef

11.

Cowan JA Jr, Barkhoudarian G, Yang LJ, Thompson BG (2004) Progression of a posterior communicating artery infundibulum into an aneurysm in a patient with Alagille syndrome. Case report. J Neurosurg 101:694–696PubMedCrossRef

12.

Epstein F, Ransohoff J, Budzilovich GN (1970) The clinical significance of junctional dilation of the posterior communicating artery. J Neurosurg 33:529–531PubMedCrossRef

13.

Stuntz JT, Ojemann GA, Alvord EC (1970) Radiographic and histological demonstration of an aneurysm developing on the infundibulum of the posterior communicating artery. J Neurosurg 33:591–595PubMedCrossRef

14.

Archer CR, Silbert S (1978) Infundibula may be clinically significant. Neuroradiology 15:247–251PubMedCrossRef

15.

Trasi S, Vincent LM, Zingesser LH (1981) Development of aneurysm from infundibulum of posterior communicating artery with documentation of prior hemorrhage. Am J Neuroradiol 2:368–370PubMed

16.

Koike G, Seguchi K, Kyoshima K, Kobayash S (1994) Subarachnoid haemorrhage due to rupture of infundibular dilation of a circumflex branch of the posterior cerebral artery: case report. Neurosurgery 34:1075–1077PubMedCrossRef

17.

Hassler O, Saltzmann G-F (1959) Histological changes in infundibular widening of the posterior communicating artery. Acta Path Micro Scand 46:305–312CrossRef

18.

Hassler O, Saltzmann G-F (1963) Angiographic and histologic changes in infundibular widening of the posterior communicating artery. Acta Radiol Diagn (Stockh) 1:321–327

19.

Punt J (1979) Some observations on aneurysms of the proximal internal carotid artery. J Neurosurg 51:151–154PubMedCrossRef

20.

Glynn LE (1940) Medial defects of the circle of Willis and their relation to aneurysmal formation. J Path Bact 51:213–222CrossRef

21.

Roach MR (1963) Changes in arterial distensibility as a cause of post-stenotic dilatation. Amer J Cardiol 12:351–470CrossRef

22.

Stehbens WE (1963) Histopathology of cerebral aneurysms. Arch Neurol 8:272–285PubMedCrossRef

23.

Bjorkesten G, Troupp H (1962) Changes in the size of intracranial arterial aneurysms. J Neurosurg 19:583–588CrossRef

24.

Drake CG (1966) On the surgical treatment of ruptured intracranial aneurysms. Clin Neurosurg 13:122–155

25.

Yoshimoto T, Suzuki J (1974) Surgical treatment of an aneurysm on the funnel-shaped bulge of the posterior communicating artery. J Neurosurg 41:377–379PubMedCrossRef

26.

Young B, Meacham F, Allen JH (1971) Documented enlargement and rupture of a small arterial sacculation: case report. J Neurosurg 34:814–817PubMedCrossRef

27.

Patrick D, Appleby A (1983) Infundibular widening of the posterior communicating artery progressing to true aneurysm. Br J Radiol 56:59–60PubMedCrossRef

28.

Itakura T, Ozaki F, Nakai FT, Hayashi S, Komai N (1983) Bilateral aneurysm formation developing from junctional dilatation (infundibulum) of the posterior communicating artery: case report. J Neurosurg 58:117–119PubMedCrossRef

29.

Radulovic D, Nestorovic B, Rakic M, Janosevic V (2006) Enlargement to a saccular aneurysm and subsequent rupture of infundibular widening of posterior communicating artery. Neurochirurgie 52:525–528PubMedCrossRef

30.

Takahashi C, Fukuda O, Hori E, Kameda H, Endo S (2006) A case of infundibular dilatation development into an aneurysm and rupturing after the rupture of an aneurysm 10 years ago. No Shinkei Geka 34:613–617PubMed

31.

Waga S, Morikawa A (1979) Aneurysm developing on the infundibular widening of the posterior communicating artery. Surg Neurol 11:125–127PubMed

32.

Kuwahara S, Uga S, Mori K (2001) Successful treatment of a ruptured enlarged infundibular widening of the posterior communicating artery—case report. Neurol Med Chir (Tokyo) 41:25–28CrossRef

33.

Coupe NJ, Athwal RK, Marshman LA, Brydon HL (2007) Subarachnoid hemorrhage emanating from a ruptured infundibulum: case report and literature review. Surg Neurol 67:204–206PubMedCrossRef

34.

Yu J, Wang H, Xu K, Wang B, Luo Q (2010) Endovascular embolization of ruptured infundibular dilation of posterior communicating artery: A case report. Case Reports in Medicine. Published online 2010 December 27; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3014759

35.

Baek H, Jayaraman MV, Karniadakis GE (2009) Wall shear stress and pressure distribution on aneurysms and infundibulae in the posterior communicating artery bifurcation. Ann Biomed Eng 37:2469–2487PubMedCrossRef

36.

González-Darder JM, Verdú-López F, Quilis-Quesada V (2011) Management of microsurgical treatment of infundibular dilatations of the posterior communicating artery. Series of nine cases and a review of the literature. Neurocirugia (Astur) 22:301–309CrossRef

Title: First demonstration of resolution of an infundibulum by direct treatment of the arterial wall with Pipeline flow-diverting stent
Authors: M. M. Kameda-Smith
J. C. Du Plessis
J. J. Bhattacharya
Publication date: 01-01-2014
Publisher: Springer Berlin Heidelberg
Published in: Neuroradiology / Issue 1/2014
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-013-1295-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

First demonstration of resolution of an infundibulum by direct treatment of the arterial wall with Pipeline flow-diverting stent

Abstract

Introduction

Methods/Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods/Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2014

Reviewers January 2013—November 2013

New Year's greetings from ESNR

Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

Computed tomography angiography intraluminal filling defect is predictive of internal carotid artery free-floating thrombus

Directional diffusion of corticospinal tract supports therapy decisions in idiopathic normal-pressure hydrocephalus

European Society of Neuroradiology (ESNR)