Published in:
01-12-2018 | Correspondence
Ruptured Fusiform Aneurysm of the Anterior Spinal Artery
Successful Treatment with Flow Diverter Stent Placed in the Feeding Vertebral Artery
Published in: Clinical Neuroradiology | Issue 4/2018
Login to get accessExcerpt
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
|