The collateral circulation was evaluated based on an elaborate analysis of the arterial and venous anatomy. EVT was performed under general anesthesia in all patients except for one who required instantaneous sacrifice of the affected VA due to a worsening clinical status. EVT was performed on the day of admission immediately after the diagnostic DSA. The procedure performed depended on patient status, location of the dissection, composition of the related vessels, and collateral circulation. We adopted EVT as the first-line treatment. The diagnosis of dissection was based on classical angiographic findings, such as fusiform dilatation, the "pearl and string" sign, subintimal flap, and irregular luminal stenosis. All patients underwent 4-vessel digital subtraction angiography (DSA). The clinical status of the patients at admission was recorded according to the Hunt-Hess grading (HHG) system, and the Fisher grading (FG) system was used to evaluate the amount of blood on CT. Two patients experienced cardiopulmonary arrest after their clinical deterioration. Presenting symptoms included headache and vomiting, decreased consciousness, and cranial nerve palsy. All patients were treated within the first day of hemorrhage. Two female patients had bilateral VADAns, one of which eventually resulted in an SAH and the other of which required a staged subsequent EVT due to the fear of a future rupture resulting from hemodynamic augmentation after occlusion of the ruptured VA. This retrospective analysis included 9 men and 14 women whose age ranged from 39 to 72 years (mean 54.2 years). SAH was confirmed by computed tomography (CT) scans, and contrast-enhanced three-dimensional CT angiography (3D-CTA) was performed to assess cerebral vasculature anomalies. Of these patients, 23 had ruptured VADAns and enrolled in our study. The present study aimed to establish an endovascular therapeutic strategy relevant to the angioarchitecture of VADAns that cause subarachnoid hemorrhages.įrom June 2006 to December 2013, 725 patients with spontaneously ruptured intracranial aneurysms were surgically or endovascularly treated at our institution. However, there is still an insufficient understanding of EVT for treating VADAns, especially those with accompanying PICA involvement, bilateral presentation, and VA dominance. Nevertheless, recent attempts to use stent-assisted coil embolization and stent-only techniques with advanced intracranial stents produced satisfactory results, including both the safe obliteration of dissected aneurysms and the preservation of VA and posterior inferior cerebellar artery (PICA) patency. Although these treatments are effective and safe with a low risk of complications, they still have ischemic risks comparable to surgical measures. It has a variable territory depending on the size of the AICA ( AICA-PICA dominance).Endovascular treatment (EVT) as a means of proximal occlusion or trapping of the VA is being used more frequently as the first-line treatment for VADAns due to several advantages, including easy accessibility, relatively minimal invasiveness, and rapid treatment transition following diagnostic angiography 9). Note: occasionally, a small vertebral artery will terminate into a common AICA-PICA complex. The posterior inferior cerebellar artery gives off the following arteries: Supplies the vermis and adjacent hemisphere The main trunk of the posterior inferior cerebellar artery usually bifurcates somewhere along the margin of the cerebellar tonsil into Supplies branches to the cerebellar surface Marks the transition between the proximal (medulla-supplying) and distal (cerebellum-supplying) parts of the posterior inferior cerebellar arteryĬourses in the cleft between the tela choroidea, inferior medullary velum rostrally, and superior pole of the cerebellar tonsil caudallyĬontains the cranial loop, also known as the choroid point or choroid arch, an upward convex loop that has a constant relation to the 4 th ventricle and gives rise to choroidal arteries Variably courses (ascending or descending) along the side of the medulla near or between the origins of the 9 th, 10 th, and 11 th cranial nerve rootsĬourses along the posterolateral surface of the medulla and inferior cerebellar tonsilĬontains the caudal loop, a downward convex loop that mostly remain superior to the foramen magnum but occasionally extend below it 6,7:Ĭourses along the front of the medulla at the level of the inferior olive The segmental anatomy was defined microsurgically by Lister et al. Occasionally arises from a common origin with the anterior inferior cerebellar artery ~20% arise extracranially, inferior to the foramen magnumġ0% arise from the basilar rather than vertebral artery The PICA is a paired artery that originates from the vertebral artery V4 segment.
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