Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

Reconstructive treatment of symptomatic vertebral artery dissecting aneurysms with Willis covered stent: Initial experience

Background:Symptomatic vertebral artery dissecting aneurysm(VADA)is a challenging disease with controversy on treatment strategy due to anatomic configuration and their nature.Moreover,the outcomes of reconstructive treatment have not been well established.Objective:To evaluate the safety and efficacy of reconstructive endovascular treatment(EVT)for symptomatic VADAs with Willis covered stent.Methods:We evaluated retrospectively 13 patients with symptomatic VADAs who treated with Willis covered stent,compared with stent-assisted coiling(SAC)on the characteristics,posttreatment course,angiographic and clinical follow-up outcomes at an average of 14.4 months(range,3-48 months).Results:A total of 33 patients with symptomatic VADAs were reviewed,23 of these patients with ruptured VADAs.The technical successful rate is 100%respectively in Willis covered stent(Group A)and SAC(Group B,n=20).The initial complete occlusion rate was significant higher in group A(100%)than group B(30%)(p<0.01).Major procedure-related complications were not significant different in the two groups.Serial follow-up angiograms revealed 5 recurrent VADAs in group B and no recurrence in group A(p>0.05).No obvious in-stent stenosis and no re-hemorrhage and delayed ischemic symptoms during the follow-up period.The final angiograms of all survived patients demonstrated the complete occlusion rate was higher in group A(100%)than group B(80%),but no significant statistical difference(p>0.05).Clinical outcomes were favorable in 31(93.9%),severe disability occurred in one in group B,and only one death in group A.The final clinical outcomes were also not significant difference in the two groups(p>0.05).Conclusions:Our initial result demonstrated reconstructive EVT with Willis covered stent provides a viable approach for selected symptomatic VADAs involving the intracranial and extracranial segments,which is similar to favorable results with SAC.However,an expanded clinical experiences and larger cohort studies are needed.

The interactions between bloodstream and vascular structure on aortic dissecting aneurysmal model: A numerical study

Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm （ADA）. However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to oc-clude ADA will result in a decreased chance of rupture.

Endovascular treatment of direct carotid cavernous fistula resulting from rupture of intracavernous carotid aneurysm: A case report

BACKGROUND Direct carotid cavernous fistulas(CCFs)are typically the result of a severe traumatic brain injury.High-flow arteriovenous shunts secondary to rupture of an intracavernous aneurysm,resulting in direct CCFs,are rare.The use of a pipeline embolization device in conjunction with coils and Onyx glue for treatment of direct high-flow CCF resulting from ruptured cavernous carotid artery aneurysm in a clinical setting is not well documented.CASE SUMMARY A 58-year-old woman presented to our department with symptoms of blepharoptosis and intracranial bruits for 1 wk.During physical examination,there was right eye exophthalmos and ocular motor palsy.The rest of the neurological examination was clear.Notably,the patient had no history of head injury.The patient was treated with a pipeline embolization device in the ipsilateral internal carotid artery across the fistula.Coils and Onyx were placed through the femoral venous route,followed by placement of the pipeline embolization device with assistance from a balloon-coiling technique.No intraoperative or perioperative complications occurred.Preoperative symptoms of bulbar hyperemia and bruits subsided immediately after the operation.CONCLUSION Pipeline embolization device in conjunction with coiling and Onyx may be a safe and effective approach for direct CCFs.

Treatment of extracranial internal carotid artery dissecting aneurysm with SUPERA stent implantation:Two case reports

BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.

Treatment of pediatric intracranial dissecting aneurysm with clipping and angioplasty,and next-generation sequencing analysis:A case report and literature review

BACKGROUND Large intracranial dissecting aneurysm(IDA)in the anterior cerebral circulation is rare in children.There has been no consensus on the diagnosis and treatment for IDA in children.CASE SUMMARY We report a 3-year-old boy with a large ruptured IDA in the right middle cerebral artery(16 mm×14 mm).The IDA was successfully managed with clipping and angioplasty.Next-generation sequencing of the blood sample followed by bioinformatics analysis suggested that the rs78977446 variant of the ADAMTS13 gene is a risk for pediatric IDA.Three years after surgery,the boy was developmentally normal.CONCLUSION Clipping and angioplasty are effective treatments for ruptured IDA in the anterior cerebral circulation.ADAMTS13 rs78977446 is a risk factor for pediatric IDA.

Research Progress on Individualized Treatment of Splenic Aneurysm

Splenic artery aneurysm has a hidden onset and atypical symptoms.There are various diagnostic methods for splenic aneurysms,among which ultrasound is the first choice for aneurysm screening.The diagnostic rate of CTA and DSA reaches 100%.In clinical practice,it is necessary to integrate medical history,symptoms and signs,and multiple imaging results to improve the diagnostic rate.In terms of treatment plans,both intervention and surgical procedures have their strengths,and the application of intervention will be more extensive.We need to adhere to the principle of individualization and choose a reasonable treatment plan for patients.At present,there are many reports on pregnant women with large splenic aneurysms both domestically and internationally.Some scholars believe that large splenic aneurysms may be related to hormonal imbalances during pregnancy,and the specific pathogenic mechanism will become a hot topic in future research.

Endovascular treatment of intracranial dissecting aneurysm

Objective To analyze the clinical features of intracranial dissecting aneurysm and summarize the experience of its endovascular embolization. Methods 16 cases of intracranial dissecting aneurysm were treated by endovascular embolization. Among these 16 patients,3 patients were treated with single stent or double

Blunt aortic injury-traumatic aortic isthmus pseudoaneurysm with right iliac artery dissection aneurysm:A case report

BACKGROUND Blunt aortic injury is a special type of aortic disease.Due to its low incidence,high prehospital mortality and high probability of leakage diagnosis,the timely identification of patients with blunt aortic injury who survive the initial injury has always been a clinical challenge.CASE SUMMARY We report a case of traumatic aortic pseudoaneurysm with right iliac artery dissection aneurysm that was diagnosed 3 mo after a traffic accident.The patient is a 76-year-old male who was knocked down by a fast-moving four-wheel motor vehicle while crossing the road(the damage mechanism was side impact).He received chest,cranial computed tomography(CT)and whole abdomen enhanced CT in the local hospital.The images suggested subarachnoid hemorrhage,right frontoparietal scalp hematoma,fracture of the right clavicle and second rib,lumpshaped mediastinal shadow outside the anterior descending thoracic aorta(mediastinal hematoma),mesenteric vascular injury with hematoma formation,pelvic fracture,and subluxation of the left sacroiliac joint.After the pelvic fracture was fixed with an external stent,he was sent to our hospital for further treatment.In our hospital,he successfully underwent partial resection of the small intestine and CT-guided screw internal fixation of the left sacroiliac joint and returned to the local hospital for rehabilitation treatment.However,since the accident,the patient has been suffering from mild chest pain,which has not aroused the attention of clinicians.During rehabilitation,his chest pain gradually worsened,and the thoracic aorta computed tomography angiography performed in the local hospital showed a pseudoaneurysm in the initial descending segment of the aortic arch.After transfer to our hospital,a dissecting aneurysm of the right external iliac artery was incidentally found in the preoperative evaluation.Finally,endovascular stent graft repair was performed,and he was discharged on the 10th day after the operation.No obvious endo-leak was found after 4 years of follow-up.CONCLUSION We highlight that emergency trauma centers should consider the possibility of aortic injury in patients with severe motor vehicle crashes and repeat the examination when necessary to avoid missed diagnoses.

Images in emergency medicine:giant ascending aortic aneurysm dissection with hemopericardium

BACKGROUND:Acute chest pain represents a common presentation at emergency department.Aortic dissection in young patients,however,is fortunately rare.METHODS:We report a case of giant ascending aortic aneurysm with Stanford type A aortic dissection in an otherwise well 22-year-old male patient.Operative aortic valve and root replacement was undertaken with favourable outcome.RESULTS:Histopathologic examination of the resected aorta revealed acute on chronic inflammatory change with Langerhans type giant cells consistent with a diagnosis of giant cell aortitis.CONCLUSION:While uncommon,emergencies of the aorta may present in young patients.Predisposing conditions are discussed.

Surgical Treatment of Aortic Aneurysm and Aortic Dissection:A Retrospective Analysis of 122 Cases

The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement （n=3）, aortic root replacement （n=43）, hemi-arch replacement/total arch replacement ＋ elephant trunk technique （n=32）, thoracic/thoracoabdominal aortic replacement （n=8） and endovascular repair （n=36）. In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage （n=1）, respiratory failure （n=1） and multiple organ dysfunction syndrome （MODS） （n=2）. Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.

Celiac Artery Aneurysm Due to Chronic Spontaneous Dissection: Two Cases of Surgical Repair

In this report, we describe two surgical cases of celiac artery aneurysm due to chronic and asymptomatic spontaneous dissection without atherosclerotic change or medial degeneration. Case 1 had replacement of the celiac and common hepatic arteries using a knitted Dacron prosthetic graft, and case 2 had simple aneurysmectomy. The incidence of celiac artery dissection is increasing lately, but subsequent aneurysm is relatively rare. Our two cases had no atherosclerotic risk factors, so it might be possible that celiac artery aneurysm due to spontaneous dissection may produce different findings from dissection of other arteries. We consider that the need for surgery should be determined carefully if the asymptomatic celiac artery aneurysm due to dissection is small and unless it shows any changes in its diameter in the follow-up period.

Marfan Syndrome Complicated by Aortic Arch Aneurysm and Aortic Dissection: A Case Report from Congo

Context and Aim: Marfan syndrome is a transmissible genetic disease of the connective tissue that is rarely encountered in Congo and in sub-Saharan African countries. Its cardiovascular complications can be life frightening. The management of that disease is still limited in our country because of a lack of technical capacity in cardiovascular surgery. The aim of this clinical report is to show the interest of echocardiography and especially angioscanner as the main technique in the diagnosis of the severity of this disease, elaborate a literature review, but also to highlight the difficulties encountered in the management of that affection in our countries. Observation: The authors report the medical observation of a 48-year-old adult with a history of cataract of the left eye and a subluxation of the lens for which he underwent surgery in 2016, without any etiology being found. He is a smoker at a rate of 6 packs yearly. He consulted for progressively worsening dyspnea and constrictive mediosternal pain. The clinical examination revealed a moderate alteration of the general state, apyrexia, a blood pressure of 140/90 mmHg, a SPO2 of 97% in ambient air, a respiratory frequency of 32 cycles/min, signs of left ventricular insufficiency, a diastolic murmur of aortic insufficiency of intensity 4/6th, a long-limbed morphotype with a wingspan superior to the height and a kyphoscoliosis. Chest X-ray showed cardiomegaly with a cardiothoracic ratio of 58%, a highly dilated and uncoiled aorta, convexity of the left inferior arch, and venocapillary hypertension and a quiet alveolar-interstitial pulmonary oedema. The ECG was in sinus rhythm and showed a poor R-wave progression in anteroseptal leads. Echocardiography showed significant aortic root dilatation up to 72.6 mm and aortic regurgitation grade IV. Angioscanner showed a dissected aortic aneurysm and areas of emphysema located in the lungs. The medical treatment was palliative with beta blocker and angiotensin II receptor antagonists, diuretics and analgesics. The patient is awaiting surgery. Conclusion: Marfan syndrome is a genetic disease of the connective tissue that can manifest itself by cardiovascular, pulmonary, orthopedic, ophthalmological and cutaneous signs. Echocardiography and especially angioscanner are the tools of choice for the diagnosis and follow-up of this condition. Surgery is reserved for serious complications of this condition.

Effectiveness and Influencing Factors of Comprehensive Rehabilitation Therapy in Patients with Aneurysmal Subarachnoid Hemorrhage

This study aimed to determine the effectiveness of comprehensive rehabilitation for patients with aneurysmal subarachnoid hemorrhage (aSAH) and to explore the factors influencing the prognosis of rehabilitation. This was a retrospective study. Twenty-five patients with aSAH were treated with physical therapy, occupational therapy, speech therapy, cognitive therapy, music therapy, Chinese acupuncture, hyperbaric oxygen, and transcranial magnetic stimulation. The general data of all patients were collected, and the functional scores at admission were compared with those at discharge. The Mini Mental State Examination, Fugl-Meyer Assessment Scale (FMAS) for motor and balance assessment, Holden Functional Ambulation Classification (FAC), modified Rankin Scale, National Institute of Health Stroke Scale, Modified Barthel Index for activities of daily living (ADL), and Glasgow Outcome Scale were significantly improved among 25 patients with aSAH after 1 month of comprehensive rehabilitation training. Hydrocephalus was an independent factor of the ability to perform ADLs (odds ratio, 0.29;95% confidence interval, 2.03. 3.15;p = 0.000). The improvement of ADLs in aSAH patients was not related to sex, surgical method, aneurysm location, age, or smoking status. Comprehensive and professional rehabilitation is effective for the cognition, movement, walking, ADLs, and functional prognosis of patients with aSAH, while early hydrocephalus may be a risk factor for poor ADLs.

Surgical repair of an emergent giant hepatic aneurysm with an abdominal aortic dissection:A case report

BACKGROUND Hepatic artery aneurysm(HAA)is the second most common visceral aneurysm.A significant number of hepatic aneurysms are found accidentally on examination.However,their natural history is characterized by their propensity to rupture,which is very serious and requires urgent treatment.An emergent giant hepatic aneurysm with an abdominal aortic dissection is less commonly reported.CASE SUMMARY We report the complicated case of a giant hepatic aneurysm with an abdominal aortic dissection.A 66-year-old female presented with the complaint of sudden upper abdominal pain accompanied by vomiting.Physical examination showed that her blood pressure was 214/113 mmHg.Her other vital signs were stable.Computed tomography found a giant hepatic proper aneurysm and dissection of the lower segment of the abdominal aorta.Furthermore,angiography showed a HAA with the maximum diameter of approximately 56 mm originating from the proper hepatic artery and located approximately 15 mm from the involved bifurcation of the left and right hepatic arteries with no collateral circulation.Therefore,we decided to use a stent to isolate the abdominal aortic dissection first,and then performed open repair.After the operation,the patient recovered well without complications,and her 3-month follow-up checkup did not reveal any late complications.CONCLUSION Open surgery is a proven method for treating giant hepatic aneurysms.If the patient's condition is complex,staged surgery is an option.

With autosomal dominant polycystic kidney disease,aortic dissection follows an abdominal aneurysm ten years later:a case report

A case of aortic dissection with a repaired abdominal aneurysm with prosthetic graft ten years ago in a 45-year-old woman is presented.Stanford type B dissection and multiple renal cysts diagnosed by contrast enhanced CT and an iliac false aneurysm by intraoperational angiography.Four stents were deployed to repair these arterial lesions with one fenestrated.With her only son revealed also with renal cysts by ultrasonogram,the diagnosis of autosomal dominant polycystic kidney disease (ADPKD) was confirmed.

Interventional Therapy for Cerebral Aneurysms Under the Guidance of 3D Printing Technology

Objective:To explore the clinical method and effect of 3D printing in the treatment of cerebral aneurysms.Methods:The authors research work on the hospital,work time in February 2019-February 2020,this study selected patients of cerebral aneurysms,this period are selected for treatment of 100 cases of patients,randomly divided into two groups,a group to give simple intervention,named as the control group,another group for the interventional therapy under the guidance of 3 D printing,named as experimental group,analyze the effect of two groups of patients with clinical intervention.Results:The length of hospital stay in the experimental group was shorter than that in the control group.Meanwhile,the incidence of complications and adverse reactions in the experimental group and the control group were 6.00%and 18.00%,the experimental group was better(P<0.05).Conclusion:3D printing technology can be applied in the treatment of patients with cerebral aneurysms to provide guidance for interventional surgical treatment.It has significant effect,can reduce the incidence complications in patients,has significant clinical effect,and can be popularized.

Successive development of ischemic malignant strokes in a patient with multiple fusiform aneurysms:A case report

BACKGROUND Intracranial fusiform aneurysms are rare,spindle-shaped,and nonsaccular arterial dilatations that may be caused by dissection.CASE SUMMARY A 48-year-old man complained of wake-up onset of dysarthria and left-sided weakness.Diffusion-weighted magnetic resonance imaging of the brain revealed an infarction in the territories of the right middle and posterior cerebral arteries.Computed tomography angiography showed fusiform aneurysms in the right vertebral artery and bilateral petrous segments of the internal carotid arteries(ICAs).Despite conservative management,malignant ischemic stroke recurred in the contralateral ICA territory within a day of the onset of the index stroke.CONCLUSION We report a rare case of successive malignant strokes in a patient with multiple fusiform aneurysms.Herein,we emphasize that clinicians should consider aggressive treatment for patients with ischemic stroke and multiple fusiform aneurysms.

Willis covered stent in the treatment of a recurrent blood blister-like aneurysm after pipeline implementation:A case report

Blood blister-like aneurysms(BBAs)are fragile and difficult to treat.However,the optimal treatment has yet to be determined.Pipeline embolization devices and Willis covered stent implementation are still controversial strategies for treating BBA.Herein,we report a case of recurrent BBA successfully treated with a Willis covered stent.A long-term follow-up angiography after the procedure indicated complete occlusion of the aneurysm.This case demonstrates the safety and efficacy of applying the Wills cover stent in the treatment of recurrent BBA after Pipeline implantation.