AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |
Back to Blog
Pica artery dissection survival8/27/2023 ![]() ![]() VADA is usually not amenable to treatment with standard clipping or coil embolization due to the morphology of the lesion. Therefore, ruptured VADA is treated emergently to prevent mortality and severe disability. In patients with rebleeding, the mortality rate is high and has been estimated near 50%. However, ruptured VADA presents a precarious situation with a high propensity for subsequent rebleeding, estimated at 30–70% and typically occurring within hours to days of the initial event. Due to its uncertain natural history, the management of unruptured lesions is controversial. Alongside surgical and endovascular treatment options, conservative management may be considered. Unruptured VADA may present with headache, ischemic symptoms (e.g., lateral medullary syndrome), or mass effect, and remain stable or even improve without treatment. The hematoma may be eccentric to the adventitia or intima subadventitial dissection preferentially occurs in the VA alone and presents as aneurysmal enlargement and SAH whereas subintimal dissection preferentially involves the basilar artery and presents with luminal narrowing and brainstem ischemia. Intracranial VADA results from a tear in the intima, degeneration of the media, or disruption of the internal elastic lamina, which lead to the formation of an intramural hematoma. Vertebral artery dissecting aneurysms (VADA) cause 3–5% of cases of subarachnoid hemorrhage (SAH), particularly in middle-aged men, and can occasionally involve the posterior inferior cerebellar artery (PICA). Keywords: Flow-diverting stent, Posterior inferior cerebellar artery, Vertebral artery dissecting aneurysm In select cases, in which the surgical risk is low or in which the anatomy is favorable (e.g., nondominant parent vessel or robust collateral circulation in the involved territories), parent artery trapping with or without microsurgical revascularization can be considered. Flow-diverting stents appear to offer the most favorable balance of securing the aneurysm and avoiding medullary infarction, but the risks and optimal anti-thrombotic treatment strategy are incompletely understood. The methods of surgical and endovascular treatment of these cases were reviewed, with particular focus on the rationale of treatment, outcomes, and complications.Ĭonclusion: Numerous treatment options for VADA involving PICA have been reported with different risk and benefit profiles. Review of the literature identified 124 cases of VADA involving the PICA origin described over the past decade. Ultimately, the patient experienced a contralateral intraparenchymal hemorrhage leading to death. After consideration of the patient’s cerebral vasculature and robustness of collaterals, a flow-diverting stent was placed with angiographic resolution of the lesion and maintenance of antegrade PICA flow. We present an illustrative case and review the literature surrounding treatment strategies.Ĭase Description: We report a patient presenting with extensive subarachnoid hemorrhage due to rupture of an intracranial VADA involving the PICA origin. Severe occlusion of this artery or to vertebral arteries could lead to Horner's Syndrome as well.Background: Vertebral artery dissecting aneurysm (VADA) involving the origin of the posterior inferior cerebellar artery (PICA) is a complex disease entity in which the dual goals of preventing future rebleeding and maintaining perfusion of the lateral medulla must be considered. The medial branch continues backward to the notch between the two hemispheres of the cerebellum while the lateral supplies the under surface of the cerebellum, as far as its lateral border, where it anastomoses with the anterior inferior cerebellar and the superior cerebellar branches of the basilar artery.īranches from this artery supply the choroid plexus of the fourth ventricle.Ī disrupted blood supply to posterior inferior cerebellar artery due to a thrombus or embolus can result in a stroke and lead to lateral medullary syndrome. ![]() It winds backward around the upper part of the medulla oblongata, passing between the origins of the vagus nerve and the accessory nerve, over the inferior cerebellar peduncle to the undersurface of the cerebellum, where it divides into two branches. The PICA supplies blood to the medulla oblongata the choroid plexus and tela choroidea of the fourth ventricle the tonsils the inferior vermis, and the inferior parts of the cerebellum. Blockage of the posterior inferior cerebellar artery can result in a type of stroke called lateral medullary syndrome. It is one of the three main arteries that supply blood to the cerebellum, a part of the brain. The posterior inferior cerebellar artery ( PICA) is the largest branch of the vertebral artery.
0 Comments
Read More
Leave a Reply. |