Abstract
This case presentation describes the clinical and imaging findings, treatment, and subsequent clinical course of a 58-year-old male patient who survived two of the most serious neurological emergencies: an acute basilar artery occlusion and subsequently a diffuse subarachnoid hemorrhage. Atherosclerosis of the vertebrobasilar junction was the underlying pathology of both events. The acute occlusion was treated with mechanical thrombectomy and stent angioplasty. Three years later the patient presented acutely with rupture of an atherosclerotic aneurysm of the same vessel segment, which was treated with coil occlusion in the acute phase and later with flow diversion, after progressive aneurysm recurrence. Atherosclerosis as a rare cause of subarachnoid hemorrhage is the main topic of this chapter.
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References
Brinjikji W, Piano M, Fang S, Pero G, Kallmes DF, Quilici L, Valvassori L, Lozupone E, Cloft HJ, Boccardi E, Lanzino G. Treatment of ruptured complex and large/giant ruptured cerebral aneurysms by acute coiling followed by staged flow diversion. J Neurosurg. 2016;125(1):120–7. https://doi.org/10.3171/2015.6.JNS151038.
Broussalis E, Hitzl W, McCoy M, Trinka E, Killer M. Comparison of endovascular treatment versus conservative medical treatment in patients with acute basilar artery occlusion. Vasc Endovasc Surg. 2013;47(6):429–37. https://doi.org/10.1177/1538574413488458.
Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, Koch WJ, Dumont AS. Biology of intracranial aneurysms: role of inflammation. J Cereb Blood Flow Metab. 2012;32(9):1659–76. https://doi.org/10.1038/jcbfm.2012.84.
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG, HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31. https://doi.org/10.1016/S0140-6736(16)00163-X.
Kang DH, Yoon W, Kim SK, Baek BH, Lee YY, Kim YW, Kim YS, Hwang YH, Kim JT, Park MS. Endovascular treatment for emergent large vessel occlusion due to severe intracranial atherosclerotic stenosis. J Neurosurg. 2019;130(6):1949–56. https://doi.org/10.3171/2018.1.JNS172350.
Kim YW, Hong JM, Park DG, Choi JW, Kang DH, Kim YS, Zaidat OO, Demchuk AM, Hwang YH, Lee JS. Effect of intracranial atherosclerotic disease on endovascular treatment for patients with acute vertebrobasilar occlusion. AJNR Am J Neuroradiol. 2016;37(11):2072–8. https://doi.org/10.3174/ajnr.A4844.
Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. Lancet Neurol. 2011;10(11):1002–14. https://doi.org/10.1016/S1474-4422(11)70229-0.
Oshio K, Ikeda T, Matsumori T, Wakui D, Ito H, Takasuna H, Tanaka Y. A case of multiple atherosclerotic fusiform cerebral aneurysms with repeated subarachnoid hemorrhage. No Shinkei Geka. 2017;45(11): 991–6. https://doi.org/10.11477/mf.1436203634.
Starke RM, Chalouhi N, Ding D, Raper DM, Mckisic MS, Owens GK, Hasan DM, Medel R, Dumont AS. Vascular smooth muscle cells in cerebral aneurysm pathogenesis. Transl Stroke Res. 2014;5(3):338–46. https://doi.org/10.1007/s12975-013-0290-1.
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AlMatter, M., Clajus, C., Henkes, H., Klisch, J. (2019). Vertebral Artery Junction Aneurysm: Atherosclerotic Aneurysm of the Vertebrobasilar Junction, Treated with Coil Occlusion and Staged Flow Diversion. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_133-1
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DOI: https://doi.org/10.1007/978-3-319-70267-4_133-1
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