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Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report

We report the case of a 49-year-old man with underlying hypertension who developed diplopia lasting 2 months. Magnetic resonance imaging and digital subtraction angiography showed multi-lobular unruptured aneurysms in the P2 portion of the posterior cerebral artery (PCA) migrating into the interpedu...

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Autores principales: Isozaki, Makoto, Arai, Hiroshi, Neishi, Hiroyuki, Kitai, Ryuhei, Kikuta, Ken-ichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386164/
https://www.ncbi.nlm.nih.gov/pubmed/28664014
http://dx.doi.org/10.2176/nmccrj.cr.2016-0096
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author Isozaki, Makoto
Arai, Hiroshi
Neishi, Hiroyuki
Kitai, Ryuhei
Kikuta, Ken-ichiro
author_facet Isozaki, Makoto
Arai, Hiroshi
Neishi, Hiroyuki
Kitai, Ryuhei
Kikuta, Ken-ichiro
author_sort Isozaki, Makoto
collection PubMed
description We report the case of a 49-year-old man with underlying hypertension who developed diplopia lasting 2 months. Magnetic resonance imaging and digital subtraction angiography showed multi-lobular unruptured aneurysms in the P2 portion of the posterior cerebral artery (PCA) migrating into the interpeduncular cistern of the midbrain. Because the shapes of the aneurysms were serpentine fusiform and the posterior communicating artery (PCoA) was the fetal type, we planned anastomosis of the occipital artery to the P4 portion of the PCA followed by endovascular obliteration of the parent artery including the aneurysms. Endovascular treatment was performed via a femoral approach one week after the anastomosis. Super-selective balloon test occlusion (BTO) of the PCoA was performed by using an occlusion balloon microcatheter before endovascular treatment. Occlusion of the proximal segment of the PCoA induced disturbance of consciousness of the patient. Occlusion of the distal segment other than the first point of the PCoA did not induce any neurological symptoms. The information from this super-selective BTO helped us to perform precise endovascular obliteration. The aneurysm was successfully obliterated, and the diplopia almost disappeared in a few months. Super-selective BTO of the PCoA might be a useful method for preventing ischemic complications due to occlusion of invisible perforators.
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spelling pubmed-53861642017-06-29 Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report Isozaki, Makoto Arai, Hiroshi Neishi, Hiroyuki Kitai, Ryuhei Kikuta, Ken-ichiro NMC Case Rep J Case Report We report the case of a 49-year-old man with underlying hypertension who developed diplopia lasting 2 months. Magnetic resonance imaging and digital subtraction angiography showed multi-lobular unruptured aneurysms in the P2 portion of the posterior cerebral artery (PCA) migrating into the interpeduncular cistern of the midbrain. Because the shapes of the aneurysms were serpentine fusiform and the posterior communicating artery (PCoA) was the fetal type, we planned anastomosis of the occipital artery to the P4 portion of the PCA followed by endovascular obliteration of the parent artery including the aneurysms. Endovascular treatment was performed via a femoral approach one week after the anastomosis. Super-selective balloon test occlusion (BTO) of the PCoA was performed by using an occlusion balloon microcatheter before endovascular treatment. Occlusion of the proximal segment of the PCoA induced disturbance of consciousness of the patient. Occlusion of the distal segment other than the first point of the PCoA did not induce any neurological symptoms. The information from this super-selective BTO helped us to perform precise endovascular obliteration. The aneurysm was successfully obliterated, and the diplopia almost disappeared in a few months. Super-selective BTO of the PCoA might be a useful method for preventing ischemic complications due to occlusion of invisible perforators. The Japan Neurosurgical Society 2016-09-01 /pmc/articles/PMC5386164/ /pubmed/28664014 http://dx.doi.org/10.2176/nmccrj.cr.2016-0096 Text en Copyright © 2016 The Japan Neurosurgical Society This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Case Report
Isozaki, Makoto
Arai, Hiroshi
Neishi, Hiroyuki
Kitai, Ryuhei
Kikuta, Ken-ichiro
Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report
title Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report
title_full Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report
title_fullStr Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report
title_full_unstemmed Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report
title_short Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report
title_sort super-selective balloon test occlusion of the posterior communicating artery in the treatment of a posterior cerebral artery fusiform aneurysm: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386164/
https://www.ncbi.nlm.nih.gov/pubmed/28664014
http://dx.doi.org/10.2176/nmccrj.cr.2016-0096
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