Cargando…

Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case

BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by the presence of asthma and eosinophilia. Because cerebral aneurysm formation induced by EGPA is a rare occurrence, there is no established treatment strategy for this condition. OB...

Descripción completa

Detalles Bibliográficos
Autores principales: Hayashi, Tetsuya, Sakata, Hiroyuki, Ezura, Masayuki, Saito, Atsushi, Osada, Yoshinari, Tominaga, Teiji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Association of Neurological Surgeons 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379623/
https://www.ncbi.nlm.nih.gov/pubmed/36209401
http://dx.doi.org/10.3171/CASE21701
_version_ 1784768708480073728
author Hayashi, Tetsuya
Sakata, Hiroyuki
Ezura, Masayuki
Saito, Atsushi
Osada, Yoshinari
Tominaga, Teiji
author_facet Hayashi, Tetsuya
Sakata, Hiroyuki
Ezura, Masayuki
Saito, Atsushi
Osada, Yoshinari
Tominaga, Teiji
author_sort Hayashi, Tetsuya
collection PubMed
description BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by the presence of asthma and eosinophilia. Because cerebral aneurysm formation induced by EGPA is a rare occurrence, there is no established treatment strategy for this condition. OBSERVATIONS: A 67-year-old female who was diagnosed with idiopathic eosinophilia 3 months ago developed de novo fusiform aneurysms in the left vertebral, left internal carotid, and bilateral superficial temporal arteries, as noted during a regular follow-up examination of a convexity meningioma. Pathological examination of the resected superficial temporal artery revealed eosinophilic granulomas, which led to the diagnosis of EGPA, as well as EGPA-induced aneurysm formation. As the partially thrombosed vertebral artery fusiform aneurysm enlarged, the compression of the medulla oblongata occurred despite intensive immunosuppressive therapy for 1 year. The patient underwent flow diversion therapy administered using the pipeline embolization device, resulting in complete disappearance of the aneurysm. LESSONS: Considering that the entire circumference of the aneurysmal wall is affected by necrotizing vasculitis, flow diverter therapy would be a reasonable and efficient approach for the treatment of EGPA-related aneurysms in cases in which the patient is nonresponsive to immunosuppressants.
format Online
Article
Text
id pubmed-9379623
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher American Association of Neurological Surgeons
record_format MEDLINE/PubMed
spelling pubmed-93796232022-10-04 Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case Hayashi, Tetsuya Sakata, Hiroyuki Ezura, Masayuki Saito, Atsushi Osada, Yoshinari Tominaga, Teiji J Neurosurg Case Lessons Case Lesson BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small-vessel vasculitis characterized by the presence of asthma and eosinophilia. Because cerebral aneurysm formation induced by EGPA is a rare occurrence, there is no established treatment strategy for this condition. OBSERVATIONS: A 67-year-old female who was diagnosed with idiopathic eosinophilia 3 months ago developed de novo fusiform aneurysms in the left vertebral, left internal carotid, and bilateral superficial temporal arteries, as noted during a regular follow-up examination of a convexity meningioma. Pathological examination of the resected superficial temporal artery revealed eosinophilic granulomas, which led to the diagnosis of EGPA, as well as EGPA-induced aneurysm formation. As the partially thrombosed vertebral artery fusiform aneurysm enlarged, the compression of the medulla oblongata occurred despite intensive immunosuppressive therapy for 1 year. The patient underwent flow diversion therapy administered using the pipeline embolization device, resulting in complete disappearance of the aneurysm. LESSONS: Considering that the entire circumference of the aneurysmal wall is affected by necrotizing vasculitis, flow diverter therapy would be a reasonable and efficient approach for the treatment of EGPA-related aneurysms in cases in which the patient is nonresponsive to immunosuppressants. American Association of Neurological Surgeons 2022-03-14 /pmc/articles/PMC9379623/ /pubmed/36209401 http://dx.doi.org/10.3171/CASE21701 Text en © 2022 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ).
spellingShingle Case Lesson
Hayashi, Tetsuya
Sakata, Hiroyuki
Ezura, Masayuki
Saito, Atsushi
Osada, Yoshinari
Tominaga, Teiji
Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
title Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
title_full Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
title_fullStr Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
title_full_unstemmed Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
title_short Flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
title_sort flow diverter therapy for immunosuppressant-resistant vertebral artery fusiform aneurysm due to eosinophilic granulomatosis with polyangiitis: illustrative case
topic Case Lesson
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379623/
https://www.ncbi.nlm.nih.gov/pubmed/36209401
http://dx.doi.org/10.3171/CASE21701
work_keys_str_mv AT hayashitetsuya flowdivertertherapyforimmunosuppressantresistantvertebralarteryfusiformaneurysmduetoeosinophilicgranulomatosiswithpolyangiitisillustrativecase
AT sakatahiroyuki flowdivertertherapyforimmunosuppressantresistantvertebralarteryfusiformaneurysmduetoeosinophilicgranulomatosiswithpolyangiitisillustrativecase
AT ezuramasayuki flowdivertertherapyforimmunosuppressantresistantvertebralarteryfusiformaneurysmduetoeosinophilicgranulomatosiswithpolyangiitisillustrativecase
AT saitoatsushi flowdivertertherapyforimmunosuppressantresistantvertebralarteryfusiformaneurysmduetoeosinophilicgranulomatosiswithpolyangiitisillustrativecase
AT osadayoshinari flowdivertertherapyforimmunosuppressantresistantvertebralarteryfusiformaneurysmduetoeosinophilicgranulomatosiswithpolyangiitisillustrativecase
AT tominagateiji flowdivertertherapyforimmunosuppressantresistantvertebralarteryfusiformaneurysmduetoeosinophilicgranulomatosiswithpolyangiitisillustrativecase