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Wang G, Li C, Piao J, Xu B, Yu J. Endovascular treatment of blunt injury of the extracranial internal carotid artery: the prospect and dilemma. Int J Med Sci 2021; 18:944-952. [PMID: 33456352 PMCID: PMC7807178 DOI: 10.7150/ijms.50275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/18/2020] [Indexed: 11/15/2022] Open
Abstract
The extracranial internal carotid artery (ICA) refers to the anatomic location that reaches from the common carotid artery proximally to the skull base distally. The extracranial ICA belongs to the C1 segment of the Bouthillier classification and is at considerable risk for injury. Currently, the understanding of endovascular treatment (EVT) for blunt injury of the extracranial ICA is limited, and a comprehensive review is therefore important. In this review, we found that extracranial ICA blunt injury should be identified in patients presenting after blunt trauma, including classical dissection, pseudoaneurysm, and stenosis/occlusion. Computed tomography angiography (CTA) is the first-line method for screening for extracranial ICA blunt injury, although digital subtraction angiography (DSA) remains the "gold standard" in imaging. Antithrombotic treatment is effective for stroke prevention. However, routine EVT in the form of stenting should be reserved for patients with prolonged neurological symptoms from arterial stenosis or considerably enlarged pseudoaneurysm. Endovascular repair is now emerging as a favored therapeutic option given its demonstrated safety and positive clinical and radiographic outcomes.
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Affiliation(s)
- Guangming Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Baofeng Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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2
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Butterfield JT, Chen CC, Grande AW, Jagadeesan B, Tummala R, Venteicher AS. The Rate of Symptomatic Ischemic Events after Passing Balloon Test Occlusion of the Major Intracranial Arteries: Meta-Analysis. World Neurosurg 2020; 146:e1182-e1190. [PMID: 33271379 DOI: 10.1016/j.wneu.2020.11.134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Balloon test occlusion is a widely used method for predicting tolerance of vessel occlusion in the treatment of aneurysms, fistulae, and head and neck neoplasms. However, the false-negative rate is variably reported due in part to the diversity of perfusion monitoring methods. OBJECTIVE To evaluate the rate of symptomatic ischemic events after a negative balloon test occlusion and determine whether perfusion monitoring methods contribute to differences in these rates. METHODS PubMed was systematically searched for studies between 1990 and 2020 that reported rates of ischemic outcomes of parental vessel occlusion in patients who passed balloon test occlusion. A generalized linear mixed model meta-analysis was performed. Results were expressed as the rate of symptomatic ischemic events after parental vessel occlusion without vessel bypass in patients who passed balloon test occlusion. RESULTS Thirty-two studies met the inclusion criteria. The overall pooled rate of ischemic events after passing balloon test occlusion was 3.7% (95% confidence interval [CI]: 1.7-7.8). This rate was 3.8% (95% CI: 1.1-12.8) when monitored with angiography, 2.2% (95% CI: 0.4-10.2) when monitored by a form of computed tomography, and 5.3% (95% CI: 1.2-20.4) when monitored by 2 or more methods of perfusion assessment. The complication rate of balloon test occlusion was 0.8% (95% CI: 0.2-2.7). CONCLUSIONS Balloon test occlusion results in a low rate of subsequent ischemic events, without conclusive evidence of variation between methods of perfusion assessment. The choice of method should focus on reduction of complication risk, experience of the interventional team, and avoidance of prolonged test occlusion times.
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Affiliation(s)
- John T Butterfield
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew W Grande
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bharathi Jagadeesan
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ramachandra Tummala
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Fukuhara N, Tsuruta W, Hosoo H, Sato M, Matsumaru Y, Yamaguchi-Okada M, Yoshino M, Hara T, Yamada S, Nishioka H. Magnetic Resonance Angiography-based Prediction of the Results of Balloon Test Occlusion. Neurol Med Chir (Tokyo) 2019; 59:384-391. [PMID: 31353325 PMCID: PMC6796060 DOI: 10.2176/nmc.oa.2019-0070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Precautious balloon test occlusion (BTO) is sometimes performed in cases of high-risk intraoperative internal carotid artery injury. We investigated whether magnetic resonance angiography (MRA) findings could predict BTO results to thus avoid the use of precautious BTO. This retrospective study, included 96 patients who underwent BTO, eight of whom underwent bilateral BTO. The relationship between the BTO results for 104 internal carotid arteries and the MRA findings obtained in 96 patients were retrospectively evaluated. On MRA, anterior cerebral artery (A1)–anterior communicating artery–A1 was defined as anterior collateral circulation (ACC), and posterior cerebral artery–posterior communicating artery was defined as posterior collateral circulation (PCC). BTO was tolerated in all 27 sides with thick ACC regardless of PCC thickness. In 31 of 44 cases with a thin ACC, the tested sides were BTO-tolerant (70.5%). Of these 44 tested sides, all five with a thick PCC were BTO-tolerant, but eight with a thin PCC and 31 with an invisible PCC showed results other than tolerance. Among cases with an invisible ACC, 10 of 33 tested sides were BTO-tolerant (30.3%). Among these 33 tested sides, outcomes other than tolerance were observed regardless of PCC thickness. Thick, thin, and invisible ACCs were assigned 3, 1, and 0 points, respectively; and thick, thin, and invisible PCCs were assigned 2, 1, and 0 points, respectively. A sum of 3 points in the ACC and PCC indicated that all sides were BTO-tolerant. In conclusion, a thick ACC or a thin ACC with a thick PCC indicates BTO-tolerance. The BTO prediction score is useful for predicting results of BTO.
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Affiliation(s)
- Noriaki Fukuhara
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital.,Department of Comprehensive Pathology, Tokyo Medical and Dental University.,Okinaka Memorial Institute for Medical Research
| | - Wataro Tsuruta
- Okinaka Memorial Institute for Medical Research.,Department of Neuro-Endovascular Therapy, Toranomon Hospital
| | - Hisayuki Hosoo
- Department of Neuro-Endovascular Therapy, Toranomon Hospital
| | - Masayuki Sato
- Division of Stroke, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Yuji Matsumaru
- Division of Stroke, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Masanori Yoshino
- Okinaka Memorial Institute for Medical Research.,Department of Neurosurgery, Tokyo Metropolitan Police Hospital
| | - Takayuki Hara
- Okinaka Memorial Institute for Medical Research.,Department of Neurosurgery, Toranomon Hospital
| | - Shozo Yamada
- Okinaka Memorial Institute for Medical Research.,Department of Neurosurgery, Tokyo Neurological Center
| | - Hiroshi Nishioka
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital.,Okinaka Memorial Institute for Medical Research
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Chen Z, Hu LN, Zhu H, Xiao EH. Validity of venous phase delay assessment in balloon occlusion test of internal carotid artery. Exp Ther Med 2019; 17:948-952. [PMID: 30651885 DOI: 10.3892/etm.2018.7009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/29/2018] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to investigate the utility of venous phase delay assessment to evaluate the balloon occlusion test (BOT) of the internal carotid artery (ICA). A total of 38 patients who received BOT of the ICA were included in this retrospective study. Clinical examination and venous phase assessment were performed in all patients to evaluate their suitability for the evaluation of the BOT of the ICA. The venous phase delay assessment compared the venous phase of supratentorial and infratentorial structures between hemispheres. Venous phase delay was defined as the time lag for opacification of the first cortical vein between the occluded hemisphere and the hemisphere examined. The results of the clinical examination and the venous phase delay assessment were compared. In most patients negative on clinical examination, the venous phase delay was no more than 2 sec, while for most patients positive on clinical examination, the delay was >2 sec. All patients with a venous phase delay of >4 sec had a positive clinical result. The present results indicated that venous phase delay assessment is a reliable method for evaluating BOT of the ICA, and in those with a delay of <2 sec, parent vessel occlusion of the ICA, which may be used as a pre-operative procedure prior to tumor resection for patients suffering from neck or skull-base tumors, was considered safe.
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Affiliation(s)
- Zhu Chen
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Li-Nan Hu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Hui Zhu
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - En-Hua Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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Nakahara M, Uozumi Y, Chiba Y, Miyake S, Fujita A, Kohmura E. Direct Carotid Cavernous Fistula Due to Rupture of a Cavernous Carotid Aneurysm Embedded Within a Prolactinoma After Cabergoline Administration. World Neurosurg 2018; 122:495-499. [PMID: 30465960 DOI: 10.1016/j.wneu.2018.11.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND A small number of reports have described subarachnoid hemorrhage resulting from a ruptured aneurysm embedded within a prolactinoma. To the best of our knowledge, no reports have described an embedded carotid cavernous fistula. We report a patient with carotid cavernous fistula secondary to a ruptured internal carotid artery aneurysm embedded within a prolactinoma. CASE DESCRIPTION A 61-year-old woman was referred to our hospital with sudden headache, vomiting, and dizziness. Magnetic resonance imaging demonstrated a small acute subdural hematoma, recurrent prolactinoma, and left cavernous carotid aneurysm. Conservative therapy was initiated. Her serum prolactin level at hospitalization was 11,300 μg/L; therefore, we initiated cabergoline therapy. Twenty days after cabergoline administration, she suddenly presented with left conjunctival injection and pulsatile tinnitus. Angiography showed a left direct carotid cavernous fistula with a connection between the cavernous internal carotid artery and the cavernous sinus via the aneurysm and venous congestion. To prevent hemorrhagic stroke, we scheduled staged surgery. First, we urgently performed embolization of the cavernous sinus and fistula. One month later, to prevent aneurysm rerupture, we performed a radical operation with superficial temporal artery-middle cerebral artery double anastomosis with proximal occlusion of the left internal carotid artery at the cervical portion. The patient was discharged 2 weeks after surgery without neurological deficits. Follow-up angiography revealed complete occlusion of the aneurysm 2 months postoperatively. CONCLUSIONS An aneurysm embedded within a prolactinoma should be closely observed when cabergoline administration is started.
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Affiliation(s)
- Masahiro Nakahara
- Department of Neurosurgery, Kita-harima Medical Center, Ono, Hyogo, Japan.
| | - Yoichi Uozumi
- Department of Neurosurgery, Kita-harima Medical Center, Ono, Hyogo, Japan; Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yoshiyuki Chiba
- Department of Neurosurgery, Kita-harima Medical Center, Ono, Hyogo, Japan
| | - Shigeru Miyake
- Department of Neurosurgery, Kita-harima Medical Center, Ono, Hyogo, Japan
| | - Atsushi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Shimizu K, Imamura H, Mineharu Y, Adachi H, Sakai C, Tani S, Arimura K, Beppu M, Sakai N. Endovascular parent-artery occlusion of large or giant unruptured internal carotid artery aneurysms. A long-term single-center experience. J Clin Neurosci 2016; 37:73-78. [PMID: 27956171 DOI: 10.1016/j.jocn.2016.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 11/18/2022]
Abstract
The development of stent-like devices has increased treatment options for complex internal carotid artery (ICA) aneurysms, but the optimal treatment remains unclear. The purpose of this study was to evaluate the safety and efficacy of endovascular parent-artery occlusion (PAO) for ICA aneurysms. We retrospectively reviewed 28 patients with unruptured ICA aneurysms ⩾10mm treated with PAO between April 2002 and March 2015 at our institution. Patients who developed neurologic symptoms or with venous-phase delay >2s during balloon test occlusion were not treated by PAO. Patients with venous-phase delays of 1-2s underwent superficial temporal artery to middle cerebral artery (STA-MCA) bypass prior to PAO. The median patient age was 65 (range, 26-84)years. Nineteen aneurysms (68%) were located in the cavernous segment. The median aneurysm size was 25 (range 11-40)mm. Venous-phase delay of 1-2s was observed in five patients. Perioperative ischemic complications (N=9, 32%), which occurred within 30days after treatment, were significantly associated with venous-phase delays of 1-2s (p<0.01) and history of hypertension (p<0.01). Six-month morbidity was observed in one (3.6%) patient. Complete occlusion at final follow-up and delayed (i.e. ⩾31days after treatment) ischemic events were observed in 100% and 0% of patients, respectively, over a median period of 63 (range, 6-147) months. Despite the high frequency of perioperative ischemic episodes, endovascular PAO with selective use of STA-MCA bypass showed excellent long-term outcomes in patients with unruptured ICA aneurysms ⩾10mm.
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Affiliation(s)
- Kampei Shimizu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Chiaki Sakai
- Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Koichi Arimura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Mikiya Beppu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, 2-2, Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan
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Asai K, Imamura H, Mineharu Y, Tani S, Adachi H, Narumi O, Sato S, Sakai C, Sakai N. X-ray Angiography Perfusion Analysis for the Balloon Occlusion Test of the Internal Carotid Artery. J Stroke Cerebrovasc Dis 2015; 24:1506-12. [PMID: 25873471 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/13/2015] [Accepted: 03/12/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A perfusion study should be performed during the balloon occlusion test (BOT) to prevent ischemic events after therapeutic carotid occlusion. We evaluated the efficacy of X-ray angiography perfusion analysis during the BOT. METHODS Twenty-one consecutive patients who underwent the BOT of the internal carotid artery were included. Patients who had a venous phase delay of less than .5 seconds and a mean stump pressure of more than 50 mm Hg without any neurologic symptoms were considered tolerant, and other patients were considered intolerant. A time-density curve was constructed for each hemisphere using X-ray angiography perfusion software (2D-Perfusion). The mean transit time and area under the curve, which correspond to cerebral blood volume, were calculated from the curve. Differences in these parameters between the occluded and nonoccluded hemispheres and the perfusion index were compared between the tolerant and intolerant groups. RESULTS In the intolerant group, the mean transit time was significantly longer (1.31 ± .72 seconds versus .44 ± .21 seconds, P = .001) and the perfusion index was significantly lower (.72 ± .16 versus .94 ± .08, P = .001) compared with those in the tolerant group. The area under the curve was not different between the groups. CONCLUSIONS Parameters obtained by X-ray angiography perfusion analysis were significantly different between the tolerant and intolerant groups. The X-ray angiography perfusion analysis could be a safe and effective method for assessing ischemic tolerance before therapeutic carotid occlusion.
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Affiliation(s)
- Katsunori Asai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan.
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Osamu Narumi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chiaki Sakai
- Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan
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