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Chlorogiannis DD, Aloizou AM, Chlorogiannis A, Kosta N, Sänger JA, Chatziioannou A, Papanagiotou P. Exploring the latest findings on endovascular treatments for giant aneurysms: a review. Rev Neurosci 2024; 35:451-461. [PMID: 38158880 DOI: 10.1515/revneuro-2023-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Giant intracranial aneurysms represent a very challenging aspect of aneurysmal pathophysiology with very high mortality and morbidity if left untreated. Their variety in clinical presentation (subarachnoid hemorrhage, cranial nerve palsy, etc.) and pathological and imaging properties (location, anatomy, presence of collateral circulation) pose serious questions regarding the best treatment option. Admirable advances have been achieved in surgical techniques, while endovascular modalities with flow diversion techniques have become widely used. However, there is still lack of data regarding whether a single endovascular technique can be the universal treatment for such cases. In this review, we aim to summarize the current funds of knowledge concerning giant intracranial aneurysms and the role of endovascular management in their treatment.
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Affiliation(s)
| | - Athina-Maria Aloizou
- Department of Neurology, St. Josef-Hospital, Ruhr Universität Bochum, 44791Bochum, Germany
| | - Anargyros Chlorogiannis
- Department of Health Economics, Policy and Management, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Nefeli Kosta
- Department of Biology, University of Patras, 265 04 Patras, Greece
| | | | - Achilles Chatziioannou
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, 115 28 Athens, Greece
| | - Panagiotis Papanagiotou
- First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, 115 28 Athens, Greece
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, 28205 Bremen, Germany
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2
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Lorga T, Pizzuto S, Coskun O, Sgreccia A, Cavazza M, Rahman MH, Rodesch G, Di Maria F, Consoli A. Reconstruction of the sphenoid sinus erosion or dehiscence after treatment of unruptured intracavernous aneurysms with flow diverter stents. J Neurointerv Surg 2023:jnis-2023-020734. [PMID: 37586819 DOI: 10.1136/jnis-2023-020734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Intracavernous carotid aneurysms (ICCAs) are rare, frequently asymptomatic, with a low rupture risk, which, however, can lead to life-threatening epistaxis. The aim of this study was to assess the effect of the treatment of asymptomatic ICCAs with flow diverters (FD) on sphenoid bone erosion or dehiscence in a selected cohort of patients. METHODS We retrospectively reviewed all asymptomatic ICCAs with sphenoid bone erosion or dehiscence detected on cone beam CT (CBCT) and treated with FD between December 2018 and December 2022. Patients were followed-up with CBCT and bone reconstruction was blindly evaluated by two interventional neuroradiologists and classified as unchanged, partial, or complete. RESULTS A total of 10 patients (women: 90%, mean age 58 years) treated with an FD for an asymptomatic ICCA with associated sphenoid bone erosion or dehiscence were included in this cohort. Sphenoid bone erosion was present in seven patients and dehiscence was observed in the remaining three. After treatment with FD, complete reconstruction of the sphenoid sinus wall occurred in seven cases, and partial reconstruction in two cases. Sphenoid bone erosion remained unchanged after treatment in only one patient. CONCLUSIONS The decision to treat asymptomatic and unruptured ICCAs remains challenging due to their benign natural history and low hemorrhagic risk. The presence of sphenoid sinus erosion or dehiscence should not be overlooked since it could be considered as an indication for prophylactic treatment of life-threatening epistaxis. The mechanisms of bone erosion by the aneurysm and of reconstruction after treatment are still to be fully elucidated.
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Affiliation(s)
- Tiago Lorga
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Neuroradiology, Centro Hospitalar Universitário de Lisboa Central EPE, Lisboa, Portugal
| | - Silvia Pizzuto
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Oguzhan Coskun
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Alessandro Sgreccia
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Martino Cavazza
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Diagnostic and Interventional Radiology, University Hospital Arcispedale Sant'Anna of Ferrara, Cona, Italy
| | - Mohammad Habibur Rahman
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Interventional Neurology, National Institute of Neurosciences and Hospital, Sher-E-Bangla Nagar, Bangladesh
| | - Georges Rodesch
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Federico Di Maria
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Hôpital Foch, Suresnes, France
- Versailles Saint-Quentin-en-Yvelines University, Versailles, France
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3
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Akimoto T, Ito Y, Akutagawa K, Sato M, Hayakawa M, Marushima A, Takigawa T, Tsuruta W, Kato N, Suzuki K, Uemura K, Yamamoto T, Matsumaru Y. Perioperative and long-term complications following therapeutic internal carotid artery occlusion. Interv Neuroradiol 2023; 29:426-433. [PMID: 35450482 PMCID: PMC10399501 DOI: 10.1177/15910199221095786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Parent artery occlusion (PAO) is an effective treatment for hemorrhagic diseases associated with the internal carotid artery. There are several reports of long-term cerebral infarction or the formation of de novo cerebral aneurysms following PAO. MATERIALS AND METHODS We retrospectively reviewed these complications in 38 patients who underwent PAO for therapeutic treatment. We investigated perioperative cerebral infarctions, long-term cerebral infarctions, and de novo aneurysms. RESULTS The mean age of the patients was 64.0 years, and 25 patients (65.8%) were female. The causative diseases were unruptured (n = 19; 50.0%) and ruptured (n = 8; 21.1%) aneurysms. PAO was performed after ischemic tolerance was assessed with balloon test occlusion (BTO), and BTO was performed in 34 patients, of whom 25 (73.5%) had ischemic tolerance. Twenty-six patients (68.4%) were treated with PAO alone, eight (23.5%) with low-flow bypass, and six (17.6%) with high-flow bypass. Perioperative complications occurred in five patients (13.2%): two of the 26 patients (7.7%) who underwent scheduled treatment and three of the 12 patients (25.0%) who underwent emergency treatment. One patient (2.6%) had long-term de novo aneurysm, and none developed cerebral infarction. CONCLUSIONS These results showed that the assessment of ischemic tolerance by performing BTO and appropriate revascularization in scheduled treatments are important to reduce perioperative and long-term cerebral infarctions. PAO must be performed with greater caution in emergency treatment.
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Affiliation(s)
- Taisuke Akimoto
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Department of Neurosurgery, Yokomhama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoshiro Ito
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazuki Akutagawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masayuki Sato
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Mikito Hayakawa
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Wataro Tsuruta
- Department of Neuroendovascular Therapy, Toranomon Hospital, Tokyo, Japan
| | - Noriyuki Kato
- Department of Neurosurgery, Mito Medical Center Hospital, Ibaraki, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Kazuya Uemura
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Yokomhama City University, Yokohama, Kanagawa, Japan
| | - Yuji Matsumaru
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Division of Stroke Prevention and Treatment, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Fortunato PN, Ueno DTY, Sukessada MS, Barros GS, Silva JFCPD, Freire BF, Gulhote DA, Piffer ABB, Silva Junior HMD. Cefaléia e disfunção de nervos cranianos secundários a aneurisma de artéria carótida: relato de dois casos e revisão da literatura. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
O seio cavernoso é um plexo venoso localizado na base do crânio. Várias patologias, como processos inflamatórios, aneurismáticos ou metastáticos, podem afetar esse plexo. A síndrome do seio cavernoso ocorre quando os nervos estão envolvidos nessa região (nervos cranianos III, IV, VI e divisões do V). Essas relações anatômicas explicam que a diplopia e a dor são os sintomas iniciais mais comuns nesses pacientes. Os aneurismas carotídeos cavernosos (CCAs) representam 2% a 9% dos aneurismas. Relatamos dois pacientes que apresentaram síndrome do seio cavernoso decorrente de aneurismas da artéria carótida. O reconhecimento da etiologia desse quadro clínico diferenciado é fundamental para evitar complicações e direcionar a melhor conduta para cada paciente.
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Tsukagoshi E, Sato H, Kohyama S. Delayed aneurysm rupture in a patient treated with flow redirection endoluminal device: A case report and literature review. Surg Neurol Int 2022; 13:506. [DOI: 10.25259/sni_783_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background:
Delayed aneurysm rupture after flow-redirection endoluminal device (FRED) implantation is rare. We report a case of internal carotid-cavernous fistula (CCF) caused by a delayed aneurysm rupture of the cavernous portion of the internal carotid artery (ICA) after FRED implantation.
Case Description:
A 75-year-old woman had a gradually enlarging aneurysm at the C4 portion of the left ICA. We performed FRED implantation for the same. The FRED implantation procedure was smooth and the FRED expanded well and attached to the vessel wall. Five days after surgery, the patient developed a strong headache, hyperemia of the left eye, and disturbance of the left eye movement. Magnetic resonance imaging and angiography revealed a left CCF with cortical venous reflux. We performed transarterial aneurysmal and transvenous cavernous sinus embolization. Postoperatively, angiography showed no fistula and complete occlusion of the aneurysm; however, minor eye movement disorder persisted.
Conclusion:
To prevent the development of delayed aneurysm rupture in patients treated with FRED, preoperative consideration of whether to add coil embolization is important, even if the aneurysm is located in the C4 portion of the ICA and there is no risk of subarachnoid hemorrhage, including the size of aneurysm. In this report, we have tried to alert surgeons regarding the risk of delayed aneurysm rupture due to FRED implantation.
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Boulouis G, Soize S, Maus V, Fischer S, Lobsien D, Klisch J, Styczen H, Deuschl C, Abdullayev N, Kabbasch C, Kaiser D, Jamous A, Behme D, Janot K, Bellanger G, Cognard C, Pierot L, Gawlitza M. Flow diversion for internal carotid artery aneurysms with compressive neuro-ophthalmologic symptoms: clinical and anatomical results in an international multicenter study. J Neurointerv Surg 2021; 14:1090-1095. [PMID: 34795018 DOI: 10.1136/neurintsurg-2021-018188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Scientific data on the safety and efficacy of flow diverter stents (FDS) for the treatment of unruptured internal carotid artery (ICA) aneurysms with compressive neuro-ophthalmological symptoms are scarce. We studied this subject in a retrospective international multicenter series, pooling data of 9 tertiary care neurointerventional departments. OBJECTIVE To investigate, in a retrospective, multicentric cohort of patients presenting with visual or oculomotor symptoms attributed to a compressive carotid artery in an unruptured intracranial aneurysm, the safety and efficacy profiles of FDS, by analyzing neuro-opthalmologic symptom evolution following FDS placement, complications, and aneurysm obliteration rates. METHODS All patients treated since 2015 with a FDS for an unruptured aneurysm of the ICA with signs of compressive cranial nerve symptoms (CN II, III, IV, VI) were included. RESULTS We treated 55 patients with 55 aneurysms; 21 (38.2%) patients had oculomotor and 15 (27.3%) visual symptoms only; 19 (34.5%) presented with a combination of both. Treatment-related morbidity/mortality occurred in 7.2% and 3.6%, respectively. At last imaging follow-up (13.1±10.5 months) rates of complete aneurysm occlusion, neck remnant, and aneurysm remnant were 72%, 14%, and 14%, respectively. At last clinical follow-up after 13±10.5 months, 19/51 (37.3%) patients had recovered completely and 18/51 (35.3%) had recovered at least partially from their neuro-ophthalmological symptoms. In multivariable models, a longer delay between symptom onset and treatment was associated with higher odds for incomplete recovery and lower odds for any improvement (aOR 1.03 (95% CI 1.01 to 1.07), p=0.047 and 0.04 (0-0.81), p=0.020). Incomplete recovery was independently associated with older age and fusiform aneurysms. CONCLUSION FDS are effective to treat patients with compressive aneurysms of the ICA causing neuro-ophthalmological symptoms, especially when treatment is initiated early after symptom onset, and aneurysm occlusion is adequate. However, serious complications are not rare.
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Affiliation(s)
| | - Sebastien Soize
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - Sebastian Fischer
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, University Hospital Knappschaftskrankenhaus Bochum,Universitätsklinik der Ruhr-Universität, Bochum, Germany
| | - Donald Lobsien
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Joachim Klisch
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nuran Abdullayev
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany
| | - Daniel Kaiser
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany.,Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Ala Jamous
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Daniel Behme
- Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Kevin Janot
- Department of Neuroradiology, CHRU Tours, Tours, France
| | | | - Cristophe Cognard
- Diagnostic and Therapeutic Neuroradiology, CHU Toulouse, Toulouse, France
| | - Laurent Pierot
- Department of Neuroradiology, Hôpital Maison Blanche, CHU Reims, Reims, France
| | - Matthias Gawlitza
- EKFZ for Digital Health, Dresden University of Technology, Dresden, Germany .,Department of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
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7
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Phukan P, Sarma K, Lynser D, Sharma BK, Baruah DK, Saikia B, Singh BK. Endovascular Parent Artery Occlusion for Intracranial Aneurysms is a Viable, Cost-Effective Alternative: An Institutional Experience from Northeast India. Acta Med Litu 2021; 28:272-284. [PMID: 35474937 PMCID: PMC8958658 DOI: 10.15388/amed.2021.28.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose. Endovascular parent artery occlusion (PAO) may be an alternative approach for complex intracranial aneurysm with potentially life-threatening complications. Moreover, the long-term follow-up of the PAO for an intracranial aneurysm is reported sparingly, limited to the case series. It is therefore important to carry out more research on long-term follow-up of the implication of PAO of intracranial aneurysm. The aim of the study was to analyses our experience of PAO for intracranial aneurysms with emphasis on long-term follow-up. Materials and Methods. The data of patients treated with PAO for intracranial aneurysms were reviewed. The outcome was evaluated based on aneurysmal occlusion on immediate angiography, follow-up magnetic resonance angiography (MRA), and complications. The modified Rankin score (mRS) was used to evaluate the functional outcome during the last follow-up. The mean, range, and standard deviation were reported for other variables – the patient’s age, number, and percentage. Results. Endovascular treatment was performed in 178 patients including PAO in 18 patients. Of these 18 (eighteen) patients, there were 13 dissecting aneurysms, 4 mycotic aneurysms, and one traumatic aneurysm. 10 (ten) patients underwent PAO for proximal intracranial artery aneurysm and 8 (eight) patients for distal cerebral aneurysms. Complete occlusion of the aneurysm was achieved in 16patients (88.89%) and retrograde filling of the aneurysm was seen in 2 (11.11%) patients. One patient had intraprocedural coil migration resulting in a major infarct with an mRS of 2. Another patient (5.56%) had recanalization of the aneurysm and presented with rupture and intracranial hemorrhage with an mRS score of 4. The mRS of the other 16 patients (88.89%) was zero. Conclusions. Endovascular PAO for cerebral aneurysms was highly feasible and achieved complete occlusion. The morbidity and mortality rates were at the long-term follow-up also acceptable with negligible complications.
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8
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Lee H, Marotta TR, Spears J, Sarma D, Montanera W, Bharatha A. Endovascular treatment of cavernous carotid artery aneurysms: A 10-year, single-center experience. Neuroradiol J 2021; 34:568-574. [PMID: 34159822 DOI: 10.1177/19714009211013487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cavernous carotid artery aneurysms can be treated by several endovascular techniques including flow diversion (FD) and parent vessel occlusion (PVO). We reviewed our institution's consecutive series of endovascularly treated cavernous carotid artery aneurysms to compare these two modalities and their associated clinical and radiographic outcomes. METHODS All patients harboring a cavernous carotid artery aneurysm treated by FD or PVO from January 2008 to December 2018 were enrolled. Data were collected retrospectively and analyzed on patient presentation, aneurysm dimensions, treatments and related complications, rate of aneurysm occlusion, sac regression, and outcomes. RESULTS Fourteen patients were treated with FD and 12 underwent PVO subsequent to passing a balloon test occlusion. There was no significant difference between treatment modalities in aneurysmal occlusion (97.0 ± 8.4% (FD) vs. 100% (PVO), p = 0.23), degree of sac regression (62.5 ± 16.7% (FD) vs. 56.8 ± 24.3% (PVO), p = 0.49), or near-complete to complete symptom improvement (66.7% (FD) vs. 81.8% (PVO), p = 0.62). Major complications included subarachnoid hemorrhage from aneurysmal rupture in 1 (7.1%) patient post-FD and 2 (16.7%) ischemic strokes following PVO. CONCLUSIONS Endovascular treatment of cavernous carotid artery aneurysms by FD or PVO are both effective and safe. There is insufficient evidence to recommend one technique over the other and decision making should be individualized to the patient, their aneurysm morphology, and operator experience.
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Affiliation(s)
- Hubert Lee
- Division of Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, Canada
| | - Thomas R Marotta
- Division of Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Canada
| | - Julian Spears
- Division of Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Canada
| | - Dipanka Sarma
- Division of Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Canada
| | - Walter Montanera
- Division of Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Canada
| | - Aditya Bharatha
- Division of Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, Canada.,Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Canada
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Tamaki R, Nakagawa I, Yagi R, Kimura S, Ogawa D, Manno T, Taniguchi H. Donut-shaped partially thrombosed cavernous segment giant aneurysm treated under proximal flow control: Technical case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Sila D, Lenski M, Rath S. Giant internal carotid aneurysm: endovascular parent artery occlusion after failed treatment using a flow diverter-case report. J Surg Case Rep 2021; 2021:rjab015. [PMID: 33628422 PMCID: PMC7890790 DOI: 10.1093/jscr/rjab015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
Treatment of giant aneurysms is challenging. While parent vessel reconstruction is the primary therapeutical target, the parent artery occlusion (PAO) is considered the next treatment option. We report a case of a 56-year-old woman with a right-sided non-ruptured giant aneurysm of the cavernous internal carotid artery. After failed aneurysm treatment by vessel remodeling through a flow diverter stent, we decided upon aneurysm coiling and PAO. Prior to the procedure, a successful balloon occlusion test (BOT) was performed, and in the second stage, just before occluding the parent artery, the BOT with induced hypotension was repeated. We achieved a good angiographic result and successful outcome without neurological deficit. In the case of failed treatment of giant aneurysm by vessel reconstruction, PAO is a therapeutical option. Prior to the vessel occlusion, a BOT with induced arterial hypotension challenge should be performed.
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Affiliation(s)
- Dalibor Sila
- Department of Neurosurgery and Interventional Neuroradiology, Donau-Isar Klinikum, 94469 Deggendorf, Germany
| | - Markus Lenski
- Neurosurgical Clinic, Clinic of the University of Munich (LMU), 81377 Munich, Germany
| | - Stefan Rath
- Department of Neurosurgery and Interventional Neuroradiology, Donau-Isar Klinikum, 94469 Deggendorf, Germany
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11
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Choi JH, Lee KS, Kim BS, Shin YS. Treatment outcomes of large and giant intracranial aneurysms according to various treatment modalities. Acta Neurochir (Wien) 2020; 162:2745-2752. [PMID: 32827268 DOI: 10.1007/s00701-020-04540-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/16/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE This study aimed to compare the treatment outcomes of large (15-25 mm) and giant (> 25 mm) intracranial aneurysms (IAs), according to different treatment modalities. METHODS In total, 112 patients with large and giant IAs treated with various treatment modalities between January 2009 and December 2018 were retrospectively reviewed. Clinical and radiological parameters were analyzed and correlated with the treatment modality. RESULTS A total of 141 procedures were performed on 112 patients. We initially treated 47 cases with coil embolization, 39 with flow diverter (FD), 13 with direct clipping, and 13 with parent artery occlusion (PAO). Recurrence (46.8%) and retreatment (31.9%) rates were significantly higher in the coiling group (p < 0.001). Complete occlusion rate (36.3%) was significantly lower in the coiling group (p = 0.027). PAO could achieve a high complete occlusion rate (90.9%) with low complication rate (12.5%). The total complication rate was 17%. In the multivariate logistic regression analysis, FD (OR 3.406, p = 0.036) and direct clipping (OR 5.732, p = 0.017) showed a significantly higher complication rate than coiling. The overall mortality rate was 8% (8/139 procedures). At the last follow-up (mean 30.6 ± 26.4 months), 70 of 96 patients (72.9%) showed complete or near-complete occlusion. Good functional outcome (mRS ≤ 2) was observed in 90 of 112 (80.3%) patients at the last follow-up (mean 33.2 ± 30.5 months). CONCLUSIONS Good clinical and radiologic outcomes with acceptable complication and mortality rates can be achieved by various treatment modalities. The selection of appropriate modality should be individualized based on the angiographic findings and clinical symptoms.
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Affiliation(s)
- Jai Ho Choi
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
| | - Kwan Sung Lee
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea
| | - Bum-Soo Kim
- Department of Radiology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu, Seoul, Korea
| | - Yong Sam Shin
- Department of Neurosurgery, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpodaero, Seochogu,, Seoul, Korea.
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Castaño-Leon AM, Alen JF, Lagares A. Opening of unusual vascular collaterals leads to early recanalization of a giant intracavernous carotid artery aneurysm following common carotid artery occlusion: A Case report and literature review. Surg Neurol Int 2020; 11:62. [PMID: 32363057 PMCID: PMC7193203 DOI: 10.25259/sni_597_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Parent artery occlusion (PAO) with or without bypass surgery is a feasible treatment for large intracavernous carotid artery (ICCA) aneurysms. The ideal occlusion site (internal or common carotid artery [CCA]) and ischemic complications after PAO have received special attention since the description of the technique. Unfrequently, some patients can also develop unusual external carotid artery-internal carotid artery collateral pathways distal to the ligation site that can explain the failure to aneurysm size reduction. Case Description: We describe a rare case of delayed refilling of a large ICCA aneurysm partially thrombosed which early recanalized after surgical ligation of the cervical CCA through an unusual collateral pathway. Conclusion: Based on our experience, we recommend periodic long-term follow-up neuroimaging, especially in those cases where potential collateral branches have not been clearly identified in the preoperative studies.
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Affiliation(s)
- Ana M Castaño-Leon
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Jose F Alen
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Avda Cordoba SN, Madrid, Spain
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13
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Sun Y, Wan B, Li Q, Li T, Huang G, Zhang W, Yang J, Tong X. Endovascular Treatment for Cavernous Carotid Aneurysms: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2020; 29:104808. [PMID: 32305281 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Coiling and flow diversion are established endovascular techniques for treatment of cavernous carotid aneurysms (CCAs). We performed a systematic review of published series on endovascular treatment of CCAs in order to assess the efficacy and safety between coiling and flow diversion. METHODS We conducted a computerized search of PubMed, MEDLINE, and Web of Science electronic databases for reports on endovascular treatment of CCAs from 1990 to 2019. Comparisons were made in complete occlusion rate, improvement of symptoms rate and intraoperative complication rate between coiling and flow diversion. RESULTS Fourteen studies with 736 patients were included in this systematic review. Five hundred ninety-4 patients underwent coiling, 142 patients underwent flow diversion. The complete occlusion rate in the coiling group was significantly lower than that in the flow division group (odds ratio .37, 95%CI .16-.83, P < .00001), a forest plot did not reveal any significant differences in the improvement of symptoms rate or intraoperative complication rate following coiling and flow diversion. Complete occlusion rate was significantly lower in the coiling group (53%, 95%CI .40-.67) compared with the flow diversion group (74%, 95%CI .55-.94). Improvement of symptoms was significantly lower in the coiling group (54%, 95%CI .46-.63) compared with the flow diversion group (92%, 95%CI .85-.99). Coiling group had lower intraoperative complication rate (9%, 95%CI .06-.12) compared with flow division group (36%, 95%CI .25-.47). CONCLUSIONS Compared with coiling, the use of flow diversion for the treatment of CCAs may increase complete occlusion rate, and improvement of symptoms rate, but it also raised intraoperative complication rate. Due to the lack of high quality control research, further randomized controlled trials are needed to verify our conclusions.
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Affiliation(s)
- Yang Sun
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Benlin Wan
- Department of Graduate School, Nan Kai University, Tianjin, China
| | - Qi Li
- Department of Graduate School, Nan Kai University, Tianjin, China
| | - Tang Li
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Ge Huang
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Wenchao Zhang
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Jianghua Yang
- Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Xiaoguang Tong
- Department of Graduate School, Tianjin Medical University, Tianjin, China; Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China.
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Kuribara T, Mikami T, Iihoshi S, Miyata K, Kim S, Kawata Y, Komatsu K, Kimura Y, Enatsu R, Akiyama Y, Hirano T, Mikuni N. Ischemic Tolerance Evaluated by Computed Tomography Perfusion during Balloon Test Occlusion. J Stroke Cerebrovasc Dis 2020; 29:104807. [PMID: 32295733 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/21/2020] [Accepted: 03/04/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Balloon test occlusion (BTO) is performed to evaluate ischemic tolerance for large and giant cerebral aneurysms and head and neck tumors that may require parent artery occlusion. However, ischemic tolerance for the temporary test occlusion does not always guarantee a tolerance for permanent occlusion. In this study, we evaluated the utility of computed tomography (CT) perfusion during BTO to quantify ischemic tolerance for detecting delayed ischemic stroke. MATERIALS AND METHODS Forty-one patients who underwent BTO for the internal carotid artery were included. The correlations between the parameters of CT perfusion and collateral angiographic appearance or stump pressure during BTO were evaluated. The cerebral blood flow (CBF), cerebral blood volume, mean transit time (MTT), and time to peak (TTP) were obtained through CT perfusion, and the asymmetry ratios were determined. Collateral angiographic appearances were categorized into 5 grades (0-4). RESULTS The collateral angiographic appearance showed moderate correlations with CBF, MTT, and TTP that was significant. Of these, the absolute value of the correlation coefficient was the highest for MTT. MTT also showed a moderate correlation with stump pressure. CBF and MTT were significantly different between the poor collateral group (grades 2 and 3) and the good collateral group (grade 4). Based on the MTT, the good collateral group was identified with high sensitivity (75.0%) and specificity (81.2%). CONCLUSIONS In BTO, the MTT obtained through CT perfusion showed a correlation with collateral angiographic appearance and stump pressure. Thus, the MTT might be useful to quantify ischemic tolerance for detecting delayed ischemic stroke.
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Affiliation(s)
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan.
| | - Satoshi Iihoshi
- Department of Endovascular Neurosurgery and Stroke Center, Saitama Medical University, International Medical Center, Hidaka, Japan
| | - Kei Miyata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Sangnyon Kim
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yuka Kawata
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Katsuya Komatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yusuke Kimura
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Yukinori Akiyama
- Department of Neurosurgery, Sapporo Medical University, Sapporo, Japan
| | - Toru Hirano
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobuhiro Mikuni
- Division of Radiology, Sapporo Medical University Hospital, Sapporo, Japan
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Lv X, Yu J, Liao T, Wang J, Wang G. Unruptured giant intracavernous aneurysms untolerate internal carotid artery occlusion test: Untreated and treated with flow-diversion. Neuroradiol J 2020; 33:105-111. [PMID: 31948343 PMCID: PMC7140296 DOI: 10.1177/1971400919898109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Giant intracavernous aneurysms (GICAs) are located in extradural space; their clinical manifestation and treatment are different from other intradural aneurysms. This study reports clinical outcomes of GICAs untolerate internal carotid artery occlusion tests. METHODS Between January 2012 and September 2017, 14 consecutive cases of GICAs untolerated internal carotid artery occlusion test were retrospectively reviewed. A total of nine patients were not treated and five patients were treated using a Pipeline Embolization Device. RESULTS Of the 14 patients, 12 had compression symptoms and 2 were incidental. In nine untreated patients, during 34 months' (range, 7-64 months) follow-up, four worsened to headaches or ablepsia (more than 34 months). One patient, who presented with ophthalmoplegia and diplopia, showed spontaneous resolution of symptoms at 32-month follow-up. Symptoms in four patients remained unchanged during less than 36-month follow-up period. In five (100%, 95% confidence interval 57% to 100%) treated patients, symptoms recovered completely during 11 months' follow-up after transient worsening of mass compression. CONCLUSIONS GICAs frequently result in intractable cranial neuropathy requiring treatment. The Pipeline Embolization Device is an effective option for these complex aneurysms in selective cases.
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Affiliation(s)
- Xianli Lv
- Neurosurgical Department, Beijing
Tsinghua Changgung Hospital, Tsinghua University, China
- Xianli Lv, Neurosurgical Department, Beijing
Tsinghua Changgung Hospital, Tsinghua University, Changping, Litang Road 168,
102218, Beijing, China.
| | - Jianjun Yu
- Linyi People Hospital, Weifang Medical
College, China
| | - Ting Liao
- Neurosurgery Department, Kiang Wu
Hospital, Macao
| | - Jin Wang
- Neurosurgical Department, Beijing
Tsinghua Changgung Hospital, Tsinghua University, China
| | - Guihuai Wang
- Neurosurgical Department, Beijing
Tsinghua Changgung Hospital, Tsinghua University, China
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16
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Ting W, Richard SA, Changwei Z, Chaohua W, Xiaodong X. Concomitant occurrence of clinoid and cavernous segment aneurysms complicated with carotid cavernous fistula: A case report. Medicine (Baltimore) 2019; 98:e18184. [PMID: 31770272 PMCID: PMC6890289 DOI: 10.1097/md.0000000000018184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/10/2019] [Accepted: 10/30/2019] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Dual aneurysms arising from the internal cerotic artery (ICA) is a very rare occurrence. Clinoid segment aneurysms (CSAs) are often seen at the carotid dural rings while cavernous carotid aneurysms (CCAs) are often a direct communication between the ICA and the cavernous sinus (CS). We present a case of complex concomitant occurrence of a CSA and a CCA complicated with delay aneurysmal rupture (DAR) resulting in carotid cavernous fistula (CCF) after our initial treatment of the patient with pipeline embolization devices (PLEDs) PATIENT CONCERNS:: We present a 64-year old female who we admitted at our institution due to one-year history of double vision. Neurological examinations were unremarkable. DIAGNOSIS Magnetic resonance imaging (MRI) and computer tomography (CT)-scan revealed dual aneurysms on the ICA. Digital subtracting angiogram (DSA) confirmed a small CSA and a large CCA on the right ICA. INTERVENTIONS We treated both aneurysms with PLED and subsequently observed DAR of CCA as a complication. OUTCOMES We successfully occluded the fistula with ONYX (ev3, Irvine, CA) via the trans-venous approach. LESIONS PLED was the best endovascular treatment option though DAR was inevitable. Although the trans-arterial approach may be the gold standard for the managing of CCF, the complex nature of our case made us opt for trans-venous approach. The trans-venous route is very appropriate for fistulas with complex parent arteries.
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Affiliation(s)
- Wang Ting
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Seidu A. Richard
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
- Department of Medicine, Princefield University, Ho-Volta Region, Ghana
| | - Zhang Changwei
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wang Chaohua
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xie Xiaodong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
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17
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Junior JR, Oliveira LM, Boechat AL, Teixeira MJ, Figueiredo EG. Cavernous carotid artery aneurysms on a single institution: An epidemiological study with 201 patients. Clin Neurol Neurosurg 2019; 186:105504. [PMID: 31499419 DOI: 10.1016/j.clineuro.2019.105504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Cavernous carotid aneurysms (CCA) represent 2-9% of all intracranial aneurysms. For long considered benign lesions, these entities are unique when it comes to clinical presentation and management. Usually asymptomatic, CCAs can grow and rupture causing different manifestations. The lack of a long-term assessment of both treated and untreated CCAs' natural history justifies why there is no consensus regarding what are the recommended therapeutic measures. While some advocate that an intervention is always necessary, others consider that patients deserve an individualized evaluation. PATIENTS AND METHODS We describe our single-institution experience in diagnosis, follow-up, and management of 201 CCAs. In addition, we evaluate the association of giant CCAs with aneurysms in other locations using a Chi-square test. RESULTS 201 patients had 245 CCAs. 92% of the patients were women. The mean age at diagnosis was 61 years. Concomitant aneurysms were observed in 53.2% of the patients, and the middle cerebral artery was the most affected artery. 66 (30.6%) CCAs were considered "giant", and the follow-up period ranged from 1 to 23 years.The presence of a giant CCA seemed to hinder other aneurysms' formation - RR 0.47 (IC 95% 0.31-0.67), p < 0.0001. CONCLUSIONS CCAs should be individually assessed. A conservative approach ought to be adopted for asymptomatic and oligosymptomatic lesions. Finally, a multidisciplinary team must evaluate the other situations, in order to define whether the microsurgical or the endovascular treatment is better option. Presence of a giant lesion within the cavernous sinus is associated with less occurrence of other aneurysms.
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Affiliation(s)
- Jefferson Rosi Junior
- Department of Neurology, Division of Neurosurgery, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | | | - Antonio Luiz Boechat
- Department of Parasitology, School of Medicine, Federal University of Amazonas (UFAM), Manaus, AM, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurology, Division of Neurology, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Eberval Gadelha Figueiredo
- Department of Neurology, Division of Neurology, School of Medicine, University of São Paulo (FMUSP), São Paulo, SP, Brazil.
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18
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Yan P, Zhang Y, Liang F, Ma C, Liang S, Guo F, Jiang C. Comparison of Safety and Effectiveness of Endovascular Treatments for Unruptured Intracranial Large or Giant Aneurysms in Internal Carotid Artery. World Neurosurg 2019; 125:e385-e391. [PMID: 30703601 DOI: 10.1016/j.wneu.2019.01.082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To analyze and compare safety and efficacy of different endovascular treatment modalities for unruptured intracranial large or giant aneurysms. METHODS We retrospectively reviewed 126 consecutive patients with 128 large (15-24 mm) or giant (≥25 mm) aneurysms that were treated with different endovascular procedures between January 2014 and February 2017. We compared clinical and angiographic outcomes and occurrence of technical events among 3 treatment modalities. RESULTS Complete occlusion at last follow-up was achieved in 65.6%, 90.5%, and 72.0% of aneurysms in stent-assisted coiling, parent artery occlusion, and Pipeline embolization device (PED) groups (P = 0.119). Complete occlusion rate at 6-month follow-up (odds ratio = 1.81, P = 0.396) and at last angiographic follow-up (odds ratio = 3.64, P = 0.123), was not superior with parent artery occlusion compared with PED. Retreatment rate was significantly different among all groups (P < 0.001); the rate was highest in the stent-assisted coiling group (21.9%). Rates of hemorrhagic events and ischemic events were not significantly different among groups (P = 0.581). Mass effect exacerbation was more frequently seen in the stent-assisted coiling group (24.4% vs. 7.7% and 3.3%, P = 0.004). Major complication rate was higher in the parent artery occlusion group compared with the PED group, but the difference was not statistically significant (19.2% vs. 16.4%, odds ratio = 1.21, P = 0.763). Rate of technical events was significantly different in the 3 groups (P = 0.0437), and technical events occurred more often in the PED group (18.0%). CONCLUSIONS For large and giant aneurysms located in the internal carotid artery, outcome for endovascular treatment remains poor, even with the introduction of PED.
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Affiliation(s)
- Peng Yan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yupeng Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Liang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Feng Guo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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19
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Elnahry AG, Elnahry GA. Computed Tomography Angiography of Bilateral Intracavernous Internal Carotid Artery Aneurysms. Neuroophthalmology 2018; 42:404-405. [PMID: 30524495 DOI: 10.1080/01658107.2018.1433690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022] Open
Abstract
Bilateral intracavernous internal carotid artery aneurysms are rare. They are more common in elderly females and are associated with hypertension. We present the computed tomography angiography findings of an 81-year-old female with history of hypertension who came complaining of diplopia and headache. Examination revealed bilateral sixth nerve palsy with left third nerve palsy. External ocular examination was normal. Computed tomography angiography was done and revealed bilateral intracavernous internal carotid artery aneurysms. She was referred to neurosurgery for further management.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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20
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Innovations in Endovascular Treatment Strategies for Large Carotid Cavernous Aneurysms—The Safety and Efficacy of a Flow Diverter. J Stroke Cerebrovasc Dis 2017; 26:1071-1080. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.12.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/24/2016] [Indexed: 11/21/2022] Open
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21
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Shi L, Zhou M, Xu S, Wu Q, Yan W, Zhang J. Endovascular Treatment of Intracavernous Internal Carotid Aneurysm Secondary to Pituitary Infection. World Neurosurg 2017; 101:816.e5-816.e9. [PMID: 28238872 DOI: 10.1016/j.wneu.2017.02.076] [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: 11/28/2016] [Revised: 02/11/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracavernous internal carotid artery (ICICA) aneurysm secondary to pituitary infection is exceedingly rare. CASE DESCRIPTION We report an unusual case of a 63-year-old man who presented with acute left blepharoptosis and imaging findings of a pituitary infection. Interestingly, sudden onset of right blepharoptosis occurred after anti-infective therapy for 10 days. Digital subtraction angiography revealed a right ICICA aneurysm. After 6 months of follow-up visits, enlargement of the ICICA aneurysm was observed, and the endovascular technique of a low-profile visualized intraluminal support stent combined with 5 detachable coils was successfully performed to treat the ICICA aneurysm, with preservation of the internal carotid artery. CONCLUSION This rare case highlights a life-threatening complication of a pituitary infection. Moreover, enlargement of the infected ICICA aneurysm could not be relieved by conservative anti-infective therapy. Endovascular treatment may be an alternative therapy for an infected ICICA aneurysm.
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Affiliation(s)
- Ligen Shi
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mading Zhou
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shenbin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qun Wu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Yan
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China; Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China.
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22
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Ganesh Kumar N, Ladner TR, Kahn IS, Zuckerman SL, Baker CB, Skaletsky M, Cushing D, Sanborn MR, Mocco J, Ecker RD. Parent vessel occlusion for treatment of cerebral aneurysms: Is there still an indication? A series of 17 patients. J Neurol Sci 2016; 372:250-255. [PMID: 28017223 DOI: 10.1016/j.jns.2016.11.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/27/2016] [Accepted: 11/22/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/PURPOSE Flow diversion has allowed cerebrovascular neurosurgeons and neurointerventionalists to treat complex, large aneurysms, previously treated with trapping, bypass, and/or parent vessel sacrifice. However, a minority of aneurysms remain that cannot be treated endovascularly, and microsurgical treatment is too dangerous. However, balloon test occlusion (macro and micro), micro WADA testing, ICG, intra-angiography and intra-operative monitoring are all available to clinically test the hypothesis that vessel sacrifice is safe. We describe a dual-institution series of aneurysms successfully treated with parent vessel occlusion (PVO). MATERIALS/METHODS Prospectively collected databases of all endovascular and open cerebrovascular cases performed at Maine Medical Center and Vanderbilt University Medical Center from 2011 to 2013 were screened for patients treated with primary vessel sacrifice. A total of 817 patients were screened and 17 patients were identified who underwent parent vessel sacrifice as primary treatment. RESULTS All 17 patients primarily treated with PVO are described below. Nine patients presented with SAH, and 3/17 involved anterior circulation. Complete occlusion was achieved in 15/17 patients. In the remaining 2 patients, significant reduction in the aneurysm occurred. Modified Rankin Score (mRS) of 0, signifying complete independence, was achieved for 16/17 patients. One patient died due to an extracranial process. CONCLUSIONS Parent vessel sacrifice remains a viable and durable solution in select ruptured and unruptured intracranial aneurysms. Many adjuncts are available to aid in the decision making. In this small series, patients naturally divided into vertebral dissecting aneurysms, giant aneurysms and small distal aneurysms. Outcomes were favorable in this highly selected group.
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Affiliation(s)
- Nishant Ganesh Kumar
- Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA.
| | - Travis R Ladner
- Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA
| | - Imad S Kahn
- Dartmouth Hitchcock Medical Center, Department of Neurosurgery, Hanover, New Hampshire, USA
| | - Scott L Zuckerman
- Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA
| | - Christopher B Baker
- Maine Medical Center, Neuroscience Institute, Portland, Maine, USA; Maine Medical Center, Department of Radiology, Portland, ME, USA
| | | | - Deborah Cushing
- Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
| | | | - J Mocco
- Mt. Sinai Medical Center, Department of Neurosurgery, New York, New York, USA
| | - Robert D Ecker
- Maine Medical Center, Neuroscience Institute, Portland, Maine, USA; Maine Medical Center, Department of Surgery, Portland, ME, USA
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23
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Guan N, Mu S, Wang L, Huo X, Jiang Y, Lv X, Li Y. Endovascular Treatment of 147 Cases of Cavernous Carotid Aneurysms: A Single-Center Experience. J Stroke Cerebrovasc Dis 2016; 25:1929-35. [PMID: 27185537 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 04/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cavernous carotid aneurysms (CCAs) are characterized by pain and neuro-ophthalmologic deficits. The optimal treatment remains unclear, especially for asymptomatic CCAs. This study investigated the efficacy of endovascular treatment for CCAs in our center. METHODS Data obtained from patients who underwent endovascular treatment for CCAs from July 2011 to July 2014 were reviewed. A retrospective analysis was conducted regarding the general condition, clinical presentation, aneurysm characteristics, therapeutic strategy, and prognosis of CCA patients. RESULTS One hundred forty-seven patients who exhibited 155 CCAs were included, which comprised 46 asymptomatic and 101 symptomatic CCA cases. Forty-eight cases presented with headache, 5 cases presented with subarachnoid hemorrhage, 20 cases presented with diplopia, 38 cases presented with cranial nerve palsy, and 27 cases presented with ischemic stroke. The mean aneurysm sizes were 15.3 ± 12.2 and 8.1 ± 7.1 mm in the symptomatic and asymptomatic groups, respectively. Different treatments were administered: coil occlusion (n = 15), stent/balloon-assisted coil occlusion (n = 123), and parent artery occlusion (PAO) (n = 17). The PAO-treated group exhibited the highest aneurysm occlusion rate. Follow-up data were available for 131 cases, which included 86 symptomatic and 45 asymptomatic cases. There were no deaths. Among the symptomatic patients, 40.7% improved, 58.1% remained stable, and 1.2% worsened; 12 patients exhibited regrowth and 6 patients had repeated endovascular treatment. The asymptomatic patients remained stable, including 5 patients who exhibited regrowth and 2 patients who had repeated endovascular treatment. CONCLUSION Endovascular treatment is safe and effective for CCAs and should be considered in patients with minimal complications, as well as in asymptomatic patients with stable symptoms.
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Affiliation(s)
- Ning Guan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linyuan Wang
- Department of Periodontics, The Second Affiliated Hospital of Liaoning Medical College, Jinzhou, Liaoning, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Raper DMS, Ding D, Peterson EC, Crowley RW, Liu KC, Chalouhi N, Hasan DM, Dumont AS, Jabbour P, Starke RM. Cavernous carotid aneurysms: a new treatment paradigm in the era of flow diversion. Expert Rev Neurother 2016; 17:155-163. [DOI: 10.1080/14737175.2016.1212661] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Daniel M. S. Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Dale Ding
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Eric C. Peterson
- Department of Neurosurgery, University of Miami Miller School of Medicine, University of Miami Hospital, Jackson Memorial Hospital, Miami Children’s Hospital, Miami, FL, USA
| | | | - Kenneth C. Liu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - David M. Hasan
- Department of Neurological Surgery, University of Iowa, Iowa City, IA, USA
| | - Aaron S. Dumont
- Department of Neurological Surgery, Tulane University, New Orleans, LA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert M. Starke
- Department of Neurosurgery, University of Miami Miller School of Medicine, University of Miami Hospital, Jackson Memorial Hospital, Miami Children’s Hospital, Miami, FL, USA
- Department of Radiology, University of Miami Miller School of Medicine, University of Miami Hospital and Jackson Memorial Hospital, Miami, FL, USA
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Kallmes DF, Brinjikji W, Boccardi E, Ciceri E, Diaz O, Tawk R, Woo H, Jabbour P, Albuquerque F, Chapot R, Bonafe A, Dashti SR, Delgado Almandoz JE, Given C, Kelly ME, Cross DT, Duckwiler G, Razack N, Powers CJ, Fischer S, Lopes D, Harrigan MR, Huddle D, Turner R, Zaidat OO, Defreyne L, Pereira VM, Cekirge S, Fiorella D, Hanel RA, Lylyk P, McDougall C, Siddiqui A, Szikora I, Levy E. Aneurysm Study of Pipeline in an Observational Registry (ASPIRe). INTERVENTIONAL NEUROLOGY 2016; 5:89-99. [PMID: 27610126 DOI: 10.1159/000446503] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/21/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Few prospective studies exist evaluating the safety and efficacy of the Pipeline Embolization Device (PED) in the treatment of intracranial aneurysms. The Aneurysm Study of Pipeline In an observational Registry (ASPIRe) study prospectively analyzed rates of complete aneurysm occlusion and neurologic adverse events following PED treatment of intracranial aneurysms. MATERIALS AND METHODS We performed a multicenter study prospectively evaluating patients with unruptured intracranial aneurysms treated with PED. Primary outcomes included (1) spontaneous rupture of the Pipeline-treated aneurysm; (2) spontaneous nonaneurysmal intracranial hemorrhage (ICH); (3) acute ischemic stroke; (4) parent artery stenosis, and (5) permanent cranial neuropathy. Secondary endpoints were (1) treatment success and (2) morbidity and mortality at the 6-month follow-up. Vascular imaging was evaluated at an independent core laboratory. RESULTS One hundred and ninety-one patients with 207 treated aneurysms were included in this registry. The mean aneurysm size was 14.5 ± 6.9 mm, and the median imaging follow-up was 7.8 months. Twenty-four aneurysms (11.6%) were small, 162 (78.3%) were large and 21 (10.1%) were giant. The median clinical follow-up time was 6.2 months. The neurological morbidity rate was 6.8% (13/191), and the neurological mortality rate was 1.6% (3/191). The combined neurological morbidity/mortality rate was 6.8% (13/191). The most common adverse events were ischemic stroke (4.7%, 9/191) and spontaneous ICH (3.7%, 7/191). The complete occlusion rate at the last follow-up was 74.8% (77/103). CONCLUSIONS Our prospective postmarket study confirms that PED treatment of aneurysms in a heterogeneous patient population is safe with low rates of neurological morbidity and mortality. Patients with angiographic follow-up had complete occlusion rates of 75% at 8 months.
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Affiliation(s)
| | | | - Edoardo Boccardi
- Department of Neuroradiology, Niguarda Ca' Granda Hospital of Milan, Milan, Italy
| | - Elisa Ciceri
- Department of Radiology, Istituto Neurologico Carlo Besta, Milan, Italy
| | - Orlando Diaz
- Department of Radiology, Houston Methodist Hospital, Houston, Tex., USA
| | - Rabih Tawk
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Fla., USA
| | - Henry Woo
- Departments of Neurosurgery at Stony Brook University, Stony Brook, N.Y., USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pa., USA
| | | | - Rene Chapot
- Neurointerventional Services, Department of Interventional Neuroradiology, Alfried Krupp Hospital, Essen, Germany
| | - Alain Bonafe
- Department of Radiology, CHU Montpellier, Montpellier, France
| | - Shervin R Dashti
- Department of Neurosurgery, Norton Neuroscience Institute, Norton Healthcare, Louisville, Ky., USA
| | - Josser E Delgado Almandoz
- Department of Radiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minn., USA
| | - Curtis Given
- Neurointerventional Services, Baptist Health Lexington, Lexington, Ky., USA
| | - Michael E Kelly
- Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Sask., Canada
| | - DeWitte T Cross
- Department of Radiology, Washington University School of Medicine, St. Louis, Mo., USA
| | - Gary Duckwiler
- Department of Neuroradiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif., USA
| | - Nasser Razack
- Neurointerventional Associates, P.A., St. Petersburg, Fla., USA
| | - Ciaran J Powers
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Demetrius Lopes
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Ill., USA
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama, Birmingham, Ala., USA
| | - Daniel Huddle
- Swedish Medical Center/RIA Neurovascular, Englewood, Colo., USA
| | - Raymond Turner
- Department of Neurosurgery, Medical University of South Carolina, Charleston, S.C., USA
| | - Osama O Zaidat
- Department of Neurology, Medical College of Wisconsin/Froedtert Hospital, Milwaukee, Wis., USA
| | - Luc Defreyne
- Department of Interventional Radiology, Ghent University Hospital, Gent, Belgium
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging and Division of Neurosurgery, Department of Surgery, University Health Network and Departments of Medical Imaging and Surgery, University of Toronto, Toronto, Ont., Canada
| | - Saruhan Cekirge
- Department of Radiology, Koru Hospital and Bayindir Hospitals, Ankara, Turkey
| | - David Fiorella
- Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, N.Y., USA
| | - Ricardo A Hanel
- Stroke and Cerebrovascular Surgery, Lyerly Neurosurgery/Baptist Neurological Institute, Jacksonville, Fla., USA
| | - Pedro Lylyk
- Department of Neurosurgery, Clinica La Sagrada Familia, ENERI, Buenos Aires, Argentina
| | - Cameron McDougall
- Endovascular Neurosurgery, Barrow Neurological Institute, Phoenix, Ariz., USA
| | - Adnan Siddiqui
- Department of Neurosurgery, University at Buffalo Neurosurgery, Buffalo, N.Y., Phoenix, Ariz., USA
| | - Istvan Szikora
- Department of Neurointerventional Services, National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Elad Levy
- Department of Neurosurgery, University at Buffalo Neurosurgery, Buffalo, N.Y., Phoenix, Ariz., USA
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Bechan RS, Majoie CB, Sprengers ME, Peluso JP, Sluzewski M, van Rooij WJ. Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients. AJNR Am J Neuroradiol 2016; 37:125-9. [PMID: 26294643 DOI: 10.3174/ajnr.a4487] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort. MATERIALS AND METHODS Between January 1995 and January 2015, occlusion of the ICA was considered in 146 patients with large or giant ICA aneurysms. Ninety-six patients (66%) passed the angiographic test occlusion, and, in 88 of these 96 patients (92%), the ICA was permanently occluded. In 11 of 88 patients with angiographic tolerance, ICA occlusion was performed with the patient under general anesthesia without clinical testing. RESULTS There was 1 hypoperfusion infarction after hypovolemic shock from a large retroperitoneal hematoma (complication rate 1.1% [95% CI, 1%-6.8%]). The mean imaging and clinical follow-up was 35 months (median 18 months; range, 3-180 months). On the latest MR imaging, 87 of 88 aneurysms (99%) were completely occluded and 61 of 80 aneurysms (76%) were decreased in size or completely obliterated. Of 62 patients who presented with cranial nerve dysfunction by mass effect of the aneurysm, 30 (48%) were cured, 25 (40%) improved, 6 (10%) were unchanged, and 1 patient (2%) was hemiplegic after a complication. CONCLUSIONS ICA occlusion for large and giant aneurysms after angiographic test occlusion was safe and effective. Two-thirds of eligible patients passed the angiographic test. Most aneurysms shrunk, and most cranial nerve dysfunctions were cured or improved.
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Affiliation(s)
- R S Bechan
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - C B Majoie
- Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands
| | - M E Sprengers
- Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands
| | - J P Peluso
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - M Sluzewski
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - W J van Rooij
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
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27
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Szikora I. Neurointerventional Treatment of Diseases Causing Neuro-ophthalmological Symptoms. Neuroophthalmology 2016. [DOI: 10.1007/978-3-319-28956-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Fungal Mycotic Aneurysm of the Internal Carotid Artery Associated with Sphenoid Sinusitis in an Immunocompromised Patient: A Case Report and Review of the Literature. Mycopathologia 2015; 181:425-33. [PMID: 26687073 DOI: 10.1007/s11046-015-9975-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022]
Abstract
In immunocompromised patients, invasive molds such as Aspergillus and Mucor can lead to locally aggressive angioinvasive infections that are often life-threatening. A particularly devastating complication is the development of a fungal mycotic aneurysm resulting from invasion of the arterial wall. Due to anatomic contiguity, the sphenoid sinus provides potential access for these fungi, which often colonize the respiratory sinuses, into the cavernous sinus and internal carotid artery (ICA), thus leading to the formation of ICA aneurysms. The ideal treatment of fungal ICA aneurysms includes a combination of surgical debridement and long-term effective antifungal therapy, but the role of endoscopic resection and the duration of antimicrobials are poorly defined. Here, we present the case of a 71-year-old immunocompromised patient who developed an ICA mycotic aneurysm, associated with a proven invasive fungal infection (presumptively Mucorales) of the sphenoid sinuses, as defined by EORTC/MSG criteria, and who survived after undergoing coil embolization with parent vessel sacrifice of the aneurysm in combination with liposomal amphotericin B. We also review the literature for published cases of invasive fungal sphenoid sinusitis associated with mycotic aneurysms of the ICA and provide a comparative analysis .
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Turek G, Kochanowicz J, Lewszuk A, Lyson T, Zielinska-Turek J, Chwiesko J, Mariak Z. Early surgical removal of migrated coil/stent after failed embolization of intracranial aneurysm. J Neurosurg 2015; 123:841-7. [PMID: 26230470 DOI: 10.3171/2015.1.jns132788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Distal coil or stent migration is a rare, but potentially morbid complication of intracranial aneurysm embolization. At present, there is no established standard of surgical evacuation of displaced material-in particular, there is no consensus on the optimum time for such intervention. The authors report their positive experiences with an ultra-early surgical evacuation of 2 migrated coils and a flow-diverter stent. METHODS Uncontrolled coil or stent migration occurred in 3 (0.75%) of approximately 400 patients treated between 1999 and 2012 in the authors' institution. In all 3 cases, the materials moved from their intended position to the middle cerebral artery (MCA). Surgical evacuation was started immediately (within half an hour) after a futile attempt of removing them via intraarterial route, under the same anesthesia and with no active reversal of heparinization. RESULTS No excessive bleeding was observed. Displaced coils were extracted through an incision of a branch of MCA-the anterior temporal artery, the stent was removed through a direct incision of MCA. Recombinant tissue plasminogen activator (rtPA) was injected to the stem of the internal carotid artery toward the end of the procedure, with no discernible adverse effects. Two patients were discharged with no deficit (Glasgow Outcome Scale [GOS] Score 5); the other patient was conscious with mild hemiparesis (GOS Score 4) at discharge. CONCLUSIONS The experiences of these 3 cases suggest that immediate removal of a migrated stent/coil is feasible and may be effective. Indirect access to the MCA through its branch helps to shorten the time of temporary clipping of the artery to a minimum. Maintaining active heparinization and direct intraarterial injection of rtPA are helpful in promoting blood flow in the MCA.
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Sahlein DH, Fouladvand M, Becske T, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Kallmes DF, Nelson PK. Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results. J Neurosurg 2015; 123:897-905. [PMID: 26162031 DOI: 10.3171/2014.12.jns141777] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Neuroophthalmological morbidity is commonly associated with large and giant cavernous and supraclinoid internal carotid artery (ICA) aneurysms. The authors sought to evaluate the neuroophthalmological outcomes after treatment of these aneurysms with the Pipeline Embolization Device (PED). METHODS The Pipeline for Uncoilable or Failed Aneurysms (PUFS) trial was an international, multicenter prospective trial evaluating the safety and efficacy of the PED. All patients underwent complete neuroophthalmological examinations both before the PED procedure and at a 6-month follow-up. All examinations were performed for the purpose of this study and according to study criteria. RESULTS In total, 108 patients were treated in the PUFS trial, 98 of whom had complete neuroophthalmological follow-up. Of the patients with complete follow-up, 39 (40%) presented with a neuroophthalmological baseline deficit that was presumed to be attributable to the aneurysm, and patients with these baseline deficits had significantly larger aneurysms. In 25 of these patients (64%), the baseline deficit showed at least some improvement 6 months after PED treatment, whereas in 1 patient (2.6%), the deficits only worsened. In 5 patients (5%), new deficits had developed at the 6-month follow-up, while in another 6 patients (6%), deficits that were not originally assumed to be related to the aneurysm had improved by that time. A history of diabetes was associated with failure of the baseline deficits to improve after the treatment. The aneurysm maximum diameter was significantly larger in patients with a new deficit or a worse baseline deficit at 6 months postprocedure. CONCLUSIONS Patients treated with the PED for large and giant ICA aneurysms had excellent neuroophthalmological outcomes 6 months after the procedure, with deficits improving in most of the patients, very few deficits worsening, and few new deficits developing.
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Affiliation(s)
| | | | | | - Isil Saatci
- Department of Interventional Neuroradiology, Koru Hospitals, Ankara
| | - Cameron G McDougall
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | | | | | - Christopher J Moran
- Division of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Henry H Woo
- Department of Neurological Surgery, Stony Brook University, Stony Brook
| | - Demetrius K Lopes
- Department of Neurological Surgery, Rush University, Chicago, Illinois
| | | | | | - Adnan H Siddiqui
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, Buffalo, New York
| | - Felipe C Albuquerque
- Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona
| | - David J Fiorella
- Department of Neurological Surgery, Stony Brook University, Stony Brook
| | | | | | - Saruhan H Cekirge
- Department of Interventional Neuroradiology, Bayindir Hospitals, Ankara/Istanbul, Turkey
| | - David F Kallmes
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Peter K Nelson
- Radiology.,Neurosurgery, New York University Langone Medical Center, New York
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.
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Affiliation(s)
- Stanlies D'Souza
- Department of Neuroanesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
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32
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Nishino K, Hasegawa H, Ito Y, Fujii Y. Bilateral Cavernous Carotid Aneurysms: The Growth Potential of a Contralateral Aneurysm after Therapeutic Unilateral Internal Carotid Artery Occlusion. J Stroke Cerebrovasc Dis 2015; 24:1865-72. [PMID: 26104242 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 04/11/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Although the introduction of flow-diverter stents has been recognized as a major revolution in the treatment of cavernous carotid aneurysms (CCAs), therapeutic internal carotid artery occlusion (TICAO) remains a reliable procedure for alleviating symptoms caused by CCAs. However, TICAO has the potential risk of the enlargement of coexisting aneurysms that are frequently detected in CCA patients. The purpose of this study is to assess the occurrence of the enlargement of aneurysms coexisting with CCAs after TICAO. METHODS We reviewed medical charts of CCA patients who were managed using unilateral TICAO. Coexisting aneurysms were identified using angiograms obtained before TICAO, and imaging data in long follow-up periods were retrospectively examined to determine the extent of the enlargement after TICAO. RESULTS Of 12 patients with CCAs, 10 had 12 coexisting aneurysms; 5 of the coexisting aneurysms (41.7%) showed enlargement during a mean follow-up period of 8.1 years, and all enlarged aneurysms were smaller of the bilateral CCAs; the larger CCA had been managed by TICAO. Five of 6 (83.3%) patients with bilateral CCAs showed enlargement of the contralateral aneurysm after TICAO. Two contralateral CCAs showed marked enlargement after TICAO and were subsequently treated with stent-assisted coil embolization. CONCLUSIONS Contralateral, smaller aneurysms frequently enlarge after unilateral TICAO in patients with bilateral CCAs. The findings emphasize the importance of long-term observation after TICAO and appropriate interventions against enlarging contralateral aneurysms.
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Affiliation(s)
- Kazuhiko Nishino
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yasushi Ito
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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Abstract
Endovascular management of intracranial aneurysms has advanced significantly over the last couple decades and continues to evolve, including aneurysms within the subgroup of supraclinoid internal carotid artery (ophthalmic, superior hypophyseal, posterior communicating, anterior choroidal, dorsal wall/blister, and carotid terminus).
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Li H, He XY, Li XF, Zhang X, Liu YC, Duan CZ. Treatment of giant/large internal carotid aneurysms: parent artery occlusion or stent-assisted coiling. Int J Neurosci 2015; 126:46-52. [DOI: 10.3109/00207454.2014.992427] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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Labeyrie MA, Lenck S, Bresson D, Desilles JP, Bisdorff A, Saint-Maurice JP, Houdart E. Parent artery occlusion in large, giant, or fusiform aneurysms of the carotid siphon: clinical and imaging results. AJNR Am J Neuroradiol 2015; 36:140-5. [PMID: 25082818 DOI: 10.3174/ajnr.a4064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parent artery occlusion has long been considered the reference treatment for large/giant or fusiform aneurysms of the carotid siphon. However, meager recent data exist on this technique, which tends to be replaced by stent-assisted reconstructive techniques. In our department since 2004, we have assessed the safety, efficacy, and complication risk factors of parent artery occlusion by using coils for trapping these aneurysms. MATERIALS AND METHODS We determined retrospectively the complication rate, factors associated with the occurrence of an ischemic event, changes in symptoms of mass effect, evolution of the aneurysmal size, and the growth of an additional aneurysm after treatment. RESULTS Fifty-six consecutive patients were included, with a median age of 54 years (range, 25-85 years; 92% women), 48% with giant aneurysms and 75% with infraclinoid aneurysms. There was a permanent morbidity rate of 5% exclusively due to ischemia, a zero mortality rate, an aneurysmal retraction rate of 91%, and an improvement rate for pain of 98% and for cranial nerve palsy of 72%, with a median follow-up of >3 years. Para-/supraclinoid topography of the aneurysm (P = .043) and the presence of cardiovascular risk factors (P = .024) were associated with an excessive risk of an ischemic event, whereas the presence of a mural thrombus had a protective role (P = .033). CONCLUSIONS In this study, parent artery occlusion by using coils to treat large/giant or fusiform aneurysms of the carotid siphon was safe and effective, especially for giant infraclinoid aneurysms. According to recent meta-analyses, these results suggest that the validation of stent-assisted reconstructive treatments for these aneurysms requires controlled studies with parent occlusion artery.
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Affiliation(s)
- M-A Labeyrie
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - S Lenck
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - D Bresson
- Neurosurgery (D.B.), Université Paris Diderot, Pôle Neurosensoriel, Lariboisière Hospital, Paris, France
| | - J-P Desilles
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - A Bisdorff
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - J-P Saint-Maurice
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - E Houdart
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
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36
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Liu D, Lv M, Li Y, Yang X, Wu Z. Technical failure of giant supraclinoid aneurysm after internal carotid artery occlusion. A report of three cases. Interv Neuroradiol 2014; 20:736-42. [PMID: 25496684 DOI: 10.15274/inr-2014-10076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/03/2014] [Indexed: 11/12/2022] Open
Abstract
We describe three cases of technical failure in patients with giant supraclinoid aneurysm treated with internal carotid artery (ICA) occlusion. Case 1 was a 65-year-old woman who presented with a two-month history of headache accompanied by blurred vision of the left eye. Case 2 was a 43-year-old woman who presented with a six-month history of headache accompanied by blurred vision of the right eye. Case 3 was a 21-year-old man admitted due to headache and blurred vision of the left eye, accompanied by left oculomotor nerve palsy for three months. Cerebral angiography revealed giant supraclinoid aneurysms in these patients. All of them were treated with ICA occlusion. One case had recurrent headache symptoms after the first procedure and was retreated. Two cases suffered from post-procedural intracranial hemorrhagic complications. Before ICA occlusion for giant supraclinoid aneurysm, balloon occlusion test was used to evaluate the collateral anastomosis between the external carotid artery (ECA) and the ICA, and still plays an important role in preventing treatment failure.
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Affiliation(s)
- Dong Liu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China -
| | - Ming Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Youxiang Li
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Xinjian Yang
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
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Liu D, Lv M, Li Y, Yang X, Wu Z. Technical Failure of Giant Supraclinoid Aneurysm after Internal Carotid Artery Occlusion. Interv Neuroradiol 2014. [DOI: 10.15274/inr-2014-1076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe three cases of technical failure in patients with giant supraclinoid aneurysm treated with internal carotid artery (ICA) occlusion. Case 1 was a 65-year-old woman who presented with a two-month history of headache accompanied by blurred vision of the left eye. Case 2 was a 43-year-old woman who presented with a six-month history of headache accompanied by blurred vision of the right eye. Case 3 was a 21-year-old man admitted due to headache and blurred vision of the left eye, accompanied by left oculomotor nerve palsy for three months. Cerebral angiography revealed giant supraclinoid aneurysms in these patients. All of them were treated with ICA occlusion. One case had recurrent headache symptoms after the first procedure and was retreated. Two cases suffered from post-procedural intracranial hemorrhagic complications. Before ICA occlusion for giant supraclinoid aneurysm, balloon occlusion test was used to evaluate the collateral anastomosis between the external carotid artery (ECA) and the ICA, and still plays an important role in preventing treatment failure.
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Affiliation(s)
- Dong Liu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Ming Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Youxiang Li
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Xinjian Yang
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
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Moon K, Albuquerque FC, Ducruet AF, Crowley RW, McDougall CG. Resolution of cranial neuropathies following treatment of intracranial aneurysms with the Pipeline Embolization Device. J Neurosurg 2014; 121:1085-92. [DOI: 10.3171/2014.7.jns132677] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Intracranial aneurysms, especially those of the cavernous segment of the internal carotid artery (ICA), can present with cranial nerve (CN) palsies. The Pipeline Embolization Device (PED) has demonstrated safety and efficacy in the treatment of cerebral aneurysms by flow diversion, but little data exist reporting the outcomes of cranial neuropathies following treatment with the device.
Methods
The prospectively maintained Barrow Neurological Institute's endovascular database was reviewed for all patients treated with the PED after presenting with one or more CN palsies secondary to a cerebral aneurysm since May 2011. Patient charts and digital subtraction angiograms were reviewed to report clinical and angiographic outcomes. Only patients with clinical follow-up were included in the analysis.
Results
A total of 127 patients were treated with the PED at the authors' institution after FDA approval. Twentytwo patients presented with cranial neuropathies, for initial inclusion in this study. Of these, 20 had sufficient followup for analysis. Cranial neuropathies included those of CN II, III, V, and VI, with presenting symptoms of diplopia, decreased visual acuity, and facial numbness and/or pain. Thirteen lesions were cavernous segment ICA aneurysms, whereas the remainder included supraclinoid and petrous segment ICA, posterior communicating artery, and basilar trunk aneurysms. At an average clinical follow-up of 9.55 months, 15 patients (75%) had resolution or significant improvement of their cranial neuropathies, and the remaining 5 had stable symptoms. Of the 18 patients with angiographic follow-up, 12 (66.7%) demonstrated complete obliteration or small neck residual, whereas 6 (33.3%) had residual lesion. Patients with complete or near-complete obliteration of their lesion were significantly more likely to demonstrate symptomatic improvement at follow-up (p = 0.009). Two patients with persistent symptoms were eventually treated with microsurgical bypass. Transient complications in this series included 6 (30%) extracranial hemorrhagic complications related to dual-antiplatelet therapy, all of which were managed medically. There was 1 delayed right ICA occlusion following retreatment that led to microsurgical bypass.
Conclusions
Intracranial aneurysms presenting with one or more CN palsies show a high rate of clinical improvement after treatment with the PED. Clinical outcomes must be weighed against the risks and challenges faced with flow diverters. Further research is warranted for patients whose symptoms do not respond optimally to device placement.
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Kikuchi K, Yoshiura T, Hiwatashi A, Togao O, Yamashita K, Honda H. Balloon test occlusion of internal carotid artery: Angiographic findings predictive of results. World J Radiol 2014; 6:619-624. [PMID: 25170400 PMCID: PMC4147443 DOI: 10.4329/wjr.v6.i8.619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/24/2014] [Accepted: 07/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To reveal angiographic findings to predict the result of balloon test occlusion (BTO).
METHODS: The cerebral angiograms of 42 consecutive patients who underwent cerebral angiography including both the Matas and Allcock maneuvers and BTO were retrospectively analyzed. Visualization of the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) by the cross flow on the tested side during the Matas or Allcock maneuver was graded on a 5-point scale. Circle of Willis (COW) anatomy with respect to the presence/absence of a collateral path to reach the tested internal carotid artery (ICA) was classified into four categories. A univariate logistic analysis was used to analyze the associations between each angiographic finding and the BTO result. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for each finding were calculated.
RESULTS: Five patients (12%) were BTO-positive and the remaining 37 patients (88%) were BTO-negative. Visualizations of the ACA and MCA as well as the COW anatomy were significantly associated with the BTO result (P = 0.0051 for ACA, P = 0.0002 for MCA, and P < 0.0001 for COW anatomy). In particular, good MCA visualization and the presence of an anterior connection (collateral path to the tested ICA from the contralateral ICA via the anterior communicating artery) in the COW were highly predictive for negative BTO (negative predictive value = 100% for both).
CONCLUSION: A BTO result may be predicted by angiographic findings including ACA/MCA visualization and COW anatomy.
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Tanweer O, Raz E, Brunswick A, Zumofen D, Shapiro M, Riina HA, Fouladvand M, Becske T, Nelson PK. Cavernous carotid aneurysms in the era of flow diversion: a need to revisit treatment paradigms. AJNR Am J Neuroradiol 2014; 35:2334-40. [PMID: 25147199 DOI: 10.3174/ajnr.a4081] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Recent techniques of endoluminal reconstruction with flow-diverting stents have not been incorporated into treatment algorithms for cavernous carotid aneurysms. This study examines the authors' institutional experience and a systematic review of the literature for outcomes and complications using the Pipeline Embolization Device in unruptured cavernous carotid aneurysms. MATERIALS AND METHODS A retrospective search for cavernous carotid aneurysms from a prospectively collected data base of aneurysms treated with the Pipeline Embolization Device at our institution was performed. Baseline demographic, clinical, and laboratory values; intrainterventional data; and data at all follow-up visits were collected. A systematic review of the literature for complication data was performed with inquiries sent when clarification of data was needed. RESULTS Forty-three cavernous carotid aneurysms were included in the study. Our mean radiographic follow-up was 2.05 years. On last follow-up, 88.4% of the aneurysms treated had complete or near-complete occlusion. Aneurysm complete or near-complete occlusion rates at 6 months, 12 months, and 36 months were 81.4%, 89.7%, and 100%, respectively. Of patients with neuro-ophthalmologic deficits on presentation, 84.2% had improvement in their visual symptoms. Overall, we had a 0% mortality rate and a 2.3% major neurologic complication rate. Our systematic review of the literature yielded 227 cavernous carotid aneurysms treated with the Pipeline Embolization Device with mortality and morbidity rates of 0.4% and 3.1%, respectively. CONCLUSIONS Endoluminal reconstruction with flow diversion for large unruptured cavernous carotid aneurysms can yield high efficacy with low complications. Further long-term data will be helpful in assessing the durability of the cure; however, we advocate a revisiting of current management paradigms for cavernous carotid aneurysms.
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Affiliation(s)
- O Tanweer
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.)
| | - E Raz
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - A Brunswick
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.)
| | - D Zumofen
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.) Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - M Shapiro
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - H A Riina
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.)
| | - M Fouladvand
- Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York
| | - T Becske
- Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.) Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York
| | - P K Nelson
- From the Departments of Neurosurgery (O.T., A.B., D.Z., P.K.N.) Radiology (E.R., D.Z., M.S., H.A.R., T.B., P.K.N.) Neurology (M.F., T.B., P.K.N.), New York University School of Medicine, New York, New York.
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Cavernous carotid artery aneurysms: epidemiology, natural history, diagnostic and treatment. An experience of a single institution. Clin Neurol Neurosurg 2014; 125:32-5. [PMID: 25083803 DOI: 10.1016/j.clineuro.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/12/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. METHODS In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. CONCLUSIONS According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services.
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Brown B, Hanel RA. Endovascular Management of Cavernous and Paraclinoid Aneurysms. Neurosurg Clin N Am 2014; 25:415-24. [DOI: 10.1016/j.nec.2014.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The Value of syngo DynaPBV Neuro During Neuro-Interventional Hypotensive Balloon Occlusion Test. Clin Neuroradiol 2014; 25:387-95. [PMID: 24920184 DOI: 10.1007/s00062-014-0316-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
AIM This study explored the value of flat detector computed tomography based brain perfusion imaging in assessing patient's tolerance prior to the permanent internal carotid artery occlusion. MATERIALS AND METHODS Ten patients diagnosed with neurovascular diseases through digital subtracted angiography (DSA) were enrolled into this study. Temporary balloon occlusion test (BOT) was performed for each patient with hypotensive challenge. During the test, parametric color-coded quantitative DSA (CCQ-DSA) was generated to evaluate the venous filling symmetry on both hemispheres. In addition, cerebral blood volume (CBV) maps were acquired before and during the test. Regions of interests were defined to quantitatively extract CBV value from affected and unaffected hemispheres and calculate relative CBV (rCBV), indicating perfusion symmetry. RESULTS All the patients showed good perfusion symmetry before the test with rCBV close to 1.00. During the test, good perfusion symmetry was detected in 7 patients with averaged rCBV 1.03 ± 0.06. Only short venous delay and no ischemic complications were recognized. One patient had neither neurologic deficits nor long venous delay detected, however, showed hyper-perfusion in specific regions in the CBV maps. Two patients failed to pass the test, which showed significantly low CBV value from the affected hemisphere with maximum rCBV reduction close to 45%. CONCLUSION CBV map had in general good consistency with clinical manifestations as well as venous filling in the BOT. Besides, it may provide further evidence of hemodynamic variations and delayed ischemic complications, and thus, had a potential to reduce risks and increase treatment safety.
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Ambekar S, Madhugiri V, Sharma M, Cuellar H, Nanda A. Evolution of management strategies for cavernous carotid aneurysms: a review. World Neurosurg 2014; 82:1077-85. [PMID: 24690538 DOI: 10.1016/j.wneu.2014.03.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cavernous carotid aneurysms are considered benign lesions with indolent natural history. Apart from idiopathic aneurysms, traumatic, iatrogenic, and mycotic aneurysms are common in the cavernous segment of the carotid artery. With rapid advances in endovascular therapy, management of cavernous carotid aneurysms has evolved. Our aim was to review the management options available for cavernous carotid aneurysms. METHODS The English literature was searched for various studies describing the management of cavernous carotid aneurysms and the evolution of various treatments was studied. RESULTS Numerous treatment options are available such as conservative management, Hunterian ligation, surgical clipping, and endovascular therapy. The introduction of flow-diverting stents has revolutionized the management of these lesions. The evolution of various treatment strategies are described. CONCLUSIONS A thorough knowledge of all the options is paramount to individualize therapy. We discuss the indications of treatment, various management options for cavernous carotid aneurysms and their outcomes.
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Affiliation(s)
- Sudheer Ambekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Venkatesh Madhugiri
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puduchery, India
| | - Mayur Sharma
- Center of Neuromodulation, Wexner Medical center, The Ohio State University, Columbus, Ohio, USA
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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Penchet G, Mourier K. Collaborative retrospective multicentre series of giant intracavernous carotid aneurysms. Neurochirurgie 2014; 61:366-70. [PMID: 24661583 DOI: 10.1016/j.neuchi.2013.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 12/03/2013] [Accepted: 12/23/2013] [Indexed: 11/19/2022]
Abstract
Giant intracavernous carotid aneurysms (GICCA) occur with very unusual clinical symptoms often resulting from a compressive mechanism that may possibly resolve although seldom from a rupture or haemorrhage. In fact, due to their clinical presentation their treatment is different from that of the intracranial subarachnoid aneurysms. The aim of this study was to analyze the clinical symptoms, therapeutic decisions, and the clinical state at 6 months follow up in a retrospective consecutive multicentre series of 27 GICCA between 2004 and 2008. All the patients in the series were female, mean age 65 years (21 to 82 years). A pseudo tumoural cavernous sinus syndrome revealed the disease in 25 patients (92.6%), an atypical headache in one patient, and in another patient an intraoperative haemorrhage led to the diagnosis. In most of the cases the aneurysms were sacciform in shape (89%), with a size between 25 and 30 millimeters (66.6%) and contained a blood clot due to intrasacular thrombosis (57.5%). An occlusion test of the internal carotid artery was performed during the diagnostic angiography in 24 cases (88.8%) and good tolerance of occlusion was observed in 16 of them. An endovascular procedure was performed in 21 patients (77.7%): selective coiling of the aneurysm facilitated by stenting or by remodeling techniques in 2 cases, whereas internal carotid artery occlusion was performed on the 19 other cases. Among these latter patients, 2 of them (10.5%) presented with a poor tolerance during the pre-therapeutic carotid occlusion test, necessitating a surgical intra-extra cranial by-pass prior to the carotid endovascular occlusion. In 1 other case of these 19, the internal carotid endovascular occlusion was carried-out in emergency because the aneurysm was revealed by a major haemorrhage during the surgical transsphenoidal approach of a hypophyseal tumour. No treatment was decided in the remaining 6 cases of the series (22.2%). At 6 months follow-up, 18 of the 21 treated patients experienced a clinical recovery of their symptoms and 10 of them (50%) had a complete clinical recovery. Among the 6 untreated patients, 4 had a partial recovery but no complete recovery of oculomotor deficits was observed in this group of patients. No clinical worsening was observed in the entire series, neither among the treated patients nor among the untreated patients. In conclusion, this study underlines the need of a treatment for symptomatic GICCA in order to achieve a complete clinical recovery of the symptoms due to intracavernous compression, although only partial recovery may be expected from spontaneous evolution.
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Affiliation(s)
- G Penchet
- Department of Neurosurgery, Pellegrin Tripode Hospital, Bordeaux University Hospital, Bordeaux, France.
| | - K Mourier
- Department of Neurosurgery, Bocage Central Hospital, Dijon University Hospital, Dijon, France.
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Turfe ZA, Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis. J Neurointerv Surg 2014; 7:250-5. [DOI: 10.1136/neurintsurg-2014-011102] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Abstract
With recent advancement in medical imaging, techniques, and endovascular tools more patients are diagnosed with unruptured intracranial aneurysms. The main aim of offering aneurysm treatment is to ameliorate the risk of future aneurysm bleeding, while not posing additional risks on the patient from the treatment itself. We discuss in this paper our approach of selecting patients for treatment (simple coiling, balloon-assisted, stent-assisted, vessel sacrifice, or flow-divertion stents). Our decision-making is based on the published data and our center experience. Risks of all option are compared to each other and weighed against natural history of intracranial aneurysms. In this paper, literature is cited and case illustrations are presented to support this approach. Factors that affect our decision-making are aneurysm location, presentation, size, aneurysm geometry, parent vessel anatomy, and relevant co-morbidities.
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Abstract
OBJECTIVES Paraclinoid aneurysms are challenging lesions to treat with traditional surgical and conventional endovascular techniques despite modern improvements in technique and technology. Flow diversion emerged recently as a promising new therapy that overcomes limitations related to the wide-neck and fusiform morphology, and importantly addresses the underlying diseased parent artery from which the aneurysm arises. METHODS We reviewed the current literature regarding the safety and efficacy of flow diversion therapy for treatment of paraclinoid aneurysms. RESULTS Early results suggest excellent ability for flow diversion to remodel the diseased parent artery and achieve durable complete angiographic occlusion of the aneurysm with acceptable rates of peri-procedural risk. DISCUSSION Flow diversion therapy can achieve durable and high rates of obliteration that surpass traditional methods of management for paraclinoid aneurysms. However, caution is warranted when considering this treatment modality due to several concerning and often-unpredictable complications associated with this technology.
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Zhang Z, Lv X, Wu Z, Li Y, Yang X, Jiang C, Xu R, Shen C. Clinical and angiographic outcome of endovascular and conservative treatment for giant cavernous carotid artery aneurysms. Interv Neuroradiol 2014; 20:29-36. [PMID: 24556297 PMCID: PMC3971137 DOI: 10.15274/inr-2014-10005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/13/2013] [Indexed: 02/07/2023] Open
Abstract
This study evaluated the outcome of endovascular and conservative treatment for giant cavernous carotid artery aneurysms (CCAAs). We retrospectively reviewed a series of 35 consecutive giant CCAAs treated with endovascular and conservative treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by parent artery occlusion (PAO), those who could not tolerate BOT were treated by stent/coil or conservative methods. Eight patients were treated conservatively, symptoms were worsened in four patients (50%), unchanged in three, and improved in one at 33.6±19.9 months (6~65 months) follow-up. In 27 aneurysms treated with endovascular methods, 17 aneurysms were treated by PAO, eight aneurysms were treated with stent-assisted coil embolization, and two aneurysms were embolized with coils. The initial post-procedure angiogram revealed complete occlusion, neck remnant, and incomplete occlusion in 81.5 %, 11.1 %, and 7.4 %, respectively. Procedure-related mortality and morbidity were 0 and 7.4 %, respectively. At 33.1±17.4 months (4~71 months) follow-up, a good clinical outcome (mRS 0-1) was observed in 25 (92.6%) patients, symptoms were resolved or improved in 20 (74.1%). Statistical analysis showed that risk factors for poor clinical outcome included age of 60 years and older (P=0.006), and conservative treatments (P=0.038). Risk factors for poor clinical outcome of giant CCAAs included conservative treatment and age older than 60 years. A symptomatic giant cavernous carotid aneurysm should be treated. The outcome of endovascular treatment of giant CCAAs is promising.
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Affiliation(s)
- Zhenhai Zhang
- Affiliated Bayi Brain Hospital, Military General Hospital of Beijing PLA; Beijing, China
- />Zhongxue Wu, MD and Xianli Lv, MD - Beijing Neurosurgical Institute and Beijing Tiantan Hospital - Tiantan, Xili, 6, Dongcheng - Beijing,100050, China - Tel.: +86 10 67098850 - Fax: +86 10 67018349 - E-mail: -
| | - Xianli Lv
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Youxiang Li
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Xinjian Yang
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Chuhan Jiang
- Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University; Beijing, China
| | - Ruxiang Xu
- Affiliated Bayi Brain Hospital, Military General Hospital of Beijing PLA; Beijing, China
| | - Chunsen Shen
- Affiliated Bayi Brain Hospital, Military General Hospital of Beijing PLA; Beijing, China
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Starke RM, Chalouhi N, Ali MS, Tjoumakaris SI, Jabbour PM, Fernando Gonzalez L, Rosenwasser RH, Dumont AS. Endovascular treatment of carotid cavernous aneurysms: Complications, outcomes and comparison of interventional strategies. J Clin Neurosci 2014; 21:40-6. [DOI: 10.1016/j.jocn.2013.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 03/10/2013] [Indexed: 11/30/2022]
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