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Li B, Zhang K, Yu J. Current state of endovascular treatment of anterior cerebral artery aneurysms. Front Neurol 2024; 15:1396701. [PMID: 39144702 PMCID: PMC11323123 DOI: 10.3389/fneur.2024.1396701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open
Abstract
The locations of anterior cerebral artery (ACA) aneurysms vary, and various aneurysms can occur along the course of the ACA. Ruptured and some unruptured ACA aneurysms may require aggressive treatment to avoid bleeding or rebleeding. Although open surgery is an effective treatment for ACA aneurysms, endovascular treatment (EVT) is becoming an alternative treatment in select cases. EVT techniques for ACA aneurysms often vary and are performed on a case-by-case basis according to the nature and location of the aneurysm. To better understand the EVT strategy for ACA aneurysms, it is necessary to review EVT for ACA aneurysms. In this review, the following topics are discussed: ACA anatomy and anomalies, classifications of ACA aneurysms, the natural history of ACA aneurysms, open surgery and EVT statuses for ACA aneurysms, EVT techniques for various ACA aneurysms, and the prognosis and complications of EVT for ACA aneurysms. According to our review and experience, traditional coiling EVT is still the preferred therapy for most ACA aneurysms. For A1 aneurysms, EVT is challenging. After the selection of appropriate cases, deployment of a flow diverter and Woven EndoBridge device can result in a good prognosis for patients with ACA aneurysms. In addition, parent artery occlusion can be used to treat A1 aneurysms with good collateral circulation and some distal ACA aneurysms. In general, EVT is gaining popularity as an alternative treatment option for ACA aneurysms.
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Affiliation(s)
- Bingwei Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Kun Zhang
- Department of Cerebrovascular Disease, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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García-Carmona JA, von Quednow E, Hernández-Fernández F, Molina-Nuevo JD, García-García J, Palao M, Segura T. Case report: Endovascular embolization of a cerebral pseudoaneurysm caused by SARS-CoV2 infection. Front Neurol 2022; 13:991610. [PMID: 36267887 PMCID: PMC9577094 DOI: 10.3389/fneur.2022.991610] [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: 07/11/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
Background Severe COVID-19 has been shown to produce convulsions, encephalitis, Guillain-Barré syndrome, or cerebrovascular disease. However, only 4 case reports described subarachnoid or brain hemorrhage caused by ruptured cerebral aneurysms or pseudoaneurysms in patients with COVID-19. Cerebral pseudoaneurysms represent <1% of all intracranial aneurysms and have been related to radiation therapy, vasculitis, rupture of true saccular aneurysms, arteriovenous malformations, and infections by bacteria and viruses, such as Epstein-Bar and Herpes virus. Case presentation A 28-year-old Caucasian woman, with no medical history of interest and completely vaccinated against SARS-CoV-2, was admitted to Neurology due to progressive tetraparesis with areflexia, a cough, and a fever of 38°C. SARS-CoV2 PCR was positive while lumbar puncture, blood tests, and electromyogram showed criteria for Guillain-Barré syndrome. Despite the treatment, the patient developed dyspnea and tetraplegia requiring invasive mechanical ventilation. There was motor neurological improvement but a decreased level of consciousness was observed on day 13. A brain CT scan demonstrated an acute haematoma and cerebral arteriography showed a 4-mm pseudoaneurysm located in a branch of the left middle cerebral artery. Given the high risk of rebleeding, endovascular treatment was decided upon. Therefore, complete embolization of the pseudoaneurysm was carried out by using the synthetic glue N-butyl-cyanocrylate. Two days later, the patient was clinically and neurologically recovered and was discharged. Lastly, a new angiography showed no evidence of the pseudoaneurysm 3-weeks later. Conclusions We report, for the first time, a patient suffering a severe immune reaction caused by SARS-CoV2 infection and developing a cerebral pseudoaneurysm treated with endovascular embolization without complications.
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Affiliation(s)
- Juan Antonio García-Carmona
- Department of Neurology, Santa Lucia University Hospital, Cartagena, Spain
- Group of Clinical and Experimental Pharmacology, Institute for Biomedical Research of Murcia (IMIB), Murcia, Spain
| | - Enzo von Quednow
- Department of Neurophysiology, General University Hospital, Albacete, Spain
| | - Francisco Hernández-Fernández
- Unit of Interventional Neuroradiology, General University Hospital, Albacete, Spain
- Department of Neurology, General University Hospital, Albacete, Spain
- *Correspondence: Francisco Hernández-Fernández
| | - Juan David Molina-Nuevo
- Unit of Interventional Neuroradiology, General University Hospital, Albacete, Spain
- Department of Radiology, General University Hospital, Albacete, Spain
| | | | - María Palao
- Department of Neurology, General University Hospital, Albacete, Spain
| | - Tomás Segura
- Department of Neurology, General University Hospital, Albacete, Spain
- Medical School, Institute for Research in Neurologic Disabilities (IDINE), University of Castilla-La-Mancha, Albacete, Spain
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Treatment of Traumatic Internal Carotid Artery Aneurysm by Flow-Diverter: A Single-Center Experience. Neurochirurgie 2022; 68:e60-e67. [PMID: 36028352 DOI: 10.1016/j.neuchi.2022.07.011] [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: 03/23/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/20/2022]
Abstract
AIM Traumatic intracranial aneurysm (TICA) is a rare vascular lesion with various etiologies and a high mortality rate when diagnosed late. In this study, we present our cases of TICA, which we treated with flow-diverter stents due to different etiological factors. METHODS Clinical data were recorded for 8 patients: age, gender, etiological factors, aneurysm location, aneurysm type, rupture, main artery status, and postoperative complications. RESULTS 75% (n:6) of the patients were male and 25% (n:2) female. Etiologically, there was intracranial tumor surgery in 3 cases (37.5%), fall from height in 2 (25%), road accident in 2 (25%), and blunt trauma in 1 (12.5%). Reconstruction used a flow-diverting stent in all cases. One patient experienced intraoperative iatrogenic rupture of the distal arterioles due to a microwire. Mean angiographic follow-up was 17.8 months (range, 6-32 months). During follow-up, none of the patients required renewed endovascular treatment. CONCLUSION Traumatic aneurysm is a vascular lesion with high mortality when diagnosed late. In case of suspected vascular injury after trauma or intracranial surgery, further evaluation should be performed without delay. TICA can be safely treated with flow-diverter stents, conserving the main artery.
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Liu Q, Qi C, Wang Y, Su W, Li G, Wang D. Treatment of direct carotid-cavernous fistula with Willis covered stent with midterm follow-up. Chin Neurosurg J 2021; 7:41. [PMID: 34517922 PMCID: PMC8436539 DOI: 10.1186/s41016-021-00256-y] [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: 07/16/2020] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
Background Willis covered stent is the first stent designed exclusively for intracranial vasculature, and its application in carotid-cavernous fistula is limited. The aim is to evaluate the feasibility and efficacy of this device in treating direct carotid-cavernous fistula. Methods Ten consecutive patients with direct carotid-cavernous fistula were treated in our institution with Willis covered stents from September 2013 to December 2015. The characteristics of these patients and the immediate and follow-up results were retrospectively reviewed. Results Of the 10 patients, 8 were treated for the first time, and 2 had been treated elsewhere. Willis covered stents were successfully released in 9 patients. Abnormal arteriovenous shunt disappeared in 6 cases immediately after stent deployment and endoleak occurred in 3 cases. Endoleak disappeared at 6-month angiography follow-up in one case and was sealed with coils through a pre-set microcatheter in another case. Parent artery was sacrificed as endoleak remained despite repeated balloon dilation and a second stent deployment in the third case. All patients got clinical follow-ups for at least 24 months and 7 patients received angiographic follow-up. Symptoms were relieved gradually in all cases except for slight oculomotor paralysis and visual acuity in one case, respectively. In-stent stenosis was found in 1 case, and no recurrence was observed. Conclusions Willis covered stent is feasible for direct carotid-cavernous fistula.
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Affiliation(s)
- Qinglin Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical Universitys, 119#, Nansihua Xi Road, Fengtai District, Beijing, 100050, China
| | - Changjing Qi
- Nursing Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Yunyan Wang
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Wandong Su
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Gang Li
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China
| | - Donghai Wang
- Neurosurgery Department of Qilu Hospital, Shandong University, 107# Wenhua Xi Road, Jinan, 250012, Shandong province, China.
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Zheng Y, Lu Z, Shen J, Xu F. Intracranial Pseudoaneurysms: Evaluation and Management. Front Neurol 2020; 11:582. [PMID: 32733358 PMCID: PMC7358534 DOI: 10.3389/fneur.2020.00582] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/20/2020] [Indexed: 12/04/2022] Open
Abstract
Intracranial pseudoaneurysms account for about 1% of intracranial aneurysms with a high mortality. The natural history of intracranial pseudoaneurysm is not well-understood, and its management remains controversial. This review provides an overview of the etiology, pathophysiology, clinical presentation, imaging, and management of intracranial pseudoaneurysms. Especially, this article emphasizes the factors that should be considered for the most appropriate management strategy based on the risks and benefits of each treatment option.
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Affiliation(s)
- Yongtao Zheng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
| | - Zheng Lu
- Department of Neurosurgery, Hai'an People's Hospital, Nantong, China
| | - Jianguo Shen
- Department of Neurosurgery, Second Affiliated Hospital of Jiaxiang University, Jiaxing, China
| | - Feng Xu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical School, Fudan University, Shanghai, China.,Department of Neurosurgery, Kashgar Prefecture Second People's Hospital, Kashgar, China
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Deng Q, Feng WF. Efficacy of pipeline endovascular device and Willis stent graft in the treatment of traumatic pseudo intracranial aneurysms. J Interv Med 2020; 3:45-48. [PMID: 34805906 PMCID: PMC8562160 DOI: 10.1016/j.jimed.2020.01.007] [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] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate the advantages and effects of pipeline embolization device (PED) or Willis stent, in treating traumatic pseudoaneurysms. Traumatic pseudo intracranial aneurysms (TPIA) can be caused by either direct trauma or iatrogenic injuries, usually caused by direct arterial wall injury or shear due to acceleration. We describe a series of patients with TPIA who received a PED or Willis stent. MATERIALS AND METHODS Retrospective analysis was performed on nine patients with TPIA admitted to the southern hospital of Southern Medical University from December 2017 to June 2019, of whom four were treated with PED and five were implanted with six Willis covered stents. The occlusive rate and complication in the two kinds of stents were compared by postoperative follow-up and modified rankin score (MRS). RESULTS After the implantation of PED, four patients showed an immediate stagnation of blood flow or a decreased filling in aneurysms, three out of four patients exhibited complete occlusion, and the remaining patient had nearly complete occlusion. Four out of five cases of Willis stent implantation were associated with immediate complete occlusion of aneurysms, and the modified rankin score of these patients ranged from 0 to 1. One patient died of unassociated complications. CONCLUSION For different types of TPIA in the internal carotid artery (ICA), PED and Willis stents provide significant advantages in treatment, with fewer postoperative complications and prognosis well.
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Affiliation(s)
- Qiao Deng
- Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
| | - Wen feng Feng
- Department of Neurosurgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China
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Sweid A, Rahm SP, Das S, Baldassari MP, Jabbour P, Alexander TD, Velagapudi L, Chalouhi N, Gooch MR, Herial N, Rosenwasser RH, Tjoumakaris S. Safety and Efficacy of Bilateral Flow Diversion for Treatment of Anterior Circulation Cerebral Aneurysms. World Neurosurg 2019; 130:e1116-e1121. [PMID: 31330338 DOI: 10.1016/j.wneu.2019.07.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nearly 20% of individuals with an aneurysm will have multiple aneurysms-these individuals are at increased risk of subarachnoid hemorrhage. Treatment of bilateral aneurysms with flow diverters (FDs), or Pipeline embolization device, has not yet been established as an effective therapy. We evaluated the safety and efficacy of a 2-stage treatment of bilateral aneurysms with Pipeline embolization devices placed 6 months apart. METHODS We performed a retrospective review to analyze the clinical and angiographic outcomes of 16 individuals with bilateral aneurysms treated with 2-stage flow diversion at a tertiary referral center from January 2010 to July 2018. RESULTS Of the 16 patients with 33 aneurysms treated with bilateral flow diversion, 1 had 2 aneurysms treated with a single FD on the contralateral side. The aneurysms treated were ophthalmic, superior hypophyseal, posterior communicating, or cavernous segment aneurysms, with an average size of 6.5 mm. No major complications, such as in-stent stenosis, thromboembolic events, distal intraparenchymal hemorrhage, rerupture, stent migration, or neurological death, were recorded. All the patients had good functional outcomes. At the 24-month follow-up examination, 81% of aneurysms showed complete occlusion. No aneurysm required repeat treatment. CONCLUSIONS The results from the present study have demonstrated that 2-stage treatment of bilateral aneurysms with FDs is both safe and efficacious. The timing of contralateral FD stent placement is critical. We found that 6 months allows for adequate neurological recovery and stent endothelialization.
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Affiliation(s)
- Ahmad Sweid
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Sage P Rahm
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Somnath Das
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Michael P Baldassari
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Tyler D Alexander
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Lohit Velagapudi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Michael R Gooch
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Nabeel Herial
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA
| | - Stavropoula Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania, USA.
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Chen SH, McCarthy DJ, Sheinberg D, Hanel R, Sur S, Jabbour P, Atallah E, Chalouhi N, Dumont A, Amenta P, Hasan D, Raper D, Liu K, Jane JA, Crowley RW, Aguilar-Salinas P, Bentley J, Monteith S, Mitchell BD, Yavagal DR, Peterson EC, Starke RM. Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms. World Neurosurg 2019; 127:e86-e93. [PMID: 30849553 DOI: 10.1016/j.wneu.2019.02.135] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. METHODS We performed a multi-institutional retrospective study of intracranial PSAs treated with the Pipeline Embolization Device (PED) between 2014 and 2017 at 7 institutions. Complications and clinical and radiographic outcomes were reviewed. RESULTS A total of 19 patients underwent PED placement for intracranial PSA. Iatrogenic injury and trauma comprised most etiologies in our series. The mean pseudoaneurysm diameter was 8.8 mm, and 18 of 19 PSAs (95%) involved the internal carotid artery (ICA). Multiple PEDs were deployed in a telescoping fashion in 7 patients (37%). Of the 18 patients with follow up imaging, 14 (78%) achieved complete pseudoaneurysm obliteration and 2 achieved near-complete obliteration (11%). Two patients (11%) were found to have significant pseudoaneurysm progression on short-term follow-up and required ICA sacrifice. No patients experienced new neurologic deficits or deterioration secondary to PED placement. No patients experienced bleeding or rebleeding from PSA. CONCLUSIONS In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.
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Affiliation(s)
- Stephanie H Chen
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - David J McCarthy
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
| | - Dallas Sheinberg
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Ricardo Hanel
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA; Department of Neurological Surgery, Baptist Health, Miami, Florida, USA
| | - Samir Sur
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Elias Atallah
- Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nohra Chalouhi
- Department of Neurological Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - Peter Amenta
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, Louisiana, USA
| | - David Hasan
- Department of Neurological Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Daniel Raper
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth Liu
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John A Jane
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - R Webster Crowley
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Josh Bentley
- Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA
| | - Stephen Monteith
- Department of Neurological Surgery, Swedish Health, Seattle, Washington, USA
| | - Bartley D Mitchell
- Department of Neurological Surgery, Methodist Institute, Houston, Texas, USA
| | - Dileep R Yavagal
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Eric C Peterson
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Robert M Starke
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
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Yan Y, Wu Y, Zhao K, Pan Y, Huang Q. Endovascular treatment of traumatic carotid pseudoaneurysm with Tubridge flow diverter: A case report. Interv Neuroradiol 2019; 25:685-687. [PMID: 31169434 DOI: 10.1177/1591019919855862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Traumatic pseudoaneurysm is a rare lesion with a high risk of rupture, and represents one of the most difficult lesions to treat, either surgically or endovascularly. Herein, we describe the case of a 32-year-old man with a traumatic pseudoaneurysm of the internal carotid artery, which was treated by overlapped flow diverters (Tubridge). The patient recovered well, and the follow-up angiography at four months showed complete occlusion of the pseudoaneurysm and patency of the internal carotid artery and the ophthalmic artery.
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Affiliation(s)
- Yazhou Yan
- Department of Neurosurgery, Changhai Hospital affiliated to the Naval Military Medical University, Shanghai, P.R. China
| | - Yina Wu
- Department of Neurosurgery, Changhai Hospital affiliated to the Naval Military Medical University, Shanghai, P.R. China
| | - Kaijun Zhao
- Department of Neurosurgery, Changhai Hospital affiliated to the Naval Military Medical University, Shanghai, P.R. China
| | - Yuan Pan
- Department of Neurosurgery, 971 Hospital of PLA, Qingdao, P.R. China
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital affiliated to the Naval Military Medical University, Shanghai, P.R. China
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Sami MT, Gattozzi DA, Soliman HM, Reeves AR, Moran CJ, Camarata PJ, Ebersole KC. Use of Pipeline™ embolization device for the treatment of traumatic intracranial pseudoaneurysms: Case series and review of cases from literature. Clin Neurol Neurosurg 2018; 169:154-160. [PMID: 29698879 DOI: 10.1016/j.clineuro.2018.04.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 04/03/2018] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Intracranial traumatic pseudoaneurysms (PSA) are a rare but dangerous subtype of cerebral aneurysm. Reports documenting use of flow-diverting stents to treat traumatic intracranial PSAs are few and lack long-term follow-up. To our knowledge, this is the largest case-series to date demonstrating use of Pipeline Endovascular Device (PED) for traumatic intracranial PSAs. PATIENTS AND METHODS Retrospective review of 8 intracranial traumatic PSAs in 7 patients treated using only PED placement. Patients were followed clinically and angiographically for at least 6 months. RESULTS Seven patients with a mean age of 37 years were treated for 8 intracranial pseudo-aneurysms between 2011-2015. Six aneurysms were the result of blunt trauma; 2 were from iatrogenic injury during transsphenoidal surgery. Mean clinical and angiographic follow-up in surviving patients was 15.2 months. In patients with angiographic follow-up, complete occlusion was achieved in all but one patient, who demonstrated near-complete occlusion. No ischemic events or stent-related stenosis were observed. One patient developed a carotid-cavernous fistula after PED, which was successfully retreated with placement of a second PED. There were two mortalities. One was due to suspected microwire perforation remote from the target aneurysm resulting in SAH/IPH. The other was due to a traumatic SDH and brainstem hemorrhage from an unrelated fall during follow-up interval. CONCLUSIONS Use of PED for treatment of intracerebral PSAs following trauma or iatrogenic injury showed good persistent occlusion, and acceptable complication rate for this high-risk pathology. Risks of this procedure and necessary antiplatelet therapy require appropriate patient selection. Larger prospective studies are warranted.
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Affiliation(s)
- Mairaj T Sami
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, Kansas City, KS, 66160, USA
| | - Domenico A Gattozzi
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, Kansas City, KS, 66160, USA.
| | - Hesham M Soliman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Alan R Reeves
- Department of Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160 USA
| | - Christopher J Moran
- Department of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, St. Louis, MO, 63100, USA
| | - Paul J Camarata
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, Kansas City, KS, 66160, USA
| | - Koji C Ebersole
- Department of Neurosurgery, University of Kansas Medical Center, Mail Stop 3021, Kansas City, KS, 66160, USA
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Giorgianni A, Pellegrino C, Micieli C, Mercuri A, Minotto R, Baruzzi F, Valvassori L. Endovascular Treatment of Extracranial Internal Carotid Pseudoaneurysm: Description of Three Cases. Surg J (N Y) 2016; 2:e15-e18. [PMID: 28824985 PMCID: PMC5553467 DOI: 10.1055/s-0036-1584168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/23/2016] [Indexed: 10/27/2022] Open
Abstract
The aim of this study is to explore the possibility of endovascular treatment of internal carotid artery pseudoaneurysm (PSA). These lesions are difficult to treat with a surgical approach, especially if they are located extracranially and close to the skull base. Endovascular stent placement in symptomatic and unstable extracranial internal carotid PSA was found to be safe and effective. Depending on hemodynamic aspects, complete local exclusion of aneurysmal formation is achieved in few months. We present three patients with carotid dissection and PSA formation that have been successfully treated by stent placement.
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Affiliation(s)
- Andrea Giorgianni
- Department of Neuroradiology, Circolo Varese Hospital, Varese, Italy
| | - Carlo Pellegrino
- Department of Neuroradiology, Circolo Varese Hospital, Varese, Italy
| | - Camilla Micieli
- Department of Radiology, Circolo Varese Hospital, Varese, Italy
| | - Anna Mercuri
- Department of Neuroradiology, Circolo Varese Hospital, Varese, Italy
| | - Renzo Minotto
- Department of Neuroradiology, Circolo Varese Hospital, Varese, Italy
| | - Fabio Baruzzi
- Department of Neuroradiology, Circolo Varese Hospital, Varese, Italy
| | - Luca Valvassori
- Department of Neuroradiology, Niguarda Ca' Granda Milano Hospital, Milano, Italy
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12
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Moon TH, Kim SH, Lee JW, Huh SK. Clinical Analysis of Traumatic Cerebral Pseudoaneurysms. Korean J Neurotrauma 2015; 11:124-30. [PMID: 27169077 PMCID: PMC4847513 DOI: 10.13004/kjnt.2015.11.2.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 11/17/2022] Open
Abstract
Objective Traumatic pseudoaneurysms are rare but life-threatening lesions. We investigated the patients with these lesions to clarify their clinical characteristics and therapeutic strategies and we also reviewed the literatures on the treatment principles, possible options, and outcomes. Methods There were a total of 8 patients who were treated with traumatic intracranial pseudoaneurysms between April 1980 and January 2009. Medical charts and the imaging studies were reviewed for analysis. The outcome was measured with modified Rankin Scale (mRS) score at 6 months after treatment. Results All 8 patients were male and the mean age was 25 years old. Six of those were located at the cavernous segment of the internal carotid artery (ICA) and the other 2 was located at the M2 segment of middle cerebral artery. The causes of trauma were car accidents in 6, penetrating injury through the orbit in 1, and slip down injury in 1 patient. Massive epistaxis or hematemesis occurred in all patients with a pseudoaneurysm at the cavernous and ophthalmic segment of the ICA. All 6 patients of the cavernous and ophthalmic ICA group showed favorable outcome of mRS 0 to 1. The outcome of patients with middle cerebral artery pseudoaneurysm was mRS 2 to 3. Conclusion Upon prompt diagnosis and proper treatment planning, it is possible to achieve favorable outcome in these patients. Lesions located at the cavernous segment of the ICA favored endovascular treatment while those at the middle cerebral artery favored surgical treatment.
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Affiliation(s)
- Tae Hun Moon
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Sung Han Kim
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Jae Whan Lee
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Seung Kon Huh
- Department of Neurosurgery, Stroke Center, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
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