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Takahashi T, Ikeda G, Igarashi H, Konishi T, Araki K, Hara K, Akimoto K, Miyamoto S, Shiigai M, Uemura K, Ishikawa E, Matsumaru Y. Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report. Surg Neurol Int 2021; 12:109. [PMID: 33880214 PMCID: PMC8053467 DOI: 10.25259/sni_806_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022] Open
Abstract
Background: Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA. Case Description: A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient’s medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21. Conclusion: In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique.
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Affiliation(s)
| | - Go Ikeda
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Haruki Igarashi
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Takahiro Konishi
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kota Araki
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kei Hara
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Ken Akimoto
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Satoshi Miyamoto
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Masanari Shiigai
- Department of Radiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kazuya Uemura
- Department of Neurosurgery Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuji Matsumaru
- Department of Stroke, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Chen K, Wang L, Wang D, Liu J, Lu J, Qi P. Balloon-in-stent assisted coiling for treatment of intracranial overwide and undertall aneurysms. J Clin Neurosci 2016; 34:202-206. [PMID: 27658574 DOI: 10.1016/j.jocn.2016.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 11/28/2022]
Abstract
This study reports our experience of balloon-in-stent assisted coiling for the treatment of morphologically unfavorable aneurysms located in the internal carotid artery (ICA). From July 2007 to April 2014, twelve patients with twelve aneurysms located in the ICA were coil embolized by simultaneously using balloon and stent assistance. Five aneurysms were ruptured and seven were unruptured. All the aneurysms were overwide (dome-to-neck ratio ⩽1.2) and undertall (aspect ratio ⩽1.2) anatomically. The procedure-related adverse events, clinical and angiographic results were retrospectively analyzed. Intraprocedural aneurysmal bleeding occurred for one unruptured aneurysm but was stopped immediately after the balloon was inflated. Periprocedural thromboembolism occurred for two ruptured aneurysms, leading to death in one patient and severe neurological deficit for the other one. Procedure-related permanent morbidity and mortality rates were 8.3% (1/12) and 8.3% (1/12). Satisfactory (total and subtotal) occlusion was obtained immediately in 11 (91.7%) cases. Nine aneurysms received digital subtraction angiography follow-up (mean 25.1months, range 6-55), and all of them except one were totally obliterated. No aneurysmal bleeding occurred during a mean period of 59.1months, clinical follow-up for eleven patients. Balloon-in-stent assisted coiling might be a therapeutic alternative to prevent growth or rupture of overwide and undertall aneurysms. Nevertheless, it should be used prudently for ruptured ICA aneurysms, for its disadvantage of technical complexity and relatively high rate of adverse events.
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Affiliation(s)
- Kunpeng Chen
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China; Beijing Institute of Geriatrics, Graduate School of Peking Union Medical College, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China
| | - Lijun Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China; Beijing Institute of Geriatrics, Graduate School of Peking Union Medical College, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China.
| | - Jiachun Liu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, China, No. 1 DaHua Road, Dong Dan, Beijing 100730, PR China
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Zhang YY, Fang YB, Wu YN, Zhang Q, Li Q, Xu Y, Huang QH, Liu JM. Angiographic Characteristics and Endovascular Treatment of Anterior Cerebral Artery A1 Segment Aneurysms. World Neurosurg 2016; 97:551-556. [PMID: 27609443 DOI: 10.1016/j.wneu.2016.08.117] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This report aimed to review the angiographic characteristics and evaluate the safety and feasibility of endovascular treatment of A1 aneurysms. METHODS Nineteen ruptured and 13 unruptured A1 aneurysms treated endovascularly were evaluated in this study. The angiographic and clinical records were retrospectively reviewed. RESULTS Endovascular treatments were successfully applied in all 32 aneurysms. Conventional coiling was performed in 24 aneurysms, stent-assisted coiling in 7, and solo stenting in 1. The immediate angiographic result was 1 aneurysm in 15, two aneurysms in 10, and 3 in 7 aneurysms according to the Raymond grade. Intraoperative rupture was detected in 1 case without clinical consequence, and no other procedure-related complication occurred. Angiographic follow-up (mean, 12 months; range, 2-42 months) of 25 aneurysms showed total occlusion in 20, improvement in 1, stability in 3, and recurrence in 1. The only recurrence was detected in a case treated using conventional coiling, and it was retreated with stent-assisted coiling. Clinical follow-up (mean, 25 months; range, 6-93 months) was available in 24 of 30 patients, and the modified Rankin Scale score was 0-1 in 22 patients. CONCLUSIONS Endovascular treatment is technically feasible and safe for A1 aneurysms.
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Affiliation(s)
- Ying-Ying Zhang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China; Department of Neurology, Huadong Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yi-Bin Fang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yi-Na Wu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qi Zhang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Yi Xu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Qing-Hai Huang
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
| | - Jian-Min Liu
- Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
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Jeong HW, Seung WB. Outcomes of Stent-assisted Coil Embolization of Wide-necked Intracranial Aneurysms Using the Solitaire™ AB Neurovascular Remodeling Device. J Cerebrovasc Endovasc Neurosurg 2016; 17:301-12. [PMID: 27066440 PMCID: PMC4823427 DOI: 10.7461/jcen.2015.17.4.301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/12/2015] [Accepted: 12/19/2015] [Indexed: 11/27/2022] Open
Abstract
Objective This retrospective study presents our experience with respect to the clinical and angiographic outcomes of patients treated with stent-assisted coil embolization using Solitaire™ AB stents. Materials and Methods From March 2011 to December 2014, 50 patients with 55 wide-necked and/or complex intracranial aneurysms were evaluated. Four patients presented with an acute subarachnoid hemorrhage. Stent deployment was performed with a standard coiling procedure in 49 aneurysms. Three patients underwent bailout stenting, 2 patients were treated by temporary stenting and one patient was treated only by stenting without coiling for dissecting aneurysm. Results Successful placement of the Solitaire AB stent was achieved in all the cases. Based on the postprocedural angiographic results, a Raymond 1 was obtained in 32 (59%) of 54 aneurysms, excluded by one case of dissecting aneurysm, and a Raymond 2 in 13 (24%), and a Raymond 3 in 9 (17%). There was one thromboembolic (2%) and three hemorrhagic complications (6%). However, procedure-related morbidity or mortality was not found. Annual follow-up angiographic results from the embolization were obtained in 40 (74.1%) of 54 cases. These results were represented as Raymond 1 in 27 (67.5%), class 2 in 9 (22.5%), and class 3 in 4 (10%) cases. Angiographic improvement associated with progressive thrombosis of the aneurysm was obtained in 10 aneurysms. Four aneurysms were recanalized without requiring additional treatment. In-stent stenosis was found in one aneurysm, but stent migration was not seen on follow-up angiography. Conclusion Stent-assisted coil embolization using the Solitaire AB stent for treating wide-necked and/or complex intracranial aneurysms was found to be safe and effective immediately post-embolization and after follow-up. Long-term follow-up will be required to identify the effect of the Solitaire AB stent on recanalization rates.
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Affiliation(s)
- Hae Woong Jeong
- Department of Diagnostic Radiology, Busan Baik Hospital, Inje University, Busan, Korea
| | - Won-Bae Seung
- Department of Neurosurgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
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Liu H, Choe J, Jung SC, Song Y, Yang KH, Park KJ, Goo HW, Park WH, Suh DC. Does a Low-wall Coverage Stent Have a Flow Diverting Effect in Small Aneurysms? Neurointervention 2015; 10:89-93. [PMID: 26389012 PMCID: PMC4571559 DOI: 10.5469/neuroint.2015.10.2.89] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKBROUND AND PURPOSE The flow diverting effect of a low-wall coverage stent remains controversial. We evaluted patients who underwent stenting for small aneurysms with a low but potential risk of growth and reviewed related literature. MATERIALS AND METHODS We evaluated 9 small aneurysms among 19 unruptured intracranial aneurysms from eight patients who underwent stenting. The patients had unexplainable severe headache (n = 8), aneurysm originating from the anterior choroidal artery (n = 3), potential growth or rupture risks including hypertension (n = 5), and multiple aneurysms (n = 6). Stents with a relatively low-wall coverage ratio (8-10%) were used. Clinical and angiographic outcomes were assessed. RESULTS One (n = 8) or two stents (n = 1) were used without any procedural difficulties or complications. Although no immediate changes of aneurysm morphology were observed, aneurysms decreased in size (n = 8) when examined by DSA (n = 8) or MRA (n = 1) during a median 28.9-month follow-up. There were no adverse events, including thromboembolism, aneurysm rupture, or stent movement during a median 31.9-month clinical follow-up (range: 17-69 months). CONCLUSION Although a variable degree of aneurysm size decrease may not prevent further growth or rupture of small aneurysms, stenting with a low-wall coverage ratio may have some advantageous hemodynamic effect. Flow modification of stent architecture vs. aneurysm characteristics, including size and location, on long-term outcome, requires further clarification.
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Affiliation(s)
- Hairi Liu
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. ; Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province 225300, P. R. China
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chul Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yunsun Song
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ku Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hae Won Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Hyong Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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