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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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ARIMURA K, IIHARA K, SATOW T, NISHIMURA A, TOKUNAGA S, SAKAI N. Safety and Feasibility of Neuroendovascular Therapy for Elderly Patients: Analysis of Japanese Registry of Neuroendovascular Therapy 3. Neurol Med Chir (Tokyo) 2019; 59:305-312. [PMID: 31130572 PMCID: PMC6694018 DOI: 10.2176/nmc.oa.2018-0325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/01/2019] [Indexed: 11/24/2022] Open
Abstract
Japan has a rapidly aging population and the application of neuroendovascular therapy (NET) for cerebrovascular diseases among elderly patients has increased, but feasibility and safety of NET for elderly patients are still debated. Therefore, this study aimed to elucidate feasibility and safety of NET by analyzing the Japanese nationwide database, the Japanese Registry of Neuroendovascular Therapy 3 (JR-NET 3). In total, 35,972 patients in the JR-NET 3 were analyzed retrospectively. "Elderly patients" were defined as those aged ≥75 years. Approximately one-quarter of patients who received NET were elderly patients. The proportion of patients with modified Rankin Scale (mRS) 0-2 before treatment and 30 days after NET was significantly low across all diseases in the elderly patients. Technical success rates were generally high across all procedures, but complication rate was significantly higher among elderly patients; ischemic complications were significantly higher with NET for unruptured aneurysms (UA) and carotid artery stenosis (CAS). Multivariate analysis revealed that mRS 0-2 before treatment [odds ratio (OR): 0.56, 95% confidence interval (CI): 0.34-0.94, P = 0.03], middle cerebral artery aneurysm (OR: 0.33, 95% CI: 0.12-0.92, P = 0.04), and complete obliteration (OR: 0.66, 95% CI: 0.44-0.97, P = 0.03) were associated with ischemic complications with NET for UA. Moreover, mRS 0-2 before treatment (OR: 0.55, 95% CI: 0.36-0.86, P < 0.01), high intensity with time-of-flight magnetic resonance angiography (OR: 1.55, 95% CI: 1.03-2.32, P = 0.04), open-cell stent (OR: 2.20, 95% CI: 1.50-3.22, P <0.01) were associated with ischemic complications with NET for CAS. Taken together, our findings indicate that cautious and precise selection of patients suitable for NET is necessary.
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Affiliation(s)
- Koichi ARIMURA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Koji IIHARA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Tetsu SATOW
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Ataru NISHIMURA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - So TOKUNAGA
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Nobuyuki SAKAI
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - JR-NET investigators
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
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Tanioka S, Ishida F, Kishimoto T, Tanaka K, Shimosaka S, Suzuki H. Prediction of the extent of thrombus formation in the parent artery after endovascular occlusion of a distal anterior cerebral artery aneurysm using computational fluid dynamics. J Clin Neurosci 2019; 74:210-212. [PMID: 31420275 DOI: 10.1016/j.jocn.2019.08.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 08/05/2019] [Indexed: 11/25/2022]
Abstract
Endovascular coiling of a cerebral aneurysm and coil occlusion of the parent artery have been occasionally performed to treat cerebral aneurysms; however, it is difficult to predict the accurate extent of thrombus formation in the parent artery proximal to the coiled aneurysm and the coil-occluded parent artery preoperatively, and unexpected occlusion of the arterial branches can occur by thrombus extension into or in the parent artery. The authors describe a case of a distal anterior cerebral artery (ACA) aneurysm treated by endovascular parent artery occlusion (PAO) with preoperative computational fluid dynamics (CFD) prediction of the extent of thrombus formation. A 73-year-old woman presented with subarachnoid hemorrhage and an aneurysm that was located on the right pericallosal artery distal to the paracentral artery bifurcation. Endovascular coiling of the aneurysm and the pericallosal artery was planned. In advance of the treatment, CFD was performed to predict the extent of thrombus formation with specific wall shear stress and shear rate thresholds. The hemodynamic results indicated that coiling of the aneurysm resulted in thrombus formation in the pericallosal artery up to just distal to the paracentral artery ostium; therefore, the treatment was implemented according to the CFD prediction. Postoperative digital subtraction angiography revealed that the extent of thrombus formation was consistent with the preoperative CFD prediction. This technique may prevent unexpected occlusion of arterial branches.
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Affiliation(s)
- Satoru Tanioka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan.
| | - Fujimaro Ishida
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan
| | - Tomoyuki Kishimoto
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan
| | - Katsuhiro Tanaka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan
| | - Shinichi Shimosaka
- Department of Neurosurgery, Mie Chuo Medical Center, 2158-5 Myojin-cho, Hisai, Tsu, Mie 514-1101, Japan.
| | - Hidenori Suzuki
- Department of Neurosurgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan.
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A comparison of the prevalence and risk factors of complications in intracranial tumor embolization between the Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and JR-NET3. Acta Neurochir (Wien) 2019; 161:1675-1682. [PMID: 31172282 DOI: 10.1007/s00701-019-03970-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Japanese Registry of NeuroEndovascular Therapy 2 (JR-NET2) and 3 (JR-NET3) were nationwide surveys that evaluated clinical outcomes after neuroendovascular therapy in Japan. The aim of this study was to compare the prevalence and risk factors of complications of intracranial tumor embolization between JR-NET2 and JR-NET3. METHODS A total of 1018 and 1545 consecutive patients with intracranial tumors treated with embolization were enrolled in JR-NET2 and JR-NET3, respectively. The prevalence of complications in intracranial tumor embolization and related risk factors were compared between JR-NET2 and JR-NET3. RESULTS The prevalence of complications in JR-NET3 (3.69%) was significantly higher than that in JR-NET2 (1.48%) (p = 0.002). The multivariate analysis in JR-NET2 showed that embolization for tumors other than meningioma was the only significant risk factor for complication (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.13-12.10; p = 0.032), and that in JR-NET3 revealed that embolization for feeders other than external carotid artery (ECA) (OR, 3.56; 95% CI, 2.03-6.25; p < 0.001) and use of liquid materials (OR, 2.65; 95% CI, 1.50-4.68; p < 0.001) were significant risks for complications. The frequency of embolization for feeders other than ECA in JR-NET3 (15.3%) was significantly higher than that in JR-NET2 (9.2%) (p < 0.001). Also, there was a significant difference in the frequency of use of liquid materials between JR-NET2 (21.2%) and JR-NET3 (41.2%) (p < 0.001). CONCLUSIONS Embolization for feeders other than ECA and use of liquid materials could increase the complication rate in intracranial tumor embolization.
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Nishi H, Ishii A, Satow T, Iihara K, Sakai N. Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3. Neurol Med Chir (Tokyo) 2018; 59:1-9. [PMID: 30531152 PMCID: PMC6350003 DOI: 10.2176/nmc.st.2018-0190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although the current standard treatment for unruptured aneurysms comprises surgical clipping or endovascular coiling, these techniques are not suitable for some cases, such as large, giant, and fusiform aneurysms. Endovascular parent artery occlusion (PAO), which includes internal trapping and proximal occlusion, is a well-established alternative treatment for such cases. Here, we retrospectively reviewed PAO cases from the Japanese Registry of Neuroendovascular Therapy 3, a nation-wide survey of all neuroendovascular therapy cases between 2010 and 2014. This dataset included 274 procedures with a mean patient age of 57.1 years and 55.4% female patients. For the treatment strategy, internal trapping was selected in 213 aneurysm cases (77.7%) and proximal occlusion in 61 aneurysm cases (22.2%). Most of the procedures were successfully completed (272/274: 99.2%). Immediately after treatment, angiographical complete occlusion was achieved in 248 cases (90.5%). Although the feasibility of this technique was excellent, there were 60 periprocedural complications (21.8%), including 48 ischemic complications (17.5%), seven hemorrhagic complications (2.5%). Overall, morbidity and mortality at 30 days postoperative were 5.8% and 0.7%, respectively. Among the pretreatment variables, a patient age of 70 and older was associated with ischemic complications [odds ratio (OR); 2.34, 95% confidence interval (CI); 1.02-5.25; P = 0.04] and a small aneurysm size (<5 mm) was associated with hemorrhagic complications (OR; 9.85, 95% CI; 1.07-221.0; P = 0.04) by multivariate analysis. In conclusion, PAO for unruptured cerebral aneurysms is feasible, but is associated with a complication rate of approximately 20%. Various alternative treatment options should be carefully considered with deconstructive strategies.
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Affiliation(s)
- Hidehisa Nishi
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University
| | - Akira Ishii
- Department of Neurosurgery, Graduate School of Medicine, Kyoto University
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
| | - Nobuyuki Sakai
- Department of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation.,Department of Neurosurgery, Kobe City Medical Center General Hospital
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Suzuki K, Suzuki R, Takigawa T, Shimizu N, Matsumoto Y, Fujii Y, Inoue Y, Sugiura Y, Hirata K, Tsuda K, Kawamura Y, Takano I, Nakae R, Nagaishi M, Tanaka Y, Hyodo A. A Single Center Experience with Coil Embolization for Cerebral Aneurysms Greater than 10 mm in the Internal Carotid Artery. Neurol Med Chir (Tokyo) 2017; 57:231-237. [PMID: 28250282 PMCID: PMC5447815 DOI: 10.2176/nmc.oa.2016-0176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We investigated endovascular treatment for 10 mm or larger aneurysms in the internal carotid artery (IC), including the cavernous portion, the paraclinoid portion, and the posterior communication artery (PC). Between 2011 and 2014 at our hospital, there were 35 cases of aneurysms that were 10 mm or larger in the carotid artery. We analyzed these 35 cases retrospectively based on the size and location of the aneurysms, method of treatment, number of coils implanted, use of a stent, complications, rupture after treatment, ophthalmologic symptoms, and need for re-treatment. There was no bleeding after treatment. Of the 35 cases, four cases (11%) had permanent complications. Re-treatment was indicated in 11 cases (31%), including eight cases localized in the paraclinoid portion, two cases in the IC-PC, and one case in the cavernous portion. Among these re-treatment cases, two cases required a third treatment. Of the 16 cases with paraclinoid aneurysms, half required re-treatment. Of the 12 cases with ophthalmologic symptoms prior to treatment, 9 (75%) improved or had no change and 3 (25%) became worse. There were no complications in the 13 re-treatment procedures. Re-treatment is not uncommon, and a scheduled follow-up is needed. Coil embolization has been one of the main options for aneurysms that are 10 mm or larger in the IC. In the future, these large aneurysms will be treated with a flow diverter stent (FD).
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Affiliation(s)
- Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Ryotaro Suzuki
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Nobuyuki Shimizu
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | | | - Yoshiko Fujii
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Yuki Inoue
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Yoshiki Sugiura
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Koji Hirata
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Kyoji Tsuda
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Issei Takano
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Ryuta Nakae
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Masaya Nagaishi
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Yoshihiro Tanaka
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
| | - Akio Hyodo
- Department of Neurosurgery, Dokkyo Medical University Koshigaya Hospital
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Matano F, Murai Y, Mizunari T, Tamaki T, Tateyama K, Koketsu K, Tanikawa R, Kamiyama H, Kobayashi S, Morita A. Recovery of Visual and Ophthalmologic Symptoms After Treating Large or Giant Internal Carotid Artery Aneurysm by High-Flow Bypass with Cervical Ligation. World Neurosurg 2017; 98:182-188. [DOI: 10.1016/j.wneu.2016.10.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/14/2016] [Accepted: 10/15/2016] [Indexed: 12/15/2022]
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Chandran A, Biswas S, Hartley JL, Nahser HC, Lancaster J, Puthuran M. Recurrent life-threatening haemoptysis from a bleeding vertebral artery pseudoaneurysm: A diagnostic dilemma. Interv Neuroradiol 2016; 22:512-5. [PMID: 27317267 DOI: 10.1177/1591019916653248] [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: 02/20/2016] [Accepted: 05/06/2016] [Indexed: 11/16/2022] Open
Abstract
A bleeding vertebral artery pseudoaneurysm is a rare cause of haemoptysis. Pseudoaneurysm can arise due to radionecrosis from previous radiotherapy in the base of skull and neck region and may present with haemoptysis many years later. It is important to be aware of this entity in the work-up of haemoptysis, particularly in patients with previous base of skull and neck radiotherapy. Our patient was successfully treated with endovascular occlusion.
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Ji W, Liu A, Lv X, Kang H, Sun L, Li Y, Yang X, Jiang C, Wu Z. Risk Score for Neurological Complications After Endovascular Treatment of Unruptured Intracranial Aneurysms. Stroke 2016; 47:971-8. [PMID: 26869386 PMCID: PMC4819491 DOI: 10.1161/strokeaha.115.012097] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Procedure-related neurological complications are common after endovascular treatment of unruptured intracranial aneurysms. We aimed to develop a score to quantify individual patient risk. METHODS We retrospectively analyzed consecutive patients who underwent endovascular treatment for unruptured intracranial aneurysms between January 2012 and September 2015. After excluding those who lost to follow-up and those with fusiform unruptured intracranial aneurysms, included patients were randomly divided into a derivation group (60%) and a validation group (40%). A neurological complication was defined as any transient or permanent increase in the modified Rankin Scale score after aneurysm embolization. A risk score for neurological complications was derived from multivariable logistic regression analyses in the derivation group and validated in the validation group. RESULTS Overall, 1060 patients were included (636 in the derivation group and 424 in the validation group). The incidence of neurological complications was 5.5% (95% confidence interval, 3.8%-7.4%). A 3-point risk score (S-C-C) was derived to predict neurological complications (size [≥10 mm=1], core areas [yes=1], and cerebral ischemic comorbidity [yes=1]). The incidence of neurological complications varied from 2.2% in 0-point patients to 25.0% in 3-point patients. The score demonstrated significant discrimination (C-statistic, 0.714; 95% confidence interval, 0.624-0.804) and calibration (McFadden R(2), 0.102) in the derivation group. Excellent prediction, discrimination, and calibration properties were reproduced in the validation group. CONCLUSIONS One in 20 patients will develop neurological complications after endovascular treatment of unruptured intracranial aneurysms. The S-C-C score may be useful for predicting these adverse outcomes based on variables in daily practice.
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Affiliation(s)
- Wenjun Ji
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huibin Kang
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liqian Sun
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinjian Yang
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- From the Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Swinnen B, Schreurs A, Heye S, Lemmens R. Limb-shaking TIA during balloon test occlusion of the internal carotid artery. Acta Neurol Belg 2015; 115:449-51. [PMID: 25283769 DOI: 10.1007/s13760-014-0366-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/18/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Bart Swinnen
- Department of Neurology, University Hospitals Leuven, University of Leuven and VIB, Herestraat 49, 3000, Leuven, Belgium
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Nussbaum ES. Surgical distal outflow occlusion for the treatment of complex intracranial aneurysms: experience with 18 cases. Neurosurgery 2015; 11 Suppl 2:8-16; discussion 16. [PMID: 25255255 DOI: 10.1227/neu.0000000000000572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Selected intracranial aneurysms still require parent artery occlusion. Although such occlusion is usually performed proximal to the aneurysm, in rare instances, it may be difficult or impossible to access the proximal parent artery. OBJECTIVE To describe the use of parent artery sacrifice distal to the aneurysm (distal outflow occlusion) in the management of complex aneurysms not amenable to standard microsurgical or endovascular therapy. METHODS We reviewed a comprehensive database of intracranial aneurysms evaluated between 1997 and 2013. Hospital records, neuroimaging studies, operative reports, and outpatient clinic notes were examined for all patients treated with distal outflow occlusion. RESULTS Eighteen patients (11 women, 7 men; ages 28-69 years) underwent surgical distal outflow occlusion. Eight (44%) underwent concomitant distal revascularization. Intraoperative and delayed postoperative angiography was performed in every case. Nine presented with acute subarachnoid hemorrhage, 1 had a remote bleeding episode. The remaining lesions were unruptured; 3 were discovered incidentally, 3 had symptomatic cerebral edema, 1 had transient ischemic attacks, and 1 had cranial neuropathy. The average follow-up period was 6.5 years; no patient was lost to follow-up review. Two aneurysms required delayed endovascular treatment. Overall, 16 patients achieved a good outcome, 1 had moderate disability, and 1 died. CONCLUSION We describe our experience with distal outflow occlusion in the treatment of complex aneurysms not amenable to primary clip reconstruction or endovascular therapy. This technique has been described in very limited fashion in the past and may be particularly useful for patients requiring parent artery occlusion when proximal occlusion is challenging or impossible.
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Affiliation(s)
- Eric S Nussbaum
- National Brain Aneurysm Center at the John Nasseff Neuroscience Institute, Allina Health, United Hospital, St. Paul, Minnesota
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