Internal Carotid Artery Bifurcation Aneurysm: Microsurgical Clipping of a Large Wide-Necked Internal Carotid Artery Bifurcation and Anterior Choroidal Artery Aneurysm After a Previous Failed Attempt at Flow Diverter Implantation

Abstract Supraclinoid internal carotid artery (ICA) aneurysms most commonly arise at the origin of the posterior communicating or anterior choroidal artery. The unique angioarchitecture presented in this case involved the anterior choroidal artery (AChA) originating from the dome of a supraclinoid ICA aneurysm. Treatment is associated with high morbidity because of the eloquent parenchyma perfused by the AChA. Therefore, the preservation of flow within the AChA during clipping is paramount. Anterior choroidal syndrome, comprising hemiplegia, hemianesthesia, and hemianopsia, conveys a significant morbidity. This syndrome is observed in the setting of AChA sacrifice and can be observed in a delayed manner after clipping. Anterior choroidal syndrome is of uncertain etiology but is associated with AChA infarction. This patient presented with tinnitus and was found to have an incidental supraclinoid ICA aneurysm with AChA originating from the aneurysmal dome. A right orbitozygomatic craniotomy was performed for a transsylvian approach to the aneurysm. A fenestrated clip was applied to occlude the aneurysmal portion of the ICA up to the point of AChA origin. A curved clip was then used to occlude the AChA segment of the aneurysm, providing patency to the AChA takeoff along the ICA. Patency of the AChA and ICA was confirmed with intraoperative angiography, and the patient had a favorable clinical outcome. This case exemplified an excellent surgical clipping of a challenging supraclinoid ICA aneurysm involving the need to preserve a vessel off the aneurysm dome. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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“Two-coil technique” for embolization of small internal carotid artery aneurysms incorporating the origin of the anterior choroidal artery

Interventional Neuroradiology ◽

10.1177/1591019916632368 ◽

2016 ◽

Vol 22 (4) ◽

pp. 396-401 ◽

Cited By ~ 3

Author(s):

Young Jin Heo ◽

Ku Hyun Yang ◽

Sung Chul Jung ◽

Jung Cheol Park ◽

Deok Hee Lee

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Anterior Choroidal Artery ◽

Single Center Experience ◽

Internal Carotid Artery Aneurysm ◽

Anterior Choroidal ◽

Choroidal Artery

Purpose The purpose of this article is to evaluate the efficacy, safety and stability of the “two-coil technique.” Materials and methods We evaluated a single-center experience by using a two-coil technique, which is a variation of the multiple-microcatheter technique in the treatment of a small internal carotid artery aneurysm with its sac incorporated with the origin of the anterior choroidal artery. Six consecutive patients with small ICA aneurysms with its sac incorporated with origin of the anterior choroidal artery and treated with the two-coil technique were included in this study. We finished the embolization with only two coils introduced via two different microcatheters without any other device assistance in all cases. Embolization status was determined at immediate postoperative and follow-up angiography after six months. Results The two-coil technique was technically successful in five of six cases; one case was converted to surgical clipping because of persistent occlusion of the anterior choroidal artery after several attempts. On follow-up study, all five cases showed stable occlusion status without recanalization or residual aneurysm. Conclusions The two-coil technique has potential to be used for coiling small aneurysms, particularly where there is an important branch incorporated into the sac or neck of the aneurysm.

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Ruptured Internal Carotid Artery Aneurysm at the Origin of a Perforating Artery Associated With a Hyperplastic Anomalous Anterior Choroidal Artery

Neurologia medico-chirurgica ◽

10.2176/nmc.50.466 ◽

2010 ◽

Vol 50 (6) ◽

pp. 466-469 ◽

Cited By ~ 2

Author(s):

Kouichi MISAKI ◽

Naoyuki UCHIYAMA ◽

Hisashi NITTA ◽

Jun-ichiro HAMADA

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Artery Aneurysm ◽

Anterior Choroidal Artery ◽

Carotid Artery Aneurysm ◽

Perforating Artery ◽

Internal Carotid Artery Aneurysm ◽

Anterior Choroidal ◽

Choroidal Artery

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The Perforating Branches of the Internal Carotid Artery: The Microsurgical Anatomy of Their Extracerebral Segments

Neurosurgery ◽

10.1227/00006123-199003000-00015 ◽

1990 ◽

Vol 26 (3) ◽

pp. 472-479 ◽

Cited By ~ 15

Author(s):

Slobodan V. Marinkovié ◽

Milan M. Milisavljevié ◽

Zorica D. Marinkovié

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Microsurgical Anatomy ◽

Great Care ◽

Anterior Choroidal Artery ◽

Frequent Site ◽

Anterior Choroidal ◽

Choroidal Artery

Abstract The perforating branches of the internal carotid artery (ICA) were examined in 30 forebrain hemispheres. These branches were present in all the cases studied, and varied from 1 to 6 in number (mean, 3.1). Their diameters ranged from 70 to 470 Mm (mean, 243 Mm). The perforating branches arose from the choroidal segment of the ICA, that is, from its caudal surface (52.3%), caudolateral surface (34.1%), or caudomedial surface (13.6%). They rarely originated from the bifurcation point of the ICA (10%). The distance of the remaining 90% of the perforators from the summit of the ICA measured between 0.6 and 4.6 mm. The perforating branches most often originated as individual vessels, and less frequently from a common stem with another vessel or by sharing the same origin site with another perforator or with the anterior choroidal artery. The bifurcation of the ICA, which is a frequent site for cerebral aneurysms, is surrounded by many perforating branches. Hence, great care must be taken to avoid damage to these important vessels during operations in that region.

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Anterior Choroidal Artery Territory Infarction due to Internal Carotid Artery Dissection Presumably Caused by Scuba Diving

Journal of the Korean Neurological Association ◽

10.17340/jkna.2020.4.9 ◽

2020 ◽

Vol 38 (4) ◽

pp. 298-300

Author(s):

Daeun Shin ◽

Yang-Ha Hwang ◽

Dong-Hyun Shim

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Scuba Diving ◽

Carotid Artery Dissection ◽

Artery Dissection ◽

Anterior Choroidal Artery ◽

Internal Carotid Artery Dissection ◽

Anterior Choroidal ◽

Choroidal Artery

We report a case of anterior choroidal artery territory infarction due to internal carotid artery dissection presumably caused by scuba diving. A 44-year-old man presented with left facial palsy and hemiparesis. He had a history of scuba diving for 18 months. His last dive was 7 days ago, and he skipped decompression practice at that dive. We assumed that repetitive traumas and microbubbles during scuba diving, which made endothelium vulnerable to damage may have caused a carotid dissection.

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