Parent artery occlusion is not obsolete in giant aneurysms of the ICA. Experience with very-long-term follow-up

2010 ◽  
Vol 53 (12) ◽  
pp. 973-982 ◽  
Author(s):  
Frédéric Clarençon ◽  
Fabrice Bonneville ◽  
Anne-Laure Boch ◽  
Lise Lejean ◽  
Alessandra Biondi
Keyword(s):  
Artery Occlusion ◽  
Parent Artery ◽  
Giant Aneurysms ◽  
Parent Artery Occlusion ◽  
Long Term Follow Up

scholarly journals Endovascular Parent Artery Occlusion for Intracranial Aneurysms is a Viable, Cost-Effective Alternative: An Institutional Experience from Northeast India

2021 ◽  
Vol 28 (2) ◽  
pp. 6
Author(s):  
Pranjal Phukan ◽  
Kalyan Sarma ◽  
Donboklang Lynser ◽  
Barun Kumar Sharma ◽  
Deb Kumar Baruah ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Complete Occlusion ◽  
Parent Artery Occlusion ◽  
Long Term Follow Up

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.

scholarly journals Internal carotid artery occlusion may affect long-term quality of life in patients with high-flow carotid cavernous fistulas

2019 ◽  
Vol 26 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Rong-Qin Dai ◽  
Wei-Xing Bai ◽  
Bu-Lang Gao ◽  
Tian-Xiao Li ◽  
Kun Zhang
Keyword(s):  
Quality Of Life ◽  
Artery Occlusion ◽  
High Flow ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Carotid Cavernous Fistulas ◽  
Headache Impact

Purpose To investigate the mid- and long-term effects of parent artery occlusion on the carotid cavernous fistula and on the quality of life of patients. Materials and methods One hundred and twenty-six patients with high-flow direct carotid cavernous fistulas were enrolled. The modified Rankin scale scores, the headache impact test and the short form health survey scores were used to evaluate the patients' clinical status. Results Fifty-two patients had parent artery occlusion, while the rest of the 74 patients had embolization of carotid cavernous fistulas with parent artery preservation. No periprocedural complications occurred. Eighteen patients in the parent artery occlusion group had low perfusion symptoms within two weeks following embolization, and three patients had Horner's syndrome on the ipsilateral side. At two months' follow-up, the patients with parent artery occlusion had a significantly ( P < 0.05) greater proportion of headache than patients with parent artery preservation. At 12 months, no significant ( P > 0.05) difference existed in the headache impact test scores in both groups. At 36 months' follow-up, the patients with parent artery occlusion had decreased SF-30 scores in all the eight health domains compared with patients treated with parent artery preservation, with a significant ( P < 0.05) lower score in general health, vitality and bodily pain in the parent artery occlusion compared with the parent artery preservation group. No recurrence was shown in patients with parent artery occlusion, but nine (12.2%) patients were recurrent in patients with parent artery preservation. Conclusion Parent artery occlusion may affect the quality of life of patients with carotid cavernous fistulas despite being an effective treatment option for high-flow direct fistulas.

scholarly journals Treatment of Intracranial Aneurysm with Bare Stent Only

2008 ◽  
Vol 14 (2_suppl) ◽  
pp. 75-78 ◽  
Author(s):  
Michael Mu Huo Teng ◽  
Chao-Bao Luo ◽  
Feng-Chi Chang ◽  
Harsan Harsan
Keyword(s):  
Intracranial Aneurysm ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Parent Artery ◽  
Fusiform Aneurysm ◽  
Surgical Clipping ◽  
Parent Artery Occlusion ◽  
Typical Treatment ◽  
Dissecting Aneurysms

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.

Combined Endovascular Stenting and Endosaccular Coiling for the Treatment of a Wide-Necked Intracranial Vertebral Aneurysm

1999 ◽  
Vol 5 (3) ◽  
pp. 245-249 ◽  
Author(s):  
S. Bracard ◽  
R. Anxionnat ◽  
E. Da Costa ◽  
A. Lebedinsky ◽  
F. Scomazzoni ◽  
...  
Keyword(s):  
Parent Artery ◽  
Collateral Flow ◽  
Endovascular Stent ◽  
Endovascular Stenting ◽  
Combined Application ◽  
Long Term Follow Up ◽  
Vertebral Aneurysm ◽  
Endovascular Stent Placement

We describe a clinical case of the combined application of endovascular stent placement and GDCoils packing in the management of a ruptured wide necked intracranial aneurysm. A 27-year-old man had a subarachnoid haemorrhage secondary to the rupture of a large wide necked left vertebral aneurysm. This aneurysm was judged to be inoperable. A functional occlusion test failed because of poor collateral flow and combined stenting and coiling was used to occlude the aneurysm with preservation of the parent artery. A femoral approach was used. An 18 mm long ACS® Duet stent was placed across the base of aneurysm and expanded to 4mm to act as a buttress. A microcatheter was then advanced through the stent mesh and GDC's were deposited for occlusion. This technique provides new possibilities for wide-necked intracranial aneurysms. Further studies are required on the mechanical and thrombogenic properties of stents and on the long-term follow-up, but this technology may play a role in some cases of aneurysm treatment.

Management of Intracranial Vertebral Artery Dissections Initially Presenting without Subarachnoid Hemorrhage

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 930-938 ◽  
Author(s):  
Isao Naito ◽  
Tomoyuki Iwai ◽  
Tomio Sasaki
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Ischemic Insult ◽  
Double Lumen ◽  
String Sign ◽  
Parent Artery Occlusion ◽  
Aneurysmal Dilation

Abstract OBJECTIVE The clinical and angiographic follow-up results for intracranial vertebral artery (VA) dissections that initially presented without subarachnoid hemorrhage (SAH) were retrospectively investigated, to clarify their management. METHODS Twenty-one patients with VA dissections that initially presented without SAH were studied. Initial angiography revealed aneurysmal dilation in 11 cases (typical pearl-and-string sign in 8 cases, aneurysmal dilation only in 2, and aneurysmal dilation with double-lumen sign in 1), occlusion in 7, double-lumen sign in 2, and string-like stenosis in 1. Nine patients (six with pearl-and-string sign, one with occlusion with aneurysmal dilations, and two with double-lumen sign), including three patients who experienced subsequent SAH, underwent endovascular proximal parent artery occlusion. The other 12 patients were treated conservatively. All patients were monitored with magnetic resonance angiography or digital subtraction angiography. RESULTS Three patients experienced subsequent SAH, 1 day (two patients) or 51 months after onset. Follow-up angiographic assessments of the 20 patients demonstrated complete resolution in five cases, reduction of aneurysmal dilation in one case, and partial recanalization in one case. However, enlargement or formation of an aneurysmal dilation was recognized in four cases and progression of dissection was observed in one case. Eighteen patients experienced good recoveries, and three patients demonstrated moderate disabilities as a result of the initial ischemic insult. CONCLUSION The risk of bleeding from unruptured VA dissections is higher than previously considered. Therefore, endovascular treatment should be considered for patients with VA dissections with relatively large or growing aneurysmal dilations.

scholarly journals Cerebral revascularization for the management of complex intracranial aneurysms: a single-center experience

2019 ◽  
Vol 131 (4) ◽  
pp. 1297-1307 ◽  
Author(s):  
Eric S. Nussbaum ◽  
Kevin M. Kallmes ◽  
Jeffrey P. Lassig ◽  
James K. Goddard ◽  
Michael T. Madison ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Case Series ◽  
Artery Occlusion ◽  
High Flow ◽  
Cerebral Revascularization ◽  
Low Flow ◽  
Parent Artery ◽  
Team Approach ◽  
Parent Artery Occlusion

OBJECTIVEBecause simple intracranial aneurysms (IAs) are increasingly treated endovascularly, neurovascular surgery has become focused on complex IAs that may require deconstructive aneurysm therapy with concomitant surgical bypass. The authors describe the decision-making process concerning cerebral revascularization and present outcomes that were achieved in a large case series of complex IAs managed with cerebral revascularization and parent artery occlusion.METHODSThe authors retrospectively reviewed the medical records, including neuroimaging studies, operative reports, and follow-up clinic notes, of all patients who were treated at the National Brain Aneurysm Center between July 1997 and June 2015 using cerebral revascularization as part of the management of an IA. They recorded the location, rupture status, and size of each IA, as well as neurological outcome using the modified Rankin Scale (mRS), aneurysm and bypass status at follow-up, and morbidity and mortality.RESULTSThe authors identified 126 patients who underwent revascularization surgery for 126 complex, atheromatous, calcified, or previously coiled aneurysms. Ninety-seven lesions (77.0%) were unruptured, and 99 (78.6%) were located in the anterior circulation. Aneurysm size was giant (≥ 25 mm) in 101 patients, large (10–24 mm) in 9, and small (≤ 9 mm) in 16 patients. Eighty-four low-flow bypasses were performed in 83 patients (65.9%). High-flow bypass was performed in 32 patients (25.4%). Eleven patients (8.7%) underwent in situ or intracranial-intracranial bypasses. Major morbidity (mRS score 4 or 5) occurred in 2 (2.4%) low-flow cases and 3 (9.1%) high-flow cases. Mortality occurred in 2 (2.4%) low-flow cases and 2 (6.1%) high-flow cases. At the 12-month follow-up, 83 (98.8%) low-flow and 30 (93.8%) high-flow bypasses were patent. Seventy-five patients (90.4%) undergoing low-flow and 28 (84.8%) high-flow bypasses had an mRS score ≤ 2. There were no statistically significant differences in patency rates or complications between low- and high-flow bypasses.CONCLUSIONSWhen treating challenging and complex IAs, incorporating revascularization strategies into the surgical repertoire may contribute to achieving favorable outcomes. In our series, low-flow bypass combined with isolated proximal or distal parent artery occlusion was associated with a low rate of ischemic complications while providing good long-term aneurysm control, potentially supporting its wider utilization in this setting. The authors suggest that consideration should be given to managing complex IAs at high-volume centers that offer a multidisciplinary team approach and the full spectrum of surgical and endovascular treatment options to optimize patient outcomes.

scholarly journals Endovascular treatment of posterior cerebral artery aneurysms: a single center's experience of 55 cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1094-1105 ◽  
Author(s):  
Xuanfeng Qin ◽  
Feng Xu ◽  
Yashengjiang Maimaiti ◽  
Yongtao Zheng ◽  
Bin Xu ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Case Series ◽  
Artery Occlusion ◽  
Dissecting Aneurysm ◽  
Attractive Alternative ◽  
Parent Artery ◽  
Parent Artery Occlusion

OBJECTIVE Aneurysms of the posterior cerebral artery (PCA) are uncommon. To date, a limited number of studies have examined the outcomes of endovascular treatment for PCA aneurysms. The authors' aim in this study is to report their experience with the endovascular treatment of PCA aneurysms. METHODS Between January 2007 and December 2014, 55 patients with 59 PCA aneurysms were treated using the endovascular approach at the authors' institution. Twenty-three patients had 25 saccular aneurysms, and 32 patients had 34 fusiform/dissecting aneurysms. The endovascular modalities included the following: 1) selective occlusion of the aneurysm (n = 22); 2) complete occlusion of the aneurysm and the parent artery (n = 20); 3) parent artery occlusion (n = 6); 4) partial coiling of the aneurysm and the parent artery (n = 5); and 5) occlusion of the dissecting aneurysm sac (n = 2). RESULTS The immediate angiographic results included 45 complete occlusions (82%), 2 nearly complete occlusions (4%), and 8 incomplete occlusions (14%). The mean follow-up period of 21.8 months in 46 patients showed 37 stable results, 6 further thromboses, and 3 recurrences. The final results included 41 complete occlusions (89%), 2 nearly complete occlusions (4%), and 3 incomplete occlusions (7%). Procedure-related complications included the following: 1) rebleeding (n = 1); 2) infarction (n = 4); and 3) perforation (n = 1). There was 1 (1.8%) procedure-related death due to rebleeding, and 2 (3.6%) non–procedure-related deaths due to severe subarachnoid hemorrhage. Clinical outcomes were excellent (Glasgow Outcome Scale 5) in 47 of 49 patients at the long-term follow-up. CONCLUSIONS PCA aneurysms may be effectively treated by different endovascular approaches with favorable clinical and radiological outcomes. However, patients who present with severe SAH still have an overall poor prognosis. Partial coiling of the aneurysm and the parent artery is an attractive alternative treatment for patients who may not tolerate parent artery occlusion. Further study with a larger case series is necessary for validation of the durability and efficacy of this treatment.

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