Intraoperative monitoring of cerebral cortical blood flow and middle cerebral artery pressure as a substitute for preoperative balloon test occlusion in patients with internal carotid artery aneurysms

2018 ◽  
Vol 160 (6) ◽  
pp. 1129-1137 ◽  
Author(s):  
Yoshitaka Kubo ◽  
Takahiro Koji ◽  
Ryushi Kondo ◽  
Kenji Yoshida ◽  
Kuniaki Ogasawara
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Intraoperative Monitoring ◽  
Internal Carotid ◽  
Cortical Blood Flow ◽  
Balloon Test Occlusion ◽  
Cerebral Cortical Blood Flow

Emergency embolectomy for embolic occlusion of the middle cerebral artery after internal carotid artery balloon test occlusion

1992 ◽  
Vol 77 (1) ◽  
pp. 134-138 ◽  
Author(s):  
Mark E. Linskey ◽  
Laligam N. Sekhar ◽  
Stephen T. Hecht
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Excellent Outcome ◽  
Balloon Test Occlusion ◽  
Temporary Occlusion

✓ Balloon test occlusion of the internal carotid artery (ICA) is useful in preoperatively assessing the risk of temporary occlusion or permanent sacrifice of the carotid artery. The incidence of symptomatic complications from this procedure is 1.7%. The case is reported of a 57-year-old woman in whom a balloon test occlusion of the left ICA was attempted. She developed a left ICA dissection/occlusion with subsequent embolization to the left middle cerebral artery, leading to right-sided hemiplegia and expressive aphasia. She was successfully treated by an emergency embolectomy followed by surgical repair of the left ICA, with an excellent outcome. This case represents the most serious complication encountered by the authors in more than 300 balloon test occlusions. Means of avoiding this complication during balloon test occlusion as well as the important factors in managing this problem are emphasized.

scholarly journals Roentengen-endovascular method of cerebral blood flow restoration in acute tandem occlusion of the internal carotid artery with embolism development in the middle cerebral artery

2016 ◽  
Vol 97 (3) ◽  
pp. 457-460
Author(s):  
M U Volodukhin
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Terminal Segment ◽  
Acute Thrombosis ◽  
Tandem Occlusion ◽  
Flow Restoration

Aim. This article proposes a roentgen-endosurgical method of performing intracranial arteries revascularization in acute tandem occlusion of the internal carotid artery with the distal embolism development in the middle cerebral artery.Methods. In the period from 2007 to 2014 endovascular revascularization in the internal carotid artery acute thrombosis was performed in 18 patients. Tandem occlusion of the cervical, petrous, cavernous and terminal segments of the internal carotid artery (53.3%) was the most commonly diagnosed. Isolated occlusion of the internal carotid artery cervical segment was determined in 5 (33.3%) patients, of the terminal segment - in 3 (20%) cases. L- and T-types occlusion of the internal carotid artery terminal segment thrombosis frequency were comparable and amounted to 20%. In 5 patients the internal carotid artery tandem occlusion with the distal embolism development in the middle cerebral artery occurred. In this type of injury a method for blood flow restoration in middle cerebral artery without restoring antegrade blood flow in the internal carotid artery was developed and applied.Results. Full blood flow restoration in the middle cerebral artery using this method was achieved in these patients in all cases. Complications associated with the intervention were not registered.Conclusion. The proposed method can be used in patients with the internal carotid artery acute tandem occlusion and the distal embolism development in the middle cerebral artery; the use of this type of revascularization is possible in patients with well-developed communicating arteries that can provide an adequate perfusion volume in the middle cerebral artery.

Tandem middle cerebral artery–internal carotid artery occlusions: reduced occlusion-to-revascularization time using a trans–anterior communicating artery approach with a Penumbra device

2012 ◽  
Vol 116 (3) ◽  
pp. 665-671 ◽  
Author(s):  
David J. Padalino ◽  
Eric M. Deshaies
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Ischemic Injury ◽  
Acute Onset ◽  
Anterior Communicating Artery ◽  
Scale Scores

Rapid revascularization of tandem extracranial and intracranial acute thromboembolic occlusions can be challenging and can delay restoration of blood flow to the cerebral circulation. Taking advantage of collateral pathways in the circle of Willis for thrombectomy can reduce the occlusion-to-revascularization time significantly, thereby protecting brain tissue from ischemic injury. The authors report using the trans–anterior communicating artery (ACoA) approach by using the Penumbra microcatheter to rapidly restore blood flow to the middle cerebral artery (MCA) territory prior to treating the ipsilateral internal carotid artery (ICA) occlusion. Two patients with acute onset of tandem ipsilateral ICA and MCA occlusions and a competent ACoA underwent rapid revascularization of the MCA using a trans-ACoA approach for pharmaceutical and mechanical thrombolysis with the 0.026-in Penumbra microcatheter. Subsequently, once blood flow was reestablished in the MCA territory via cross-filling from the contralateral ICA, the proximally occluded ICA dissection was revascularized with a stent. Both patients had rapid revascularization of the MCA territory (both Thrombolysis in Myocardial Infarction Grade 3) with the trans-ACoA approach (19 and 36 minutes) followed by treatment of the ipsilateral proximal ICA occlusion. This prevented prolonged MCA ischemia time (72 and 47 minutes for ICA revascularization time saved) that would have otherwise occurred if the dissections were treated prior to revascularization of the MCA. Both patients had improved NIH Stroke Scale scores after the procedure. No adverse events from crossing the ACoA with the Penumbra microcatheter were encountered during the revascularization procedure. The trans-ACoA approach with the Penumbra microcatheter for rapid revascularization of an acutely thrombosed MCA in the setting of a simultaneous ipsilateral proximal ICA occlusion is feasible in patients with a competent ACoA. This technique can significantly minimize ischemic injury by reducing the occlusion-to-revascularization time and allow for MCA perfusion via collateral circulation while treating a proximal occlusion. To the best of the authors' knowledge, this is the first reported trans-ACoA approach with the Penumbra microcatheter and the first to report the utilization of the collateral intracranial circulation to reduce occlusion-to-revascularization time.

scholarly journals Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm

2019 ◽  
Vol 10 ◽  
pp. 205
Author(s):  
Seiei Torazawa ◽  
Hideaki Ono ◽  
Tomohiro Inoue ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Optimal Treatment ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm

Background: Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult. Case Description: Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping. Conclusion: Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

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