Treatment strategy for giant aneurysms in the cavernous portion of the internal carotid artery

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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Successful management of bilateral internal carotid artery fusiform giant aneurysms in a patient with intimal fibroplasia using multiple flow diverters: With long-term imaging follow up

Interventional Neuroradiology ◽

10.1177/15910199211049129 ◽

2021 ◽

pp. 159101992110491

Author(s):

Jieun Roh ◽

Seung Kug Baik ◽

Jeong A Yeom ◽

Joo-Young Na ◽

Sang-Won Lee

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Flow Diverter ◽

Giant Aneurysms ◽

The Past ◽

Effective Treatment Modality ◽

Flow Diverters

The authors report a rare case of sequentially developed bilateral internal carotid artery (ICA) fusiform giant aneurysms in a patient with pathologically confirmed intimal fibroplasia. Both ICA fusiform aneurysms were treated with multiple flow diverter insertion and were well-managed over the past 5.5 years of follow-up. The development of aneurysms in this rare disease entity appears to be a lifelong process based on the authors’ observations in serial angiographic follow-up studies. Reconstruction therapy using flow-diverting stents in this unique condition may be a safe and effective treatment modality.

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Discussion to 66 Giant Aneurysms of the Internal Carotid Artery

Neurologia medico-chirurgica ◽

10.2176/nmc.11.167 ◽

1971 ◽

Vol 11 ◽

pp. 167-167

Author(s):

Shiro WAGA ◽

Kinya OHTSUBO ◽

Masayuki MATSUDA ◽

Hajime HANDA

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Giant Aneurysms

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Treatment Strategy Based on Plaque Vulnerability and the Treatment Risk Evaluation for Internal Carotid Artery Stenosis

Neurologia medico-chirurgica ◽

10.2176/nmc.oa.2017-0228 ◽

2018 ◽

Vol 58 (5) ◽

pp. 191-198 ◽

Cited By ~ 1

Author(s):

Yoshiro ITO ◽

Wataro TSURUTA ◽

Yasunobu NAKAI ◽

Tomoji TAKIGAWA ◽

Aiki MARUSHIMA ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Treatment Strategy ◽

Carotid Artery Stenosis ◽

Risk Evaluation ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

Plaque Vulnerability ◽

Treatment Risk

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Carotid Artery Sacrifice for Unclippable and Uncoilable Aneurysms: Endovascular Occlusion Vs Common Carotid Artery Ligation

Neurosurgery ◽

10.1227/neu.0b013e3181f076ac ◽

2010 ◽

Vol 67 (5) ◽

pp. 1431-1437 ◽

Cited By ~ 43

Author(s):

Mohamed Samy Elhammady ◽

Stacey Quintero Wolfe ◽

Hamad Farhat ◽

Mohammad Ali Aziz-Sultan ◽

Roberto C Heros

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Common Carotid Artery ◽

Internal Carotid ◽

Parent Artery ◽

Giant Aneurysms ◽

Presenting Symptoms ◽

Endovascular Occlusion ◽

Large And Giant Aneurysms

Abstract BACKGROUND: Optimal treatment of intracranial aneurysms involves complete occlusion of the aneurysm with preservation of the parent artery and all of its branches. Attempts to occlude the aneurysm and preserve the parent artery may be associated with a higher level of risk than parent vessel occlusion or trapping. OBJECTIVE: To evaluate our series of patients with large and giant aneurysms who underwent treatment via endovascular coiling with parent artery sacrifice or surgical ligation of the common carotid artery (CCA) and gain insight into the advantages and risks of each of these alternatives. METHODS: We retrospectively reviewed all patients with aneurysms who underwent carotid sacrifice via endovascular occlusion or surgical CCA ligation during an 8-year period at our institution. RESULTS: Twenty-seven patients with large and giant aneurysms of the internal carotid artery underwent carotid artery sacrifice via endovascular occlusion (n = 15) or CCA ligation (n = 12). Of the patients who underwent endovascular occlusion, 3 developed groin complications, 1 developed a new sixth nerve palsy, 1 died from vasospasm related to subarachnoid hemorrhage, and 1 died secondary to rupture of an associated 3-mm anterior communicating artery aneurysm 5 days postoperatively. Of the patients undergoing CCA ligation, 1 patient developed a partial hypoglossal palsy. Clinical improvement of presenting symptoms was observed in all surviving patients regardless of the method of treatment. Complete aneurysm obliteration was documented in all patients during the initial hospital stay. The mean radiographic long-term follow-up was 14.2 months, which was available in 20 of the 25 surviving patients (80%). Complete obliteration was confirmed at follow-up in all but 2 patients with large cavernous aneurysms; 1 was initially treated with endovascular occlusion and the other with carotid ligation. CONCLUSION: Parent artery sacrifice is still a viable treatment for some complex aneurysms of the internal carotid artery. CCA ligation is a reasonable alternative to endovascular arterial sacrifice.

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