Giant Cavernous-Segment Internal Carotid Artery Aneurysm Presenting with Cranial Neuropathy

2019 ◽  
pp. 129-136
Author(s):  
Jacob F. Baranoski ◽  
Tyler S. Cole ◽  
Colin J. Przybylowski ◽  
Rami O. Almefty ◽  
Dale Ding ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Cranial Neuropathy ◽  
Parent Vessel ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Procedural Complications ◽  
Technical Details ◽  
Cavernous Carotid Artery

Abstract: This chapter discusses issues surrounding the management of giant cavernous carotid artery aneurysms. These aneurysms most commonly present with symptoms of cranial neuropathy. They present a unique treatment challenge given their location and often large size. Endovascular flow diversion has emerged as the mainstay of treatment, although parent vessel sacrifice, high-flow bypass, and surgical trapping are important alternatives. Evaluation of the nature of collateral circulation and the tolerance of the intracranial circulation to carotid artery sacrifice should also be part of the work-up. The technical details of endovascular flow diversion strategy are described, as well as the management of known post-procedural complications.

scholarly journals Treatment of an internal carotid artery aneurysm with a flow diverter through a double lumen balloon catheter

2017 ◽  
Vol 23 (3) ◽  
pp. 255-259
Author(s):  
José M Amorim ◽  
Santiago Rosati ◽  
Ronit Agid ◽  
Vítor Mendes Pereira ◽  
Timo Krings
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Flow Diverter ◽  
Double Lumen ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Procedural Complications ◽  
Wall Apposition ◽  
Flow Diverters

Background Double lumen balloon catheters (DLBCs) are currently used in the treatment of intracranial aneurysms, especially when involving balloon or stent-assisted coiling. The existing DLBCs allow the delivery of self-expandable stents but do not offer the possibility to deploy flow-diverters. Despite the increasing use and success of flow-diverters, there have been numerous reports of procedural complications such as early in-stent thrombosis or delayed distal embolization. It seems that these complications can be avoided by correct stent positioning and adequate wall apposition, achieved either by manoeuvres with the microguidewire and/or microcatheter or by performing balloon angioplasty following an exchange guidewire manoeuvre. Objective Report the use of a new DLBC able to deliver a flow-diverter. Methods A 41-year-old woman presented to our hospital with binocular horizontal diplopia for two weeks and reduced visual acuity. A left internal carotid artery aneurysm involving the cavernous and ophthalmic segments was found, with a maximum height of 19 mm and a broad 8 mm neck. It presented extra- and intra-dural components and the parent vessel was significantly narrowed. A decision was made to perform endovascular treatment of the aneurysm with placement of a flow diverter through a DLBC. Results Patency and adequate expansion of the flow diverter with evident intra-aneurysmal contrast stasis was observed in the final angiogram. No peri-procedural complications were observed. Conclusion This is a technical note demonstrating the feasibility of a new device to deploy a flow diverter, aiming to improve wall apposition and stent configuration without the need of additional devices or exchange manoeuvres.

Cavernous Carotid Artery Aneurysm Associated with Marfan's Syndrome: Treatment by Balloon Embolization Therapy

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 297-300 ◽  
Author(s):  
Randall T. Higashida ◽  
V. Van Halbach ◽  
Grant B. Hieshima ◽  
Leslie Cahan
Keyword(s):  
Carotid Artery ◽  
Intracranial Aneurysms ◽  
Alternative Therapy ◽  
Artery Aneurysm ◽  
Marfan’S Syndrome ◽  
Parent Vessel ◽  
Marfan's Syndrome ◽  
Carotid Artery Aneurysm ◽  
Cavernous Carotid Artery ◽  
Balloon Embolization

Abstract Intracranial aneurysms arising in the region of the cavernous carotid artery are difficult to manage surgically because of the surrounding cavernous sinus. With recent advances in microballoon technology and permanent solidification agents, it is now possible to treat certain intracranial aneurysms by detachable balloons and preserve the parent vessel. A patient with Marfan's syndrome presented with severe retroorbital pain, ophthalmoplegia, and headaches. Cerebral angiography demonstrated a large cavernous carotid artery aneurysm measuring 17 × 9 × 6 mm. This was successfully treated by placing three detachable balloons within the aneurysm and preserving the carotid artery via a transvascular approach. Intravascular detachable balloon embolization may offer a form of alternative therapy for the management of surgically difficult aneurysms. (Neurosurgery 22:297-300, 1988)

Spontaneous rupture of an intra-cavernous internal carotid artery aneurysm presenting with massive epistaxis

2011 ◽  
Vol 125 (10) ◽  
pp. 1070-1072 ◽  
Author(s):  
A Davies ◽  
O Dale ◽  
S Renowden
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Treatment Method ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
History Of ◽  
Cavernous Carotid Artery ◽  
Endovascular Coils

AbstractObjective:We report a rare case of epistaxis resulting from a ruptured internal carotid artery aneurysm, and present a successful treatment method.Case report:A 72-year-old woman was admitted following recurrent massive epistaxis. There was no history of trauma or surgery. Radiographic imaging demonstrated a large internal carotid artery aneurysm. An attempt was made to occlude the aneurysm with endovascular coils. Despite this, the patient went on to have further epistaxis. Endovascular ablation of the feeding internal carotid artery led to complete resolution.Conclusion:This case demonstrates that spontaneous epistaxis from intra-cavernous carotid artery aneurysms can be managed using endovascular techniques. To our knowledge, we report the first use of interventional radiological techniques to assess the collateral circulation to the brain and subsequently undertake endovascular ablation of the internal carotid artery.

Rerupture of a Blister Aneurysm After Treatment With a Single Flow-Diverting Stent

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. E634-E638 ◽  
Author(s):  
Marcus D. Mazur ◽  
Philipp Taussky ◽  
Joel D. MacDonald ◽  
Min S. Park
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Successful Treatment ◽  
Internal Carotid ◽  
Case Reports ◽  
Treatment Strategies ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Multiple Treatment ◽  
Internal Carotid Artery Aneurysm

Abstract BACKGROUND AND IMPORTANCE: As the use of flow-diverting stents (FDSs) for intracranial aneurysms expands, a small number of case reports have described the successful treatment of blister aneurysms of the internal carotid artery with flow diversion. Blister aneurysms are uncommon and fragile lesions that historically have high rates of morbidity and mortality despite multiple treatment strategies. We report a case of rebleeding after treatment of a ruptured blister aneurysm with deployment of a single FDS. CLINICAL PRESENTATION: A 29-year-old man presented with subarachnoid hemorrhage and a ruptured dorsal variant internal carotid artery aneurysm. Despite a technically successful treatment with a single FDS, a second catastrophic hemorrhage occurred during the course of his hospitalization. CONCLUSION: This case highlights the risk of hemorrhage during the period after deployment of a single FDS. Ruptured aneurysms, especially of the blister type, are at risk for rehemorrhage while the occlusion remains incomplete after flow diversion.

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