Management of Thromboembolic Complications During Aneurysm Coiling: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ricardo A Domingo ◽  
Jaime L Martinez Santos ◽  
Krishnan Ravindran ◽  
Rabih G Tawk ◽  
Adam Arthur ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Artery Aneurysm ◽  
Left Internal Carotid Artery ◽  
Thromboembolic Complications ◽  
Cerebral Angiogram ◽  
Aneurysm Neck ◽  
Internal Carotid Artery Aneurysm ◽  
Aneurysm Coiling

Abstract Thromboembolic complications during aneurysm coiling are rare, with higher rates noted in ruptured aneurysms as patients are not usually premedicated with dual antiplatelet therapy.1,2 Management includes a series of escalating strategies, including medical therapy and intra-arterial thrombolysis.3-6 Additional strategies include mechanical thrombectomy with suction aspiration and stent retrievers.3 Intracranial stenting can be used as a last resource, especially in ruptured cases given the need for dual antiplatelets to prevent stent thrombosis.2  We present the case of a 42-yr-old man with a ruptured left internal carotid artery aneurysm with associated intracranial and intraventricular hemorrhage. The patient was initially presented to an outside facility after he was found in bed unable to speak and with right hemiparesis. The patient consented for surgery and underwent external ventricular drain (EVD) placement for the treatment of obstructive hydrocephalus, followed by diagnostic cerebral angiogram and aneurysm coiling. After the deployment of the last coil, control angiogram showed a small filling defect at the interface between the aneurysm neck and the distal vessel. The patient received intravenous heparin for therapeutic ACT and aspirin load. After progressive enlargement of the thrombus, the patient received intra-arterial glycoprotein (GP) IIB/IIIA inhibitors with a microcatheter positioned proximal to the thrombus. As the thrombus mass continued to enlarge, mechanical thrombectomy with an aspiration catheter was performed twice. Follow-up angiogram 20 min after the second aspiration demonstrated near-complete resolution of the thrombus. The patient recovered from his right hemiparesis, and he was discharged to rehabilitation on POD #21.

scholarly journals Limiting foetal doses during a four-vessel angiogram and endovascular stent-assisted berry aneurysm repair: A case report

2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Demaré Potgieter ◽  
William I.D. Rae ◽  
Coert S. De Vries
Keyword(s):  
Radiation Protection ◽  
Artery Aneurysm ◽  
Active Management ◽  
Left Internal Carotid Artery ◽  
Endovascular Stent ◽  
Cerebral Angiogram ◽  
Carotid Artery Aneurysm ◽  
Paraclinoid Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Aneurysm Repair

A 36-year-old female patient, 20 weeks pregnant, was diagnosed with a left internal carotid artery aneurysm. Fluoroscopically guided repair was justified. A four-vessel cerebral angiogram was performed, and a left paraclinoid aneurysm was demonstrated. The patient subsequently underwent endovascular stent-assisted berry aneurysm repair. As the patient was pregnant, the procedure was preceded by consideration of the required radiation protection. The foetal dose was estimated as negligible. Active management of foetal exposures may improve radiation protection during pregnancy.

Retrograde Suction Decompression for Clipping of a Giant Ophthalmic Internal Carotid Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Visish M Srinivasan ◽  
Michael Zhang ◽  
Lea Scherschinski ◽  
Alexander C Whiting ◽  
Mohamed A Labib ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Carotid Bifurcation ◽  
Aneurysm Neck ◽  
Microsurgical Clipping ◽  
Complex Anatomy ◽  
Internal Carotid Artery Aneurysm ◽  
Paraclinoid Aneurysms

Abstract Microsurgical clipping of large paraclinoid aneurysms is challenging because of the complex anatomy of the dural rings, lack of easy proximal control, and wide aneurysm necks. Proximal retrograde suction decompression, or the Dallas technique, can reduce aneurysm turgor and, with aspiration of the trapped cervical and supraclinoid internal carotid arteries (ICAs), can collapse the aneurysm to aid microsurgical clipping.1-5  A woman in her late 30s presented with decreased right-eye visual acuity. Informed written consent was obtained for microsurgical management and publication. Upon cervical exposure of the carotid bifurcation, we performed a standard pterional craniotomy, trans-sylvian exposure, and intradural anterior clinoidectomy. After burst suppression and cross-clamping of the carotid, we inserted an angiocatheter at the common carotid artery (CCA). Distal temporary clips were placed on the posterior communicating artery and C7 ICA. With the cervical ICA unclamped, retrograde suction was continuously applied to deflate the aneurysm. We applied 2 pairs of fenestrated-booster clips to the aneurysm dome and a fifth clip to the aneurysm neck. After restoration of flow, indocyanine green angiography and Doppler assessments were performed. The proximal clip was converted into a curved clip to optimize ICA flow.  Postoperative angiography confirmed complete occlusion of the aneurysm. The patient was discharged on postoperative day 3, with stable visual acuity.6 This video demonstrates that retrograde suction decompression via the cervical CCA can be safely performed to facilitate clipping of complex paraclinoid ICA aneurysms. Comprehensive planning of temporary aneurysm trapping for suction decompression and permanent clip construct for aneurysm occlusion are needed for effective aneurysm repair.

Management of Mobile Thrombus With Distal Protection Devices During Carotid Artery Angioplasty: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Salomon Cohen-Cohen ◽  
Giuseppe Lanzino ◽  
Waleed Brinjikji ◽  
Adam Arthur ◽  
Mark Bain ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Video Production ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Cerebral Angiogram ◽  
Protection Devices

Abstract Embolic protection devices (EPDs) have become a standard of care during internal carotid artery revascularization.1,2 This video is about a 57-yr-old-male who presented with a wake-up stroke with a left hemispheric syndrome. Head computed tomography angiography (CTA) revealed tandem occlusions of the proximal left internal carotid artery (ICA) and of the distal left middle cerebral artery (MCA) with an ASPECT (Alberta Stroke Program Early CT Score) score of 6. The patient underwent a cerebral angiogram and was treated with balloon angioplasty with a distal EPD and mechanical thrombectomy. The EPD became occluded with thrombus from the ICA and was retrieved through a 6-Fr Sofia (MicroVention) under continuous aspiration. Successful revascularization of the proximal ICA and distal MCA was achieved. No procedure-related complications occurred, and the patient's neurological exam improved. Tandem occlusions can occur in up to 15% of strokes. The optimal treatment can be controversial, but mechanical thrombectomy and ICA revascularization with a distal EPD appear to be safe and effective in selected patients.3 Consent was obtained for the procedure and for the video production.

Plasmapheresis for Management of Antiphospholipid Syndrome in the Neurosurgical Patient

2018 ◽  
Vol 16 (4) ◽  
pp. E124-E129
Author(s):  
Eric J Arias ◽  
Brent Bruck ◽  
Ananth K Vellimana ◽  
Charles Eby ◽  
Matthew R Reynolds ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Anticoagulation Therapy ◽  
Artery Aneurysm ◽  
Perioperative Period ◽  
Autoimmune Disorder ◽  
Left Internal Carotid Artery ◽  
Neurosurgical Procedures ◽  
Internal Carotid Artery Aneurysm ◽  
Increased Risk ◽  
Neurosurgical Patients

Abstract BACKGROUND AND IMPORTANCE Antiphospholipid syndrome (APS) is an autoimmune disorder associated with a hypercoagulable state and increased risk of intraoperative and postoperative thrombosis. Few neurosurgical studies have examined the management of these patients, though the standard of care in most other disciplines involves the use of anticoagulation therapy. However, this is associated with risks such as hemorrhage, thrombosis due to warfarin withdrawal, and is not compatible with operative intervention. CLINICAL PRESENTATION We report the cases of 2 antiphospholipid positive patients who were on anticoagulant therapy and underwent surgical bypasses and received perioperative management with plasmapheresis. The first was a 44-yr-old woman who presented with worsening vision, recurring headaches, and a known left internal carotid artery aneurysm that was unsuccessfully treated twice via extracranial to intracranial (ECIC) bypass at another institution. Preoperative tests at our institution revealed elevated beta 2 glycoprotein 1 IgA autoantibodies. The second case was a 24-yr-old woman with previously diagnosed APS, who presented for surgical evaluation of moyamoya disease after sustaining recurrent left hemispheric strokes. Both cases were managed with perioperative plasmapheresis to avoid the need for anticoagulation during the perioperative period, and both underwent successful ECIC bypass procedures without perioperative ischemic or hemorrhagic complications. CONCLUSION Management of neurosurgical patients with APS can be a precarious proposition. We describe the successful use of plasmapheresis and antiplatelet therapy to better manage patients undergoing neurosurgical procedures, specifically ECIC bypass, and feel this approach can be considered in future cases.

scholarly journals Marked Hyperprolactinemia Caused by Carotid Aneurysm

1997 ◽  
Vol 24 (1) ◽  
pp. 64-66 ◽  
Author(s):  
Susan R. Kahn ◽  
Richard Leblanc ◽  
Abbas F. Sadiko ◽  
I. George Fantus
Keyword(s):  
Prolactin Level ◽  
Artery Aneurysm ◽  
Cranial Computed Tomography ◽  
Serum Prolactin ◽  
Left Internal Carotid Artery ◽  
Carotid Artery Aneurysm ◽  
Pituitary Dysfunction ◽  
Internal Carotid Artery Aneurysm ◽  
Aneurysm Repair

ABSTRACT:Background:Pituitary dysfunction caused by intracranial aneurysms is rare. We report a patient with the unique feature of hyperprolactinemia to a degree previously seen only with prolactinsecreting tumours.Method:Case report.Result:A 42-year-old woman had a galactorrhea, left-sided headache, reduced vision in the left eye and a left temporal hemianopsia. Serum prolactin was elevated (365 μg/L). Cranial computed tomography (CT) revealed a suprasellar mass, which carotid angiography showed to be a left internal carotid artery aneurysm. At craniotomy, this aneurysm and a smaller one of the ophthalmic artery were repaired, and the patient's vision returned to normal. The prolactin level fell to normal. Follow-up CT showed no evidence of pituitary adenoma or hypothalamic lesion.Conclusions:Carotid aneurysm can cause reversible pituitary dysfunction. A prolactin level >300 μg/L is not a reliable cut-off for distinguishing prolactin-secreting adenomas from other causes of elevated prolactin. A co-existing prolactinoma was felt to be ruled out by both a normal CT scan and normal prolactin levels following aneurysm repair. Patients with marked hyperprolactinemia should be considered for angiography or MRI to rule out carotid aneurysm, since the consequences of pituitary exploration in this setting are potentially grave.

Extracranial internal carotid artery aneurysm presenting as pharyngeal mass with dysphagia

2005 ◽  
Vol 120 (2) ◽  
pp. 1-3 ◽  
Author(s):  
Bruno Sergi ◽  
Vittorio Alberti ◽  
Gaetano Paludetti ◽  
Francesco Snider
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Left Internal Carotid Artery ◽  
Extracranial Internal Carotid Artery ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm

Aneurysms of the extracranial portion of the internal carotid artery are rare. Generally, they occur just at the level of, or above, the bifurcation. Here we report a case of a left internal carotid artery aneurysm presenting as an oropharyngeal mass causing dysphagia.

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