scholarly journals Cervical to Petrous Carotid Artery High-Flow Bypass for Carotid Artery Pseudoaneurysm Through Zygomatic Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Rami O Almefty ◽  
Ossama Al-Mefty
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Penetrating Trauma ◽  
Mass Effect ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Balloon Occlusion ◽  
High Flow ◽  
Artery Pseudoaneurysm

Abstract Pseudoaneurysms of the cervical internal carotid artery may generate grave risk from catastrophic rupture, thromboembolic stroke, or mass effect. They have many causes, including malignancy, infection, and iatrogenic and most commonly blunt or penetrating trauma.1 These aneurysms require treatment to eliminate their risk. Treatment options include trapping, with or without revascularization, or endovascular stenting. Trapping without revascularization requires evaluation of the cerebral collateral under a physiological challenge, which is usually done with a balloon occlusion test, which is not applicable in this lesion.2 Occluding the carotid without revascularization carries the risk of delayed ischemia and aneurysm formation.3,4 Carotid stenting has been applied in the treatment of these lesions5,6; however, the extent of the lesion in our patient from the carotid bifurcation to the petrous carotid makes endovascular treatment challenging. We present a patient with a delayed post-traumatic pseudoaneurysm of the carotid artery that extended from the bifurcation to the petrous carotid who was treated with trapping and high-flow saphenous vein bypass from the proximal cervical internal carotid to the petrous carotid. Adequate exposure of the petrous carotid to perform anastomosis requires a thorough knowledge of the anatomy and surgical nuances, which we demonstrate here through a zygomatic approach.7 The patient consented to the procedure and publication of imaging. Image at 2:28 from Al-Mefty O, Operative Atlas of Meningiomas, © LWW, 1997, with permission.

scholarly journals Traumatic cavernous internal carotid artery pseudoaneurysm presenting with massive epistaxis-a morbid clinical entity

2020 ◽  
Vol 6 (12) ◽  
pp. 2323
Author(s):  
Santosh Kumar Swain
Keyword(s):  
Head Injury ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Balloon Occlusion ◽  
Clinical Entity ◽  
Diagnosis And Treatment ◽  
Artery Pseudoaneurysm ◽  
Recurrent Epistaxis

<p>Epistaxis is commonly encountered by clinicians in emergency department. However, severe and recurrent epistaxis is very uncommon especially that arise from the cavernous internal carotid artery (ICA) pseudoaneurysm. Traumatic cavernous internal carotid pseudoaneurysm is a rare cause of the epistaxis but is a fatal and life-threatening clinical condition if left untreated. Massive epistaxis following head injury should alert the clinician to rule out traumatic cavernous ICA pseudoaneurysm. Traumatic pseudoaneurysm of the cavernous part of the ICA is a challenging clinical entity both in diagnosis and treatment. This clinical diagnosis may be suspected in case of patient with history of head injury, massive recurrent epistaxis and delayed onset of blindness. Massive epistaxis after head trauma should alert the clinician for possible cavernous ICA pseudoaneurysm. Carotid angiography confirms the site of pseudoaneurysm. The treatment options are endovascular stent and coil embolization, arterial balloon occlusion and surgical trapping. Timely diagnosis and treatment of this condition give a favorable outcome. In this review article, we discuss the epidemiology, etiopathology, clinical presentations, investigations and current treatment of the traumatic cavernous ICA pseudoaneurysm.</p>

Clip reconstruction of an 8 cm giant internal carotid artery bifurcation aneurysm: microsurgical technique

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video20
Author(s):  
Ulas Cikla ◽  
Kutluay Uluc ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Vasogenic Edema ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Mass Effect ◽  
Carotid Artery Bifurcation ◽  
Bifurcation Aneurysm

Thrombosed giant intracranial aneurysms usually present with symptoms and signs from their mass effect. Although multiple treatment options are available, direct clip reconstruction with thromboendarterectomy remains the gold standard. Here we present a 66-year-old man with seizure, aphasia and hemiparesis. Work-up revealed a giant partially thrombosed aneurysm of the internal carotid artery bifurcation with surrounding vasogenic edema. He underwent clip reconstruction of the aneurysm via a cranio-orbital approach. Although we prepared for bypass with the radial artery and/or the superficial temporal artery, we were able to clip-reconstruct the aneurysm without bypass. The patient improved upon his pre-morbid state after surgery and made an excellent recovery.The video can be found here: http://youtu.be/P_10hRQFuPo.

scholarly journals Balloon Test Occlusion for an Option to Decide Whether Simple ICA Ligation is Better Option than Trapping and High Flow Bypass of The Giant ICA Cavernous Aneurysm

2017 ◽  
Vol 14 (2) ◽  
pp. 32-35
Author(s):  
Saujanya Rajbhandari ◽  
Pravesh Rajbhandari ◽  
Pranaya Shrestha ◽  
Basant Pant ◽  
Anish Neupane
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cross Flow ◽  
Balloon Occlusion ◽  
High Flow ◽  
Aneurysm Neck ◽  
Balloon Test Occlusion ◽  
Therapeutic Occlusion ◽  
Temporary Balloon Occlusion

Balloon Test occlusion (BTO) is a preoperative angiographic test used to estimate the risk of stroke after permanent therapeutic occlusion of an internal carotid artery (ICA) involved by aneurysms. Temporary balloon occlusion at the cavernous ICA aneurysm neck was performed in an attempt to assess the adequacy of cross flow from the opposite ICA. Adequate fl ow following BTO are preferred to have simple ICA ligation and incase of those who did not pass BTO trapping and high flow bypass is preferred .We have done Right ICA Ligation on our case report.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:32-35

scholarly journals Endovascular Trapping for a Giant Aneurysm of the Cervical Internal Carotid Artery: A Case Report

2007 ◽  
Vol 13 (3) ◽  
pp. 281-285 ◽  
Author(s):  
H. Nakayama ◽  
S. Iwabuchi ◽  
M. Hayashi ◽  
T. Yokouchi ◽  
H. Terada ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Giant Aneurysm ◽  
Carotid Bifurcation ◽  
Balloon Occlusion ◽  
Occlusion Test ◽  
Balloon Occlusion Test ◽  
The Right ◽  
Cervical Internal Carotid Artery

We describe a case of giant cervical internal carotid aneurysm successfully treated by endovascular trapping. A 57-year-old woman with a history of maxillary contusion seven years before presented with pharyngeal discomfort during swallowing. MRI revealed a 4 cm mass in the right parapharyngeal space. A common carotid angiogram revealed a giant aneurysm with a wide neck originating from the cervical internal carotid artery; kinking of the internal carotid artery was noted at a point distal to the carotid bifurcation. Analysis of cerebral blood flow by SPECT during a balloon occlusion test showed no hypoperfusion areas, and the patient underwent endovascular trapping. There were no neurological or other complications after the procedure. A follow-up MRI revealed complete thrombosis of the aneurysm. Our results show that endovascular trapping for pseudoaneurysm of the cervical internal carotid artery can be a reliable and effective treatment in patients who tolerate a balloon occlusion test.

Management of Aberrant Internal Carotid Artery Injury: A Real Emergency

2002 ◽  
Vol 127 (5) ◽  
pp. 470-473 ◽  
Author(s):  
Rajan Jain ◽  
T.R. Marotta ◽  
G. Redekop ◽  
D. W. Anderson Vancouver
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Ear ◽  
Internal Carotid ◽  
Penetrating Trauma ◽  
Fistula Formation ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Artery Pseudoaneurysm ◽  
Aberrant Internal Carotid Artery

Carotid artery pseudoaneurysm or fistula formation can occur due to spontaneous dissection, blunt or penetrating trauma, or iatrogenic injury. Most of the iatrogenic injuries in the petrous region occur during middle ear operations in patients with an aberrant internal carotid artery (ICA). Aberrant ICA is a rare anomaly that can be associated with life-threatening aural hemorrhage if inadvertently injured during middle ear surgery. Other causes of unexpected hemorrhage during or after middle ear surgery include high jugular bulb, aneurysm, and glomus tumor. The management of aberrant ICA injury has always been a challenging task because of the difficult surgical approach. With major advances in the neuroendovascular field, endovascular treatment of these lesions can be quick and effective. We discuss here a case of endovascular management of an aberrant ICA that was probably injured during previous middle ear operations that led to pseudoaneurysm formation and ruptured subsequent to ear infection and drainage.

scholarly journals Slip Clip after successful microsurgery of a blister aneurysm: Should bypass always be the first option?

2021 ◽  
Vol 23 (3) ◽  
pp. 245-250
Author(s):  
Aline Lariessy Campos Paiva ◽  
Guilherme Brasileiro de Aguiar ◽  
Juan Antonio Castro Flores ◽  
José Carlos Esteves Veiga
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Cerebral Angiography ◽  
Internal Carotid ◽  
Treatment Options ◽  
High Flow ◽  
Definitive Treatment ◽  
Rupture Risk ◽  
Dynamic Nature

Blood Blister-like aneurysms are intracranial non-saccular aneurysms with higher rupture risk due to its fragile wall. Diagnosis is performed in the acute phase of a subarachnoid hemorrhage. There are several treatment options based on reconstructive or deconstructive techniques. This paper aims to discuss the limitations of microsurgery clipping for a ruptured blister aneurysm. We report on a case of a female patient presented with a Fisher III subarachnoid hemorrhage. Cerebral angiography revealed an internal carotid artery blister aneurysm. Initially microsurgery clipping was successfully performed. However, after a few days the patient presented new subarachnoid hemorrhage. The new cerebral angiography showed growth of the previously clipped aneurysm, with displacement of the clip from the position adjacent to the artery. High-flow bypass was performed obtaining definitive treatment. This is a definitive approach for blister aneurysms. If microsurgery clipping is chosen, a strict follow-up is required due to the dynamic nature of this lesion and the chance of re-bleeding even after successfully clipping.

Endovascular reconstruction of enlarging traumatic internal carotid artery pseudoaneurysm

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Omar Choudhri ◽  
Jeremy Heit ◽  
Huy M. Do
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Penetrating Trauma ◽  
Antiplatelet Agents ◽  
Covered Stent ◽  
Thromboembolic Complications ◽  
Artery Pseudoaneurysm ◽  
Interval Enlargement ◽  
Cervical Internal Carotid Artery

Traumatic dissecting pseudoaneurysms of the cervical and petrous internal carotid artery are often a result of blunt or penetrating trauma. These patients are at high risk for thromboembolic complications and are managed with antiplatelet agents. Patients who develop neurologic symptoms while on antiplatelet agents, or have interval enlargement of their pseudoaneurysms, may require repair of the vessel. We describe a case in which we performed an endovascular repair of an enlarging distal cervical internal carotid artery pseudoaneurysm, with placement of a covered stent.The video can be found here: http://youtu.be/uCypcsBvOZ4.

scholarly journals An internal carotid artery aneurysm presenting with dysarthria

2013 ◽  
Vol 95 (7) ◽  
pp. e6-e8 ◽  
Author(s):  
PT Davey ◽  
I Rychlik ◽  
M O’Donnell ◽  
R Baker ◽  
I Rennie
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Carotid Bifurcation ◽  
Balloon Occlusion ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Pulsatile Mass ◽  
The Right

A 72-year-old woman presented to her general practitioner with a 4-week history of right neck swelling. Clinical examination elicited a pulsatile mass consistent with a carotid artery aneurysm. Five days later the patient noticed her tongue movements had become awkward with associated dysarthria. Computed tomography confirmed a 4cm internal carotid artery aneurysm arising just distally to the carotid bifurcation. She proceeded to transfemoral diagnostic carotid angiography. Balloon occlusion of the right internal carotid artery origin was performed for a ten-minute period without any neurological deficit. The decision was taken to proceed to surgical ligation of the origin of the internal carotid artery. Her symptoms of dysarthria have resolved.

Carotid Artery Pseudoaneurysm after Endovascular Stent Placement: Diagnosis and Follow-up Duplex Ultrasonography

2005 ◽  
Vol 29 (1) ◽  
pp. 28-32 ◽  
Author(s):  
Wei Zhou ◽  
Ruth L. Bush ◽  
Peter H. Lin ◽  
Megan D. Hodge ◽  
Deborah D. Felkai ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Graft ◽  
Stent Placement ◽  
Duplex Ultrasound ◽  
Carotid Bifurcation ◽  
Carotid Stenting ◽  
Duplex Scan ◽  
Artery Pseudoaneurysm ◽  
Endovascular Stent Placement

Purpose Carotid artery pseudoaneurysm development after endarterectomy, albeit rare, has been attributed to patch deterioration. We present an unusual case of pseudoaneurysm development 1 year after stent placement for recurrent carotid artery stenosis. Case Report A 64-year-old man had transient hemiparesis develop 1 week after carotid artery endarterectomy (CEA) with patch angioplasty for monocular transient ischemic attack. Carotid angiography reviewed an intimal flap at the distal endarterectomy site, which was successfully treated with carotid stent placement. During a duplex scan 1 year later, he was found to have a symptomatic 2.5-cm pseudoaneurysm at the level of stented carotid bifurcation. This was successfully treated with a combined open and endovascular approach, which consisted of stent-graft placement by means of an open carotid exposure. Completion angiogram showed successful stent-graft exclusion of the pseudoaneurysm. A follow-up duplex scan 6 months later demonstrated diminution of pseudoaneurysm size without endoleak. Conclusion This report highlights the importance of duplex ultrasound surveillance in patients with CEA or carotid stenting, because it can accurately detect recurrent stenosis or carotid pseudoaneurysm. Moreover, a combined open and endovascular therapy using stent graft successfully treated the carotid pseudoaneurysm in our patient.

scholarly journals Advances in the endovascular treatment of direct carotid-cavernous fistulas

2016 ◽  
Vol 62 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Guilherme Brasileiro de Aguiar ◽  
Maurício Jory ◽  
João Miguel de Almeida Silva ◽  
Mario Luiz Marques Conti ◽  
José Carlos Esteves Veiga
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Internal Carotid ◽  
Treatment Options ◽  
High Flow ◽  
Endovascular Techniques ◽  
Carotid Cavernous Fistulas ◽  
Carotid Flow ◽  
The Ideal

SUMMARY Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid artery and the cavernous sinus. They are considered direct when there is a direct connection between the internal carotid artery and the cavernous sinus. These cases are generally traumatic. Direct CCFs are high-flow lesions, possibly related to intracranial bleeding, visual loss, corneal exposure or even fatal epistaxis. Treatment of such lesions is, thus, always recommended. The ideal treatment for direct CCF is to exclude the fistula from circulation, preserving the carotid flow. This can be attained using diverse endovascular techniques. The objective of the present article is to review the current techniques for treatment of direct CCFs, with special attention to the currently available endovascular treatment options.

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