Acute thromboembolic complication after stent-assisted aneurysm embolization of ruptured dissecting aneurysm in communicating internal carotid artery segment

ABSTRACT OBJECTIVE AND IMPORTANCE The carotid and the vertebrobasilar circulation were connected, effectively creating a new posterior communicating artery (PComA). The excimer laser-assisted nonocclusive anastomosis technique is a new anastomosis technique whereby formerly untreatable patients may be treated with an intracranial artery-to-intracranial artery bypass procedure. This report is the first one in which an angiographically proved patent internal carotid artery-posterior cerebral artery segment P1 bypass is presented. CLINICAL PRESENTATION Our patient presented with repeated episodes of vertebrobasilar ischemia because of vertebral artery occlusion and stenosis. INTERVENTION An internal carotid artery-posterior cerebral artery segment P1 bypass procedure was performed. Because the patient experienced transient ischemia in the left cerebral hemisphere at the end of postoperative angiography procedure, no radiological intervention was performed, and the patient refused to undergo a new radiological intervention at a later stage. TECHNIQUES Both anastomoses were made using the excimer laser-assisted nonocclusive anastomosis technique. CONCLUSION Intraoperative flowmetry was performed using an ultrasound flowmeter, which disclosed blood flow of 35 ml/min through the bypass. We hope that this new PComA suffices to protect the patient from infarction in the territory of the vertebrobasilar circulation.

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High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

Journal of Neurosurgery ◽

10.3171/2013.9.jns131030 ◽

2014 ◽

Vol 120 (1) ◽

pp. 93-98 ◽

Cited By ~ 13

Author(s):

Masahiro Indo ◽

Soichi Oya ◽

Michihiro Tanaka ◽

Toru Matsui

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Ophthalmic Artery ◽

Internal Carotid ◽

Medical Center ◽

Anterior Wall ◽

Dissecting Aneurysm ◽

Anomalous Origin ◽

Aneurysm Formation ◽

Saccular Aneurysms

Object Surgery for aneurysms at the anterior wall of the internal carotid artery (ICA), which are also referred to as ICA anterior wall aneurysms, is often challenging. A treatment strategy needs to be determined according to the pathology of the aneurysm—namely, whether the aneurysm is a saccular aneurysm with firm neck walls that would tolerate clipping or coiling, a dissecting aneurysm, or a blood blister–like aneurysm. However, it is not always possible to properly evaluate the condition of the aneurysm before surgery solely based on angiographic findings. Methods The authors focused on the location of the ophthalmic artery (OA) in determining the pathology of ICA anterior wall aneurysms. Between January 2006 and December 2012, diagnostic cerebral angiography, for any reason, was performed on 1643 ICAs in 855 patients at Saitama Medical Center. The authors also investigated the relationship between the origin of the OA and the incidence of ICA anterior wall aneurysms. The pathogenesis was also evaluated for each aneurysm based on findings from both angiography and open surgery to identify any correlation between the location where the OA originated and the conditions of the aneurysm walls. Results Among 1643 ICAs, 31 arteries (1.89%) were accompanied by an anomalous origin of the OA, including 26 OAs originating from the C3 portion, 3 originating from the C4 portion, and 2 originating from the anterior cerebral artery. The incidence of an anomalous origin of the OA had no relationship to age, sex, or side. Internal carotid artery anterior wall aneurysms were observed in 16 (0.97%) of 1643 ICAs. Female patients had a significantly higher risk of having ICA anterior wall aneurysms (p = 0.026). The risk of ICA anterior wall aneurysm formation was approximately 50 times higher in patients with an anomalous origin of the OA (25.8% [8 of 31]) than in those with a normal OA (0.5% [8 of 1612], p < 0.0001). Based on angiographic classifications, saccular aneurysms were significantly more common in patients with an anomalous origin of the OA than in those with a normal OA (p = 0.041). Ten of 16 patients with ICA anterior wall aneurysms underwent craniotomies. Based on the intraoperative findings, all 6 aneurysms with normal OAs were dissecting or blood blister–like aneurysms, not saccular aneurysms. Conclusions There was a close relationship between the location of the OA origin and the predisposition to ICA anterior wall aneurysms. Developmental failure of the OA and subsequent weakness of the vessel wall might account for this phenomenon, as previously reported regarding other aneurysms related to the anomalous development of parent arteries. The data also appear to indicate that ICA anterior wall aneurysms in patients with an anomalous origin of the OA tend to be saccular aneurysms with normal neck walls. These findings provide critical information in determining therapeutic strategies for ICA anterior wall aneurysms.

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Distal internal carotid artery dissecting aneurysm

Journal of Vascular Surgery ◽

10.1016/j.jvs.2004.12.056 ◽

2006 ◽

Vol 43 (6) ◽

pp. 1290

Author(s):

Leopoldo Fernández-Alonso ◽

Juan Alcalde ◽

Fernando Bergaz ◽

David Cano ◽

Pablo Dominquez

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Dissecting Aneurysm ◽

Distal Internal Carotid Artery

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Endovascular Treatment of Internal Carotid Artery Aneurysms with Guglielmi Coils (GDC)

Rivista di Neuroradiologia ◽

10.1177/197140099701000302 ◽

1997 ◽

Vol 10 (3) ◽

pp. 265-278

Author(s):

A. Lavaroni ◽

E. Biasizzo ◽

M.C. De Colle ◽

P.P. Janes ◽

G. Fabris

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Endovascular Treatment ◽

Internal Carotid ◽

Excellent Result ◽

Cerebral Haemorrhage ◽

Thromboembolic Complication ◽

Total Occlusion ◽

Heparin Infusion ◽

Patients Âgés

This paper evaluates the result of endovascular treatment in aneurysms arising in the internal carotid artery, intracranial tract, using Guglielmi detachable coils. We selected one years, from November 1995 to November 1996 in which we used GDC to breat 26 patients with intracranial aneurysm; 14 of them in the carotid siphon. Patients' ages ranged from 29 to 77 years (9 women and 5 men). Following, the Yasargil classification we divided the aneurysmal origin into: ICA lateral site (posterior communicating artery), 7 cases; ICA inferior site, 3; ACI medial distal site, 1; ICA bifurcation site, 3. Regarding size, the aneurysm was: small in 7 patients, medium in 6 and large in 1. The occlusion percentage was total in 9 patients, sub-total in 4, partial in 1. The clinical presentation was with subarachnoid haemorrhage in 11 patients (6 of them were treated within 3 days from the onset of symptoms); in three of them aneurysm detection was occasional (real occasional in 2, occasional in 1). All 14 patients were evaluated on discharge with the Glasgow Outcome Scale (GOS) modified, according to the Guglielmi proposals: 10 out of 14 patients had an excellent GOS with no deaths. All treatment was performed in anaesthesia with heparin infusion 5000 Ul ev in bolus + 1000 Ul each hour); the heparin infusion was suspended 12 hours after the treatment and then paediatric Aspirin or Fraxiheparin was administered for 4–5 days. No perforation of the aneurysmal sac occurred during treatment or cerebral haemorrhage due to the catheter positioning. In one patient with H-H IIIa, with a wide neck aneurysm and siphon dysplasia rebleeding occurred 21 days after treatment requiring prompt surgery; on discharge the GOS was fair. Regarding thrombo-embolic complications, one patient with H-H grade IIIa, had a hypodense ischaemic lesion, in a temporoparietal site ipsilateral to the aneurysm, without associated symptoms. Another patient, with IIIa H-H grade, presented a thromboembolic complication after treatment; the CT scan revealed multiple hypodense lesions in sub- and supratentorial sites; the GOS was poor on discharge with associated permanent neurological deficit. No patient died as a direct of the treatment. The radiation dose to patient and operator should not be underestimated: in our experience we had three cases of transient localised alopecia. The angiographic controls after treatment, at discharge and after 3–6 months, showed persistent occlusion; in one case of sub-total occlusion, total occlusion was achieved by re-do surgery. The GOS remained stable at 3–6 months after treatment in patients with an excellent result; one patient with GOS fair at discharge reached an excellent result; the other two patients with GOS poor and fair have improved during time reaching a fair and good outcome respectively.

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Transoral Carotid Ultrasonography Is Useful for Detection and Follow-Up of Extracranial Internal Carotid Artery Dissecting Aneurysm

Cerebrovascular Diseases ◽

10.1159/000103619 ◽

2007 ◽

Vol 24 (1) ◽

pp. 144-146 ◽

Cited By ~ 4

Author(s):

Yusuke Yakushiji ◽

Yukinori Takase ◽

Masafumi Kosugi ◽

Hiroharu Inoue ◽

Akira Uchino ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Dissecting Aneurysm ◽

Extracranial Internal Carotid Artery ◽

Carotid Ultrasonography

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Ruptured dissecting aneurysm in communicating internal carotid artery segments treated using a stent-assisted endovascular technique

Interventional Neuroradiology ◽

10.1177/1591019917747244 ◽

2018 ◽

Vol 24 (2) ◽

pp. 130-134 ◽

Cited By ~ 1

Author(s):

Chae Wook Huh ◽

Sung-Chul Jin

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Glasgow Outcome Scale ◽

Internal Carotid ◽

Neurological Complications ◽

Dissecting Aneurysm ◽

Digital Subtraction ◽

Endovascular Technique ◽

Dissecting Aneurysms

Hemorrhagic intracranial dissecting aneurysms are known to have a poor natural history and an increased tendency to rebleed. The communicating segment of the internal carotid artery (ICA) is an infrequent site of dissection that is difficult to manage using deconstructive endovascular treatment because of the need to preserve important vascular branches. We report two cases of ruptured dissecting aneurysms that occurred in communicating segments of the ICA and treated using a reconstructive endovascular technique involving stent-assisted coiling. Case 1 was a 59-year-old woman who was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) indicated a ruptured dissecting aneurysm that arose from the left communicating segment of the ICA. Stent-assisted coiling was performed and followed by a second overlapping stent technique. No deterioration was observed on DSA after one week of follow-up or on magnetic resonance angiography (MRA) after four months of follow-up. The patient was discharged without neurological complications (Glasgow Outcome Scale 5). Case 2 was a 34-year-old man who was admitted with a diagnosis of SAH. DSA revealed a suspected lesion of a ruptured dissecting aneurysm of the left communicating segment of the ICA. Stent-assisted coiling was performed, and partial occlusion was achieved. No deterioration was observed on DSA after two weeks of follow-up or on MRA after six months of follow-up. The patient was discharged without neurological complications (Glasgow Outcome Scale 5). These cases suggest that using stent-assisted coiling could be a feasible modality for treating ruptured ICA dissecting aneurysms in the communicating segment.

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Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011769 ◽

2015 ◽

Vol 8 (3) ◽

pp. 279-286 ◽

Cited By ~ 29

Author(s):

Geoffrey P Colby ◽

Li-Mei Lin ◽

Justin M Caplan ◽

Bowen Jiang ◽

Barbara Michniewicz ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Flow Diverter ◽

Flow Diversion ◽

Initial Experience ◽

Unruptured Aneurysms ◽

Aneurysm Neck ◽

Aneurysm Embolization ◽

Grade Ii

BackgroundFlow diversion is an important tool for treatment of cerebral aneurysms, particularly large and giant aneurysms. The Surpass flow diverter is a new system under evaluation in the USA.ObjectiveTo report our initial experience of 20 cases with the Surpass flow diverter to demonstrate its basic properties, the required triaxial delivery platform, and the methodologies used to deploy it during treatment of large internal carotid artery (ICA) aneurysmsMethodsTwenty patients with ICA aneurysms ≥10 mm with ≥4 mm neck treated as part of the Surpass IntraCranial Aneurysm Embolization System Pivotal Trial (the SCENT trial; Stryker) were included. Details of patient demographics, aneurysm characteristics, and technical procedures were collected.ResultsTwenty patients (mean age 63.3±1.3 years; range 51–72) with 20 unruptured aneurysms (mean size 13.4±0.9 mm; range 10–21 mm) were treated. For proximal access, 60% of cases had aortic arch ≥grade II, 55% had significant cervical ICA tortuosity, and 60% had cavernous ICA ≥grade II. The Surpass device was implanted in 19/20 (95%) cases. Of 19 cases, a single device was used in 18 cases (95%) and 2 devices in only 1 case (5%). Balloon angioplasty was performed in 8/19 cases (42%). Complete aneurysm neck coverage and adequate vessel wall apposition was obtained in all 19 cases.ConclusionsSurpass is a next-generation flow diverter with unique device-specific and delivery-specific features compared with clinically available endoluminal flow diverters. Our initial experience demonstrates a favorable technical profile in treatment of large and giant ICA aneurysms.Trial registration numberNCT01716117.

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