Endovascular treatment of unruptured ophthalmic artery aneurysms: clinical usefulness of the balloon occlusion test in predicting vision outcomes after coil embolization

BackgroundEndovascular coil embolization for ophthalmic artery (OphA) aneurysms has the latent risk of occlusion of the OphA during the procedure, which can lead to loss of vision. We report clinical and angiographic results of endovascular treatment of OphA aneurysms together with the efficacy of the balloon occlusion test (BOT).MethodsFrom August 2005 to December 2013, 31 consecutive patients with 33 OphA aneurysms were treated in our institution. The patients were classified into two groups according to the location of the OphA within the aneurysmal sac. The BOT was performed in 28 patients using a hypercompliant balloon before endovascular coiling. Collateral circulation between the external carotid artery and the OphA was examined and visual function tests were performed before and after treatment. Patient demographics, angiographic and clinical outcomes were reviewed.ResultsAmong the 28 patients who underwent the BOT, intact collateral circulation was demonstrated in 26 (92.9%) patients and complete occlusion of the OphA was obtained in three patients after coiling. Retrograde filling of the OphA with choroidoretinal blush was observed on post-procedural angiography and no specific visual symptoms were reported during the follow-up period. Complete embolization was achieved in 30 lesions (96.8%) and only five patients (16.1%) had minor recanalization.ConclusionsEndovascular treatment of OphA aneurysms can be performed safely and effectively in conjunction with BOT. The BOT may give useful information to predict visual outcome in patients whose OphA is likely to be threatened by the coiling procedure and to determine the optimal treatment strategy.

Download Full-text

A Case of Partially Thrombosed Giant Basilar Aneurysm Successfully Treated by Coil Embolization Followed by Proximal Clipping

Interventional Neuroradiology ◽

10.1177/15910199980040s117 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 85-88

Author(s):

H. Manabe ◽

S. Fujita ◽

M. Kimura ◽

T. Hatayama ◽

S. Suzuki

Keyword(s):

Basilar Artery ◽

Coil Embolization ◽

Balloon Occlusion ◽

Collateral Flow ◽

Anterior Circulation ◽

Occlusion Test ◽

Balloon Occlusion Test

A case of unclippable partially thrombosed giant basilar artery (BA) aneurysm was treated successfully by intra-aneurysmal GDC embolization followed by proximal BA occlusion. Balloon occlusion test of the BA showed a good opacification of the aneurysm angiographically through plentiful collateral flow from anterior circulation. This combination may prevent coil compaction and will promote intra-aneurysmal thrombosis.

Download Full-text

By-pass extra-intracranici con graft di vena safena

Rivista di Neuroradiologia ◽

10.1177/197140090301600121 ◽

2003 ◽

Vol 16 (1) ◽

pp. 165-167

Author(s):

A. Santoro ◽

E. Passacantilli ◽

G.P. Cantore

Keyword(s):

Collateral Circulation ◽

Internal Carotid ◽

Saphenous Vein Graft ◽

Cerebral Aneurysms ◽

Balloon Occlusion ◽

Graft Occlusion ◽

Parent Vessel ◽

Occlusion Test ◽

Balloon Occlusion Test ◽

The Brain

Extracranial-intracranial by-pass is a valid technique for the treatment of uncoilable and unclippable cerebral aneurysms combined with the treatment of the parent vessel. This technique is utilized in giant and fusiform aneurysms of the internal carotid artery of the prepetrous, petrous, intracavernous and paraclinoid segments. The rationality of this method is to exclude the aneurysm by trapping of the parent vessel and to revascularize the brain through a saphenous vein graft. We report our experience with 51 brain revascularizations performed between 1985 and 2001 at our Institution, 46 of these were done for the treatment of uncoilable and unclippable cerebral aneurysms. In the first period, preoperative balloon occlusion test was performed to assess the type of anastomosis, then we performed the test intraoperatively by EEG. The incidence of graft occlusion was 12.9%. Our experience in this series suggests that the indications for cerebral revascularization should be widened even to include patients with adequate collateral circulation, particularly those who have a long life expentancy.

Download Full-text

Cavernous Sinus Exenteration for Invasive Cranial Base Tumors

Neurosurgery ◽

10.1227/01.neu.0000053364.33375.c2 ◽

2003 ◽

Vol 52 (4) ◽

pp. 772-782 ◽

Cited By ~ 23

Author(s):

Bernard George ◽

Cristina Anastasia Ferrario ◽

Alexandre Blanquet ◽

Frédéric Kolb

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Cavernous Sinus ◽

Internal Carotid ◽

Balloon Occlusion ◽

Biological Behavior ◽

Cerebrospinal Fluid Leakage ◽

External Carotid ◽

Occlusion Test ◽

Balloon Occlusion Test

Abstract OBJECTIVE Invasive tumors involving the cavernous sinus, such as recurrent benign meningiomas or sarcomas, raise therapeutic problems that may be resolved by cavernous sinus exenteration (CSE). METHODS Our series comprises 18 patients (9 women and 9 men ranging in age from 14 to 64 yr) who underwent CSE during the past 8 years. The tumors in these patients included 12 meningiomas, 3 chondrosarcomas, 1 rhabdomyosarcoma, 1 lipomyosarcoma, and 1 epidermoid carcinoma. Preoperative occlusion of the internal carotid artery was confirmed in 15 cases by a balloon occlusion test. Three patients had a negative balloon occlusion test, and their internal carotid arteries were preserved (n = 1) or revascularized (n = 2) through an external carotid artery-to-middle cerebral artery bypass. RESULTS CSE was performed as a primary treatment in 5 patients and after one to five recurrences in 13 patients. In all patients, CSE included the internal carotid artery and Cranial Nerves III, IV, and VI and one to three branches of Cranial Nerve V. Orbital exenteration was performed in eight patients, and partial hypophysectomy was performed in five patients. Ten patients had received radiotherapy before CSE, and five patients underwent irradiation after CSE. The operative mortality includes two patients. Cerebrospinal fluid leakage was the main complication in four patients, with three patients having meningitis. Follow-up ranged from 6 months to 5 years, with three deaths from new recurrences at 2, 3, and 4 years after CSE. As compared with their clinical courses before CSE, all patients except the two who died postoperatively benefited from CSE. CONCLUSION CSE has useful indications in invasive and rapidly growing tumors, including apparently benign meningiomas. A better understanding of the biological behavior of these tumors is necessary for appropriate selection of patients for CSE.

Download Full-text

Relevance of Occlusion Test in Endovascular Coiling of Posterior Cerebral Artery (P2 Segment) Aneurysms

Interventional Neuroradiology ◽

10.1177/159101990401000306 ◽

2004 ◽

Vol 10 (3) ◽

pp. 235-248 ◽

Cited By ~ 14

Author(s):

P. N. Jayakumar ◽

S. Desai ◽

S. G. Srikanth ◽

S. Ravishankar ◽

J. M. E. Kovoor

Keyword(s):

Cerebral Artery ◽

Clinical Decision Making ◽

Posterior Cerebral Artery ◽

Clinical Decision ◽

Balloon Occlusion ◽

Neurological Deficits ◽

Endovascular Coiling ◽

Post Intervention ◽

Occlusion Test ◽

Balloon Occlusion Test

P2 segment aneurysms are located on the posterior cerebral artery (PCA) between the junction of the posterior communicating artery with the PCA and the quadrigeminal cisternal part of the PCA. We reviewed our experience with endovascular coiling in such aneurysms. Clinical and pre-procedural data from four patients, referred for endovascular treatment of P2 segment aneurysms, were retrospectively studied for factors influencing post-interventional neurological deficits caused by ischemia of the PCA distal territory. Balloon occlusion was done in three patients and patient tolerance was assessed using clinical and anatomic criteria. Embryologic and anatomic features of the PCA were reviewed. Balloon occlusion test and endovascular coiling of aneurysms was possible in three patients. Control angiogram after embolization showed elimination of aneurysms from the circulation and the distal PCA filled through leptomeningeal anastomoses. One patient deteriorated due to aneurysmal rupture soon after the balloon occlusion test and coiling could not be done. In the other three patients post-intervention CT and MRI images showed PCA territory infarcts in spite of demonstration of good collateral circulation distal to the occluded PCA. In conclusion, P2 aneurysms can be effectively treated by endovascular coiling without a balloon occlusion test. While the balloon occlusion test does not contribute to clinical decision-making it may be associated with potential morbidity and mortality.

Download Full-text