scholarly journals Extraintracranial Bypass as a Rescue Therapy for Symptomatic Flow Diverter Thrombosis

2015 ◽  
Vol 2015 ◽  
pp. 1-5
Author(s):  
Luigi A. Lanterna ◽  
Alessandro Lunghi ◽  
Carlo Brembilla ◽  
Paolo Gritti ◽  
Claudio Bernucci
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rescue Therapy ◽  
Flow Diverter ◽  
Minor Stroke ◽  
Transient Ischemic Attacks ◽  
Postoperative Course ◽  
A Minor ◽  
Ischemic Events

A 56-year-old female with a giant partially thrombosed unruptured carotid-ophthalmic aneurysm was treated with a Pipeline flow diverter. Three months after the procedure, in concomitance with the discontinuation of one of the antiplatelet medications, the patient suffered from a minor stroke and relapsing transient ischemic attacks. The angiography demonstrated the occlusion of the internal carotid artery, and a perfusion-weighted CT scan showed a condition of hypoperfusion. The patient underwent a double-barrel extraintracranial bypass. The postoperative course was uneventful and she has experienced no further ischemic events to date.

Quantitative flow measurement after placing a flow diverter for a distal internal carotid artery aneurysm

2016 ◽  
Vol 9 (12) ◽  
pp. 1238-1242 ◽  
Author(s):  
Chien-Wei Chen ◽  
Ho-Fai Wong ◽  
Yu-Ling Ye ◽  
Yao-Liang Chen ◽  
Wei-Liang Chen ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Peak Time ◽  
Flow Measurements ◽  
Distal Internal Carotid Artery ◽  
Aneurysm Volume ◽  
Quantitative Flow

ObjectivesTo evaluate the differences in arterial flow after flow diverter placement using quantitative flow measurements based on digital subtraction angiography (DSA).MethodsBetween November 2013 and November 2015, all patients who had flow diverters placed for distal internal carotid artery (ICA) aneurysms were reviewed. Patients in whom the stent was placed across the ostia of the ophthalmic artery (OphA) and anterior choroidal artery (AChA) were enrolled. Five regions of interest were selected: the proximal ICA (as a reference), terminal ICA, middle cerebral artery (MCA), anterior cerebral artery (ACA), OphA, and AChA. The values of the peak, time-to-peak (TTP), and area under the curve (AUC) were analyzed using a quantitative DSA technique.ResultsThe study enrolled 13 patients. The quantitative flow analysis showed improved flow in the terminal ICA (peak and AUC, p=0.036 and p=0.04, respectively), MCA (AUC, p=0.023), and ACA (AUC, p=0.006), and decreased flow in the OphA (peak and AUC, p=0.013 and p=0.005, respectively) and AChA (peak and subtracted TTP, p=0.023 and p=0.050, respectively) after flow diverter placement. Larger aneurysm volume was significantly correlated with decreased OphA flow after the procedure (peak and AUC, p=0.049 and p=0.037, respectively). Larger aneurysm volume also had a marginal correlation with increased distal ICA flow after the procedure, but this did not reach significance (peak and AUC, p=0.195 and p=0.060, respectively).ConclusionsWithout using extra contrast medium or radiation dosages, color-coded DSA enables quantitative monitoring of the cerebral circulation after flow-diverting treatment.

scholarly journals Surgical treatment of internal carotid artery restenosis following eversion endarterectomy

2012 ◽  
Vol 140 (9-10) ◽  
pp. 577-582
Author(s):  
Djordje Radak ◽  
Slobodan Tanaskovic ◽  
Miloje Vukotic ◽  
Srdjan Babic ◽  
Nikola Aleksic ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Surgical Techniques ◽  
Minor Stroke ◽  
Graft Occlusion ◽  
Redo Surgery ◽  
Eversion Endarterectomy ◽  
Late Morbidity

Introduction. Carotid angioplasty and internal carotid artery stenting is the therapeutic method of choice in the treatment of carotid restenosis, but when it is not technically feasible (expressed tortuosity of supraaortic branches, calcifications, presence of pathological elongation of very long lesions) a redo surgery is indicated. Objective. The aim of our study was to examine the benefits and risks of redo surgery in patients with symptomatic and asymptomatic significant internal carotid artery restenosis and its impact on early and late morbidity and mortality. Methods. The study included 45 patients who were surgically treated for a hemodynamically significant internal carotid artery restenosis from January 2000 to December 2009. Surgical techniques included redo endarterectomy with direct suture, redo anderectomy with a patch plastic and resection with Dacron tubular graft interposition. The patients were followed for postoperative neurological ischemic events (transient ischemic attack (TIA), stroke), local surgical complications and lethal outcome after one month, six months, one year and after two years). Results. In the early postoperative period (up to 30 days) there were no lethal outcomes. TIA was diagnosed in four patients (8.8%), minor stroke in one patient (2.2%) and one patient (2.2%) also had cranial nerve injury. After two years two patients died (4.4%) due to fatal myocardial infarction, three patients (6.5%) had ipsilateral stroke and one patient developed graft occlusion (2%). Conclusion. In the case of symptomatic and asymptomatic carotid restenosis that cannot be treated by carotid percutaneous angioplasty, redo surgical treatment is therapeutic option with an acceptable rate of early and late postoperative complications.

Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: A Technical Report

2018 ◽  
Vol 29 (4) ◽  
pp. 707-715 ◽  
Author(s):  
Christopher Alan Hilditch ◽  
Waleed Brinjikji ◽  
Joanna Schaafsma ◽  
Chun On Anderson Tsang ◽  
Patrick Nicholson ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Technical Report ◽  
Carotid Artery Reconstruction ◽  
Artery Reconstruction ◽  
Spontaneous Dissection

Successful management of bilateral internal carotid artery fusiform giant aneurysms in a patient with intimal fibroplasia using multiple flow diverters: With long-term imaging follow up

2021 ◽  
pp. 159101992110491
Author(s):  
Jieun Roh ◽  
Seung Kug Baik ◽  
Jeong A Yeom ◽  
Joo-Young Na ◽  
Sang-Won Lee
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Giant Aneurysms ◽  
The Past ◽  
Effective Treatment Modality ◽  
Flow Diverters

The authors report a rare case of sequentially developed bilateral internal carotid artery (ICA) fusiform giant aneurysms in a patient with pathologically confirmed intimal fibroplasia. Both ICA fusiform aneurysms were treated with multiple flow diverter insertion and were well-managed over the past 5.5 years of follow-up. The development of aneurysms in this rare disease entity appears to be a lifelong process based on the authors’ observations in serial angiographic follow-up studies. Reconstruction therapy using flow-diverting stents in this unique condition may be a safe and effective treatment modality.

scholarly journals Flow-diverter stenting in post-traumatic pseudoaneurysm of cavernous internal carotid artery with epistaxis

2015 ◽  
Vol 21 (3) ◽  
pp. 325-328 ◽  
Author(s):  
Andrea Giorgianni ◽  
Carlo Pellegrino ◽  
Renzo Minotto ◽  
Anna Mercuri ◽  
Fabio Baruzzi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Left Internal Carotid Artery ◽  
Sphenoidal Sinus ◽  
Occlusion Test ◽  
Flow Diverter Stent ◽  
Traumatic Pseudoaneurysm ◽  
Post Traumatic

This paper is a case report of a young patient after a major head trauma causing multiple skull base fractures. The trauma occasioned pseudoaneurysm (PSA) from intracavernous C4 segment of left internal carotid artery (ICA) protruding in the sphenoidal sinus. After two months, two episodes of massive epistaxis occurred. Consequently, the post-traumatic PSA was treated, after carotid occlusion test, with flow-diverter stent positioning. A computed tomography angiography study performed in the following days showed complete resolution of the post-traumatic PSA lesion and ICA patency.

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