scholarly journals Experimental regional cerebral ischemia in the middle cerebral artery territory in primates. Part 1: Angio-anatomy and description of an experimental model with selective embolization of the internal carotid artery bifurcation.

Stroke ◽  
1977 ◽  
Vol 8 (1) ◽  
pp. 61-70 ◽  
Author(s):  
O Watanabe ◽  
A M Bremer ◽  
C R West
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Experimental Model ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Middle Cerebral Artery Territory ◽  
Selective Embolization ◽  
Carotid Artery Bifurcation

scholarly journals Ipsilateral Internal Carotid Artery Bifurcation Aneurysm and Contralateral Middle Cerebral Artery Aneurysm Clipping: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E32-E32
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Video Recording ◽  
Sylvian Fissure ◽  
Carotid Artery Bifurcation ◽  
Bifurcation Aneurysm ◽  
Mca Aneurysm

Abstract Contralateral clipping of a middle cerebral artery (MCA) aneurysm is challenging but possible with favorable anatomy. This patient had bilateral aneurysms, an ipsilateral internal carotid artery bifurcation aneurysm and a contralateral MCA aneurysm. The surgical goal was to clip both aneurysms if possible. After opening the ipsilateral sylvian fissure, the arachnoid planes were opened along the anterior cerebral arteries to the contralateral sylvian fissure. The arachnoid planes within the sylvian fissure were dissected to permit visualization of the contralateral proximal MCA and anatomy, which permitted the MCA to be followed to the aneurysm. If adequate proximal and distal control is present, the aneurysm is clipped. The surgeon needs to be comfortable in backing out if the exposure is too limited. The sequence of clipping should be to clip the contralateral aneurysm first to avoid inadvertent manipulation of the ipsilateral clip during the contralateral procedure. Postoperative angiography demonstrated that the bilateral aneurysms were clipped and that all vessels were patent. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Trapping, dome puncture, and direct suction decompression in conjunction with assistant superficial temporal artery- middle cerebral artery bypass to clip giant internal carotid artery bifurcation aneurysm

2019 ◽  
Vol 10 ◽  
pp. 205
Author(s):  
Seiei Torazawa ◽  
Hideaki Ono ◽  
Tomohiro Inoue ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Optimal Treatment ◽  
Aneurysm Neck ◽  
Bifurcation Aneurysm

Background: Very large and giant aneurysms (≥20 mm) of the internal carotid artery (ICA) bifurcation (ICAbif) are definitely rare, and optimal treatment is not established. Endovascular treatments are reported as suboptimal due to difficulties of complete occlusion and tendencies to recanalization. Therefore, direct surgery remains an effective strategy if the clipping can be performed safely and reliably, although very difficult. Case Description: Two cases of ICAbif aneurysms (>20 mm) were treated. Prior assistant superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed to avoid ischemic complications during prolonged temporary occlusion of the arteries in both cases. In Case 1 (22-mm aneurysm), the dome was inadvertently torn in applying the clip because trapping had resulted in insufficient decompression. Therefore, in Case 2 (28-mm aneurysm), almost complete trapping of the aneurysm and subsequent dome puncture was performed, and the aneurysm was totally deflated by suction from the incision. This complete aneurysm decompression allowed safe dissection and successful clipping. Conclusion: Trapping, deliberate aneurysm dome puncture, and suction decompression from the incision in conjunction with assistant STA-MCA bypass can achieve complete aneurysm deflation, and these techniques enable safe dissection of the aneurysm and direct clipping of the aneurysm neck. Direct clipping with this technique for very large and giant ICAbif aneurysms may be the optimal treatment choice with the acceptable outcome if endovascular treatment remains suboptimal.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

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