scholarly journals Endovascular Exclusion of the Anterior Communicating Artery with Flow-Diverter Stents as an Emergency Treatment for Blister-Like Intracranial Aneurysms

2013 ◽  
Vol 19 (4) ◽  
pp. 471-478 ◽  
Author(s):  
Aymeric Rouchaud ◽  
Suzana Saleme ◽  
Benjamin Gory ◽  
David Ayoub ◽  
Charbel Mounayer
Keyword(s):  
Emergency Treatment ◽  
Arterial Wall ◽  
Therapeutic Option ◽  
Cerebral Arteries ◽  
Flow Diverter ◽  
Anterior Communicating Artery ◽  
Aneurysm Wall ◽  
Complete Exclusion ◽  
Small Aneurysms

Blood blister-like aneurysms (BLAs) are rare lesions, associated with diffuse subarachnoid hemorrhage (SAH). BLAs tend to rebleed quickly after first bleeding and must be treated as an emergency. Acute treatment is challenging using surgical and endovascular approaches due to the fragile aneurysm wall and small sac. Flow-diverter stents (FDSs) may offer a new option for the treatment of difficult small aneurysms. We describe a case of a ruptured BLA on the anterior communicating artery (AComA) treated in the acute phase of SAH by endovascular exclusion of the AComA with deployment of two FDSs in the A1/A2 junctions of both anterior cerebral arteries (ACAs). A 61-year-old man was admitted for diffuse SAH with a focal interhemispheric hematoma. Angiography revealed multiple arterial wall irregularities on the AComA and both ACAs. We performed an endovascular shunt of the AComA by deploying two FDSs in both A1/A2 junctions. Immediate control injections confirmed flow diversion in the A1/A2 segments of the ACAs with decreased blood flow in the AComA. The patient's course in hospital was uneventful. A three-month follow-up angiogram confirmed complete exclusion of the aneurysms, complete exclusion of the AComA, and patency of the two ACAs without any persistent arterial wall irregularity. Endovascular bypass using an FDS for a ruptured BLA has never been described. It establishes a new therapeutic option despite the need for antiplatelet therapy. Endovascular AComA exclusion using an FDS may be a solution when no other treatment is available for a ruptured BLA.

Prevention of Rebleeding after Operation for Subarachnoid Hemorrhage of Unknown Cause

Neurosurgery ◽  
1985 ◽  
Vol 17 (6) ◽  
pp. 942-946 ◽  
Author(s):  
Noboru Sakai ◽  
Hiromu Yamada ◽  
Takashi Ando ◽  
Yasuaki Nishimura
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Surgical Treatment ◽  
Arterial Wall ◽  
Internal Carotid ◽  
Cerebral Arteries ◽  
Anterior Communicating Artery ◽  
Computed Tomographic ◽  
Follow Up Study ◽  
Computed Tomographic Scan

Abstract This study is presented to promote prophylactic operation to prevent rebleeding after subarachnoid hemorrhage (SAH) of unknown cause. Twenty-two cases of nontraumatic SAH of unknown cause of a total of 254 cases of SAH treated during a 5-year period (1980-1984) were available for this study. A follow-up study (4 to 61 months after treatment; median, 43 months) revealed a 4.5% mortality rate. Four patients chosen from among the 22 SAH cases underwent prophylactic operation. The decision to operate was based on repeated angiography showing regional cerebral vasospasm corresponding to a limited hyperdense area on the computed tomographic scan at the time of the onset of SAH. Microsurgery revealed a minute protrusion (less than 2 mm in diameter) or thinning of the arterial wall with old hematoma of the surrounding brain in all 4 cases, and treatment required only coating of the abnormal site. All 4 patients are now fully recovered. Frequently, abnormal changes of such cerebral arteries as the anterior communicating artery, the internal carotid artery (C-1 and C-2), and the middle cerebral artery (M-1) may occur. Therefore, the authors emphasize the necessity of surgical treatment for specific cases of SAH with an unknown cause.

scholarly journals Endovascular management of a carotid aneurysm into the sphenoid sinus presenting with epistaxis

2015 ◽  
Vol 21 (6) ◽  
pp. 660-663 ◽  
Author(s):  
Mohamed Akkari ◽  
Grégory Gascou ◽  
Vincent Trévillot ◽  
Alain Bonafé ◽  
Louis Crampette ◽  
...  
Keyword(s):  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Digital Subtraction ◽  
Endovascular Management ◽  
Clinical Recurrence ◽  
Neurological Sequelae ◽  
Recurrent Epistaxis ◽  
Complete Exclusion

Non-traumatic cavernous internal carotid artery (ICA) aneurysms are rare, and favour the occurrence of massive recurrent epistaxis, which is associated with a high mortality rate. We report the case of a 67-year-old woman presenting a ruptured ICA aneurysm extending into the sphenoid sinus, revealed by epistaxis. Selective coil embolization of the aneurysm was performed. Flow-diverter stents were deployed in order to utterly exclude the aneurysm and prevent revascularization. Anti-platelet treatment was provided to lower the risk of in-stent thrombosis. A left frontal hematoma associated with a subarachnoid haemorrhage occurred at day 2. Outcome was favourable with no neurological sequelae, and no clinical recurrence of epistaxis occurred. A 4 months follow-up digital subtraction angiography showed a complete exclusion of the aneurysm. In addition, a magnetic resonance cerebral angiography at 16 months showed stable results. Thus, this two-stage endovascular procedure has proven its effectiveness in preventing epistaxis recurrence while preserving the ICA patency.

Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery

1986 ◽  
Vol 64 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Jiro Suzuki ◽  
Kazuo Mizoi ◽  
Takashi Yoshimoto
Keyword(s):  
Cerebral Arteries ◽  
Distal Portion ◽  
Anterior Communicating Artery ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Early Operations ◽  
Temporary Clip ◽  
Fine Print

✓ The authors review their experience with the bifrontal interhemispheric approach in 603 cases of single anterior communicating artery (ACoA) aneurysms and describe the operative technique. With this approach, the olfactory tracts are dissected, and both A1 segments of the anterior cerebral arteries are identified subfrontally. The interhemispheric fissure is then dissected and A2segments are followed from the distal portion toward the ACoA complex. Following the administration of a combination of mannitol, vitamin E, and dexamethasone, a temporary clip is placed on at least the dominant A1 segment prior to dissection of the aneurysm itself. Once the aneurysm has been completely freed from the surrounding structures, the neck is ligated and clipped. If the aneurysm ruptures during surgery, temporary clips are placed on both A1 and A2 segments bilaterally and the operation proceeds in a completely dry field. With this method, it is possible to occlude any of the intracranial vessels for up to 40 minutes within 100 minutes of drug administration. To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, the authors have adopted a policy of performing ultra-early operations within 48 hours of the onset of symptoms. Among the 257 cases operated on during the 9 years since 1975, one-fifth have been operated on within 48 hours of rupture, and the in-hospital mortality rate has been only 4.3% (11 cases). Follow-up studies have shown that 87% of the 246 surviving patients have returned to useful lives.

scholarly journals Consecutive Endovascular Treatment of 20 Ruptured Very Small (<3 mm) Anterior Communicating Artery Aneurysms

2016 ◽  
Vol 5 (1-2) ◽  
pp. 57-64 ◽  
Author(s):  
Kaiz S. Asif ◽  
Ahsan Sattar ◽  
Marc A. Lazzaro ◽  
Brian-Fred Fitzsimmons ◽  
John R. Lynch ◽  
...  
Keyword(s):  
Coil Embolization ◽  
External Ventricular Drain ◽  
Maximum Diameter ◽  
Anterior Communicating Artery ◽  
Anterior Communicating Artery Aneurysms ◽  
Average Maximum ◽  
Aneurysm Occlusion ◽  
Small Aneurysms ◽  
Clinical Worsening

Background: Small aneurysms located at the anterior communicating artery carry significant procedural challenges due to a complex anatomy. Recent advances in endovascular technologies have expanded the use of coil embolization for small aneurysm treatment. However, limited reports describe their safety and efficacy profiles in very small anterior communicating artery aneurysms. Objective: We sought to review and report the immediate and long-term clinical as well as radiographic outcomes of consecutive patients with ruptured very small anterior communicating artery aneurysms treated with current endovascular coil embolization techniques. Methods: A prospectively maintained single-institution neuroendovascular database was accessed to identify consecutive cases of very small (<3 mm) ruptured anterior communicating artery aneurysms treated endovascularly between 2006 and 2013. Results: A total of 20 patients with ruptured very small (<3 mm) anterior communicating artery aneurysms were consecutively treated with coil embolization. The average maximum diameter was 2.66 ± 0.41 mm. Complete aneurysm occlusion was achieved for 17 (85%) aneurysms and near-complete aneurysm occlusion for 3 (15%) aneurysms. Intraoperative perforation was seen in 2 (10%) patients without any clinical worsening or need for an external ventricular drain. A thromboembolic event occurred in 1 (5 %) patient without clinical worsening or radiologic infarct. Median clinical follow-up was 12 (±14.1) months and median imaging follow-up was 12 (±18.4) months. Conclusion: This report describes the largest series of consecutive endovascular treatments of ruptured very small anterior communicating artery aneurysms. These findings suggest that coil embolization of very small aneurysms in this location can be performed with acceptable rates of complications and recanalization.

Flow-Diverting Stents for Intracranial Bifurcation Aneurysm Treatment

Neurosurgery ◽  
2014 ◽  
Vol 75 (6) ◽  
pp. 623-631 ◽  
Author(s):  
Suzana Saleme ◽  
Christina Iosif ◽  
Sanita Ponomarjova ◽  
George Mendes ◽  
Yann Camilleri ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Flow Diverter ◽  
Side Branch ◽  
Anterior Communicating Artery ◽  
Aneurysm Treatment ◽  
Bifurcation Aneurysm ◽  
Group A ◽  
Group B ◽  
Permanent Neurological Deficit

Abstract Background: Although initially considered safe when covering bifurcation sites, flow-diverting stents may provoke thrombosis of side branches that are covered during aneurysm treatment. Objective: To understand the occurrence and clinical expression of side-branch remodeling in distal intracranial arterial sites after flow diverter deployment by means of correlation of imaging and clinical data. Methods: We analyzed our prospectively collected data on a series of patients treated with flow diverters for intracranial aneurysms at bifurcation sites. From February 2011 to May 2013, 32 patients with 37 aneurysms (anterior communicating artery, 9 [24.3%]; anterior cerebral artery, 5 [13.5%]; middle cerebral artery, 19 (51.4%); terminal internal carotid artery, 4 [10.8%]) were treated. We divided aneurysms into 2 groups based on the side branches covered by the stent during treatment. Group A consisted of cases with side branches that supplied brain territories also receiving a direct collateral supply. Group B consisted of cases in which side branches supplied territories without direct collateral supply. The 2 groups were compared statistically. Results: Total exclusion occurred in 97.3% of aneurysms at follow-up. Initial modified Rankin Scale (mRS) score was 0 to 1 for 29 patients (90.6%) and 2 for 3 patients (9.4%). New permanent neurological deficit was reported in 3 patients (9.4%). At the 6-month follow-up, the mRS score was 0 to 1 for 31 patients (96.8%) and 3 for 1 patient (3.2%). Although 78.5% of side branches in group A underwent narrowing or occlusion after 6 months, no new stroke was found on magnetic resonance imaging. Conclusion: Symptomatic modifications of side branches after flow diverter treatment depend on the extent and type of collateral supply.

scholarly journals Microsurgical treatment of basilar tip aneurysms: is it still acceptable?

2017 ◽  
Vol 75 (10) ◽  
pp. 697-702
Author(s):  
Felix Hendrik Pahl ◽  
Matheus Fernandes de Oliveira ◽  
José Marcus Rotta
Keyword(s):  
Surgical Treatment ◽  
Glasgow Outcome Scale ◽  
Surgical Results ◽  
Success Rates ◽  
Giant Aneurysms ◽  
Complex Anatomy ◽  
Scale Scores ◽  
Complete Exclusion ◽  
Small Aneurysms

ABSTRACT Basilar tip aneurysms (BTAs) have a complex anatomy, making them difficult to treat. We describe our surgical results for BTAs. Methods: From 2004 to 2015 (12 years), a total of 25 small BTAs and two giant BTAs were treated in the Hospital do Servidor Público Estadual de São Paulo. Results: In 23 patients harboring aneurysms positioned anteriorly or straight, all aneurysms were clipped (complete exclusion in all on follow-up angiography). In two patients with posteriorly positioned aneurysms, there was residual neck. All patients submitted to surgical treatment of small aneurysms presented with late Glasgow Outcome Scale scores of 4 or 5. Two patients with giant aneurysms died. Conclusion: Surgical treatment of these lesions may be accomplished with quite high success rates and low morbidity.

scholarly journals Rare Recurrence of Traumatic Carotid Cavernous Fistula after Parent Artery Occlusion—Report of Two Cases and Review of Literature

2018 ◽  
Vol 02 (02) ◽  
pp. 101-105
Author(s):  
Savith Kumar ◽  
Virender Malik ◽  
Jayadevan Rajan ◽  
Santhosh Kannath
Keyword(s):  
Arterial Wall ◽  
Therapeutic Option ◽  
Artery Occlusion ◽  
Vasa Vasorum ◽  
Parent Artery ◽  
Review Of Literature ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Parent Artery Occlusion ◽  
Complete Exclusion

AbstractThe authors present two cases of recurrence of traumatic carotid cavernous fistula (CCF) following complete exclusion by parent artery occlusion (PAO). In both cases, the fistula recurred through the development of indirect CCF and reconstitution of the occluded artery through the development of vasa vasorum or simple recanalization of the parent artery. The cavernous venous sac was patent in both cases. The patent cavernous sac along with the inflammatory or angiogenetic factors might have induced dural neovascularization leading to the development of indirect CCF. These factors along with ischemia of the arterial wall secondary to the steal phenomenon due to persistent shunt flow would have triggered the development of vasa vasorum. Thus the cavernous sac embolization may have to be considered in addition to PAO when PAO is planned as a therapeutic option for direct CCF.

scholarly journals Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms

2016 ◽  
Vol 74 (4) ◽  
pp. 314-319
Author(s):  
Felix Hendrik Pahl ◽  
Matheus Fernandes de Oliveira ◽  
Roger Schmidt Brock ◽  
José Erasmo Dal Col Lucio ◽  
José Marcus Rotta
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Flow Diverter ◽  
Good Choice ◽  
Endovascular Technique ◽  
Surgical Clipping ◽  
Paraclinoid Aneurysms ◽  
Complete Exclusion ◽  
Extradural Approach

ABSTRACT Paraclinoid aneurysms are lesions located adjacent to the clinoid and ophthalmic segments of the internal carotid artery. In recent years, flow diverter stents have been introduced as a better endovascular technique for treatment of these aneurysms. Method From 2009 to 2014, a total of 43 paraclinoid aneurysms in 43 patients were surgically clipped. We retrospectively reviewed the records of these patients to analyze clinical outcomes. Results Twenty-six aneurysms (60.5%) were ophthalmic artery aneurysms, while 17 were superior hypophyseal artery aneurysms (39.5%). The extradural approach to the clinoid process was used to clip these aneurysms. One hundred percent of aneurysms were clipped (complete exclusion in 100% on follow-up angiography). The length of follow-up ranged from 1 to 60 months (mean, 29.82 months). Conclusion Surgical clipping continues to be a good option for the treatment of paraclinoid aneurysms.

scholarly journals First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating

2021 ◽  
Vol 12 ◽  
Author(s):  
Helge Winters ◽  
Marie-Sophie Schüngel ◽  
Cordula Scherlach ◽  
Dirk Mucha ◽  
Jörg Thalwitzer ◽  
...  
Keyword(s):  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Flow Diverter ◽  
Parent Vessel ◽  
Anterior Circulation ◽  
Low Profile ◽  
Procedural Complications ◽  
Caroticocavernous Fistula ◽  
Treatment For Cerebral Aneurysms

Background: In the last decade, flow diversion (FD) has been established as hemodynamic treatment for cerebral aneurysms arising from proximal and distal cerebral arteries. However, two significant limitations remain—the need for 0.027” microcatheters required for delivery of most flow diverting stents (FDS), and long-term dual anti-platelet therapy (DAPT) in order to prevent FDS-associated thromboembolism, at the cost of increasing the risk for hemorrhage. This study reports the experience of three neurovascular centers with the p64MW-HPC, a FDS with anti-thrombotic coating that is implantable via a 0.021” microcatheter.Materials and methods: Three neurovascular centers contributed to this retrospective analysis of patients that had been treated with the p64MW-HPC between March 2020 and March 2021. Clinical data, aneurysm characteristics, and follow-up results, including procedural and post-procedural complications, were recorded. The hemodynamic effect was assessed using the O'Kelly–Marotta Scale (OKM).Results: Thirty-two patients (22 female, mean age 57.1 years) with 33 aneurysms (27 anterior circulation and six posterior circulation) were successfully treated with the p64MW-HPC. In 30/32 patients (93.75%), aneurysmal perfusion was significantly reduced immediately post implantation. Follow-up imaging was available for 23 aneurysms. Delayed aneurysm perfusion (OKM A3: 8.7%), reduction in aneurysm size (OKM B1-3: 26.1%), or sufficient separation from the parent vessel (OKM C1-3 and D1: 65.2%) was demonstrated at the last available follow-up after a mean of 5.9 months. In two cases, device thrombosis after early discontinuation of DAPT occurred. One delayed rupture caused a caroticocavernous fistula. The complications were treated sufficiently and all patients recovered without permanent significant morbidity.Conclusion: Treatment with the p64MW-HPC is safe and feasible and achieves good early aneurysm occlusion rates in the proximal intracranial circulation, which are comparable to those of well-established FDS. Sudden interruption of DAPT in the early post-interventional phase can cause in-stent thrombosis despite the HPC surface modification. Deliverability via the 0.021” microcatheter facilitates treatment in challenging vascular anatomies.

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