scholarly journals Open-cell stent and use of cone-beam CT enables a safe and effective coil embolization of true ophthalmic artery and anterior choroidal artery aneurysms with preservation of parent vessel: Clinical and angiographic results

2017 ◽  
Vol 24 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Samuel Y Hou ◽  
Anna Luisa Kühn ◽  
Ajit S Puri ◽  
Ajay K Wakhloo
Keyword(s):  
Coil Embolization ◽  
Ophthalmic Artery ◽  
Intraoperative Imaging ◽  
Cone Beam ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Open Cell ◽  
Anterior Choroidal ◽  
Choroidal Artery

Background Treatment of true ophthalmic artery (OA) or anterior choroidal artery (AChA) aneurysms with preservation of the parent vessel may be challenging. Flow diverters have limitations when dealing with branch vessels arising from the aneurysm sac. Visual loss or AChA territory infarcts have been reported both for surgical and endovascular treatment. Methods We evaluated the safety and efficacy of an open-cell design, laser-cut, self-expanding Nitinol stent, and use of cone-beam computed tomography (CBCT) for stent-assisted coil embolization. Results A total of seven patients with unruptured OA or AChA aneurysms were enrolled in this prospective small case study and the data were analyzed retrospectively. A complete obliteration was achieved in all aneurysms immediately post-intervention or at six-month follow-up without any evidence for recanalization at up to three-year follow-up. All patients tolerated the procedure well and there was no change in baseline modified Rankin Scale. Conclusions Our study suggests that specific features of an open-cell stent allow a safe and effective treatment of OA or AChA aneurysms with a high technical success rate and excellent mid-term angiographic and clinical outcome. CBCT is a useful intraoperative imaging tool.

scholarly journals Patency of the anterior choroidal artery covered with a flow-diverter stent

2015 ◽  
Vol 123 (6) ◽  
pp. 1540-1545 ◽  
Author(s):  
Hiroaki Neki ◽  
Jildaz Caroff ◽  
Pakrit Jittapiromsak ◽  
Nidhal Benachour ◽  
Cristian Mihalea ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Clinical Symptoms ◽  
Flow Diverter ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Flow Diverter Stent ◽  
Anterior Choroidal ◽  
Long Course ◽  
Choroidal Artery

OBJECT The concept of the flow-diverter stent (FDS) is to induce aneurysmal thrombosis while preserving the patency of the parent vessel and any covered branches. In some circumstances, it is impossible to avoid dangerously covering small branches, such as the anterior choroidal artery (AChA), with the stent. In this paper, the authors describe the clinical and angiographic effects of covering the AChA with an FDS. METHODS Between April 2011 and July 2013, 92 patients with intracranial aneurysms were treated with the use of FDSs in the authors’ institution. For 20 consecutive patients (21.7%) retrospectively included in this study, this involved the unavoidable covering of the AChA with a single FDS during endovascular therapy. AChAs feeding the choroid plexus were classified as the long-course group (14 cases), and those not feeding the choroid plexus were classified as the short-course group (6 cases). Clinical symptoms and the angiographic aspect of the AChA were evaluated immediately after stent delivery and during follow-up. Neurological examinations were performed to rule out hemiparesis, hemihypesthesia, hemianopsia, and other cortical signs. RESULTS FDS placement had no immediate effect on AChA blood flow. Data were obtained from 1-month clinical follow-up in all patients and from midterm angiographic follow-up in 17 patients (85.0%), with a mean length of 9.8 ± 5.4 months. No patient in either group complained of transient or permanent symptoms related to an AChA occlusion. In all cases, the AChA remained patent without any flow changes. CONCLUSIONS The results of this study suggest that when impossible to avoid, the AChA may be safely covered with a single FDS during intracranial aneurysm treatment, irrespective of anatomy and anastomoses.

Endovascular coil embolization of anterior choroidal artery aneurysms

2009 ◽  
Vol 111 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Hyun-Seung Kang ◽  
Bae Ju Kwon ◽  
O-Ki Kwon ◽  
Cheolkyu Jung ◽  
Jeong Eun Kim ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Thromboembolic Events ◽  
Anterior Choroidal Artery ◽  
Endovascular Coil Embolization ◽  
Anterior Choroidal ◽  
Choroidal Artery

Object Anterior choroidal artery (AChA) aneurysms are difficult to treat, and the clinical outcome of patients is occasionally compromised by ischemic complications after clipping operations. The purpose of this study was to document the outcome and follow-up results of endovascular coil embolization in patients with AChA aneurysms. Methods Between July 1999 and March 2008, 88 patients with 90 AChA aneurysms (31 ruptured and 59 unruptured aneurysms) were treated with endovascular coil embolization in 91 sessions. There were 87 small aneurysms (< 10 mm) and 3 large aneurysms, with a mean aneurysm volume of 60.9 ± 83.3 mm3. Preprocedural oculomotor nerve palsy associated with AChA aneurysms was noted in 8 patients. Efficacy and safety were evaluated based on the degree of initial occlusion, procedure-related complications, patient outcome based on the Glasgow Outcome Scale score, and follow-up results. Results The degree of angiographic occlusion of the aneurysms was complete for 15 aneurysms (17%), near complete for 69 aneurysms (77%) and partial for 6 aneurysms (7%). There were 4 (4.4%) symptomatic procedure-related complications (3 thromboembolic events and 1 procedural hemorrhage). The procedural hemorrhage resulted in death; however, the thromboembolic events only caused transient deficits. A favorable outcome (Glasgow Outcome Scale score of 5 or 4) was achieved in 90% (79 of 88) of the patients at the time of discharge. No patient showed signs of bleeding or rebleeding during the follow-up period (mean 25 months). Major aneurysm recanalization occurred in 2 cases. The AChA aneurysm–associated oculomotor nerve palsy tended to become aggravated transiently after coil embolization and then completely recovered over the course of 2–9 months. Conclusions Coil embolization is a safe and effective treatment modality in cases of AChA aneurysms. Coil embolization enables procedural recognition of arterial compromise and immediate reestablishment of flow, thus contributing to a favorable outcome.

scholarly journals Surgical Challenges Associated With Anterior Choroidal Artery Aneurysm Clipping: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (3) ◽  
pp. E289-E289
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Region Of Interest ◽  
Artery Aneurysm ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Institutional Review ◽  
Adjacent Structures ◽  
Clip Application ◽  
Anterior Choroidal ◽  
Choroidal Artery

Abstract Surgical treatment of anterior choroidal artery (AChA) aneurysms is challenging because of the constrained operative corridor and limitations imparted by the surrounding rigid structures during the exposure. The AChA most commonly arises as a single branch from the communicating (C7) segment of the internal carotid artery but has 2 to 4 branches in approximately one-third of cases, and aneurysms generally arise from the parent vessel interface with these branches. This patient experienced a sentinel headache 4 d before presenting with subarachnoid hemorrhage. The patient had a large right AChA aneurysm with a unique configuration in which the parent vessel was located anterior to the aneurysm. Endovascular therapy was aborted because there was an AChA branch at the base of the aneurysm. An orbitozygomatic craniotomy was performed that provided transsylvian access to the region of interest. Clip application was challenging because of the close proximity of the branch vessels. Intraoperative indocyanine green evaluation and postoperative angiogram showed patency of the AChA and posterior communicating artery. This video demonstrates the surgical challenge associated with AChA aneurysms because of the proximity of adjacent structures and highlights the importance of meticulous technique during clip application. 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 Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations

2017 ◽  
Vol 126 (4) ◽  
pp. 1114-1122 ◽  
Author(s):  
Alaa Elkordy ◽  
Hidenori Endo ◽  
Kenichi Sato ◽  
Yasushi Matsumoto ◽  
Ryushi Kondo ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Open Surgery ◽  
Gamma Knife Radiosurgery ◽  
Internal Capsule ◽  
Endovascular Embolization ◽  
Anterior Choroidal Artery ◽  
Cerebral Avms ◽  
Anterior Choroidal ◽  
Choroidal Artery

OBJECTIVE The anterior and posterior choroidal arteries are often recruited to supply arteriovenous malformations (AVMs) involving important paraventricular structures, such as the basal ganglia, internal capsule, optic radiation, lateral geniculate body, and medial temporal lobe. Endovascular embolization through these arteries is theoretically dangerous because they supply eloquent territories, are of small caliber, and lack collaterals. This study aimed to investigate the safety and efficacy of embolization through these arteries. METHODS This study retrospectively reviewed 13 patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between 2006 and 2014. Embolization was performed as a palliative procedure before open surgery or Gamma Knife radiosurgery. Computed tomography and MRI were performed the day after embolization to assess any surgical complications. The incidence and type of complications and their association with clinical outcomes were analyzed. RESULTS Decreased blood flow was achieved in all patients after embolization. Postoperative CT detected no hemorrhagic complications. In contrast, postoperative MRI detected that 4 of the 13 patients (30.7%) developed infarctions: 3 patients after embolization through the anterior choroidal artery, and 1 patient after embolization through the lateral posterior choroidal artery. Two of the 4 patients in whom embolization was from the cisternal segment of the anterior choroidal artery (proximal to the plexal point) developed symptomatic infarction of the posterior limb of the internal capsule, 1 of whom developed morbidity (7.7%). The treatment-related mortality rate was 0%. Additional treatment was performed in 12 patients: open surgery in 9 and Gamma Knife radiosurgery in 3 patients. Complete obliteration was confirmed by angiography at the last follow-up in 10 patients. Recurrent bleeding from the AVMs did not occur in any of the cases during the follow-up period. CONCLUSIONS Ischemic complications are possible following the embolization of cerebral AVMs through the choroidal artery, even with modern neurointerventional devices and techniques. Although further study is needed, embolization through the choroidal artery may be an appropriate treatment option when the risk of surgery or radiosurgery is considered to outweigh the risk of embolization.

scholarly journals Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1064-1069 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Stephan A. Munich ◽  
Naser Jaleel ◽  
Marshall C. Cress ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Side Branch ◽  
Terminal Branch ◽  
Anterior Choroidal Artery ◽  
Anterior Circulation ◽  
Branch Vessel ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Ophthalmic Arteries

OBJECTIVE The Pipeline Embolization Device (PED) has become increasingly used for the treatment of intracranial aneurysms. Given its high metal surface area coverage, there is concern for the patency of branch vessels that become covered by the device. Limited data exist regarding the patency of branch vessels adjacent to aneurysms that are covered by PEDs. The authors assessed the rate of intracranial internal carotid artery, anterior circulation branch vessel patency following PED placement at their institution. METHODS The authors retrospectively reviewed the records of 82 patients who underwent PED treatment between 2009 and 2014 and in whom the PED was identified to cover branch vessels. Patency of the anterior cerebral, posterior communicating, anterior choroidal, and ophthalmic arteries was evaluated using digital subtraction angiography preoperatively and postoperatively after PED deployment and at longer-term follow-up. RESULTS Of the 127 arterial branches covered by PEDs, there were no immediate postoperative occlusions. At angiographic follow-up (mean 10 months, range 3–34.7 months), arterial side branches were occluded in 13 (15.8%) of 82 aneurysm cases and included 2 anterior cerebral arteries, 8 ophthalmic arteries, and 3 posterior communicating arteries. No cases of anterior choroidal artery occlusion were observed. Patients with branch occlusion did not experience any neurological symptoms. CONCLUSIONS In this large series, the longer-term rate of radiographic side branch arterial occlusion after coverage by a flow diverter was 15.8%. Terminal branch vessels, such as the anterior choroidal artery, remained patent in this series. The authors' series suggests that branch vessel occlusions are clinically silent and should not deter aneurysm treatment with flow diversion.

scholarly journals Delayed brain infarction caused by mechanical compression of the anterior choroidal artery after coil embolization for a large internal carotid-posterior communicating artery aneurysm: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2093375
Author(s):  
Naoki Wakuta ◽  
Satoshi Yamamoto
Keyword(s):  
Coil Embolization ◽  
Internal Carotid ◽  
Brain Infarction ◽  
Artery Aneurysm ◽  
Posterior Communicating Artery ◽  
Anterior Choroidal Artery ◽  
Mechanical Compression ◽  
Posterior Communicating Artery Aneurysm ◽  
Anterior Choroidal ◽  
Choroidal Artery

A 65-year-old male received coil embolization for a large internal carotid-posterior communicating artery aneurysm. Pre- and postoperative angiography at surgery demonstrated that the ipsilateral anterior choroidal artery branched from the internal carotid artery near the distal side of the aneurysm, and elevated and expanded on the aneurysmal dome, but was clearly visualized. Three days following endovascular treatment, the patient presented hemiparesis on the left side, with brain infarction in the territory of the right anterior choroidal artery despite antithrombotic therapy. The delayed brain infarction was likely caused by a reduction in anterior choroidal artery perfusion caused by mechanical compression following a postoperative increase in internal carotid-posterior communicating artery aneurysmal volume during intra-aneurysmal thrombosis. Transient volume expansion after coil embolization for intracranial aneurysms is rarely reported as a cause of brain infarction. It is important to recognize these arteries as potential postoperative complication risks, and consider the use of open surgery to avoid this risk.

Surgical Treatment of 127 Anterior Choroidal Artery Aneurysms A Cohort Study of Resultant Ischemic Complications

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 933-940 ◽  
Author(s):  
Bradley N. Bohnstedt ◽  
William J. Kemp ◽  
Yiping Li ◽  
Troy D. Payner ◽  
Terry G. Horner ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radiation Treatment ◽  
Small Diameter ◽  
Fisher Exact Test ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Complex Anatomy ◽  
Anterior Choroidal ◽  
Temporary Clip ◽  
Choroidal Artery

Abstract BACKGROUND: The anterior choroidal artery (AChA) supplies important areas of the nervous system, particularly the posterior limb of the internal capsule and optic radiation. Treatment of AChA aneurysms poses particular challenges because of the complex anatomy of the aneurysm associated with the relatively small diameter of AChAs, making preservation of the parent vessel during clip ligation or endosaccular coiling challenging. OBJECTIVE: To investigate the incidence and features of ischemia in treatment of AChA aneurysms. METHODS: A prospectively maintained database of patients who underwent treatment of aneurysms from 1985 to 2011 was queried to find patients with AChA aneurysms. Age, sex, Hunt and Hess grade, treatment modality, and complications were analyzed by use of the unpaired Student t test and Fisher exact test. RESULTS: One hundred twenty-two patients harbored 127 AChA aneurysms, and 67% (82 of 122) had multiple aneurysms. Treatment included 112 microsurgical clip ligations, 8 endosaccular coil embolizations, 5 aneurysmal wrappings, and 2 surgical explorations. Complications developed in 53% (67 of 127) of AChA aneurysms. Postoperative ischemia occurred in 12% (15 of 127) of treated aneurysms. The number of temporary clip applications was most closely associated with postoperative ischemia. Glasgow Outcome Scale scores of 4 or 5 were obtained by 78% at discharge, 89% at 6 months, and 85% at 1 year. CONCLUSION: The ischemic complication rate from surgical treatment of AChA aneurysms is most closely associated with higher frequency of temporary clip applications for proximal control and may be lower than previously reported. Supplementary intraoperative tools and limitation of vessel manipulation should be used to improve outcomes.

Sign in / Sign up

Export Citation Format

Share Document