Endovascular treatment of cavernous carotid artery aneurysms: A 10-year, single-center experience

2021 ◽  
pp. 197140092110134
Author(s):  
Hubert Lee ◽  
Thomas R Marotta ◽  
Julian Spears ◽  
Dipanka Sarma ◽  
Walter Montanera ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Artery Aneurysm ◽  
Treatment Modalities ◽  
Symptom Improvement ◽  
Consecutive Series ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Significant Difference ◽  
Cavernous Carotid Artery

Background Cavernous carotid artery aneurysms can be treated by several endovascular techniques including flow diversion (FD) and parent vessel occlusion (PVO). We reviewed our institution’s consecutive series of endovascularly treated cavernous carotid artery aneurysms to compare these two modalities and their associated clinical and radiographic outcomes. Methods All patients harboring a cavernous carotid artery aneurysm treated by FD or PVO from January 2008 to December 2018 were enrolled. Data were collected retrospectively and analyzed on patient presentation, aneurysm dimensions, treatments and related complications, rate of aneurysm occlusion, sac regression, and outcomes. Results Fourteen patients were treated with FD and 12 underwent PVO subsequent to passing a balloon test occlusion. There was no significant difference between treatment modalities in aneurysmal occlusion (97.0 ± 8.4% (FD) vs. 100% (PVO), p = 0.23), degree of sac regression (62.5 ± 16.7% (FD) vs. 56.8 ± 24.3% (PVO), p = 0.49), or near-complete to complete symptom improvement (66.7% (FD) vs. 81.8% (PVO), p = 0.62). Major complications included subarachnoid hemorrhage from aneurysmal rupture in 1 (7.1%) patient post-FD and 2 (16.7%) ischemic strokes following PVO. Conclusions Endovascular treatment of cavernous carotid artery aneurysms by FD or PVO are both effective and safe. There is insufficient evidence to recommend one technique over the other and decision making should be individualized to the patient, their aneurysm morphology, and operator experience.

Giant Cavernous-Segment Internal Carotid Artery Aneurysm Presenting with Cranial Neuropathy

2019 ◽  
pp. 129-136
Author(s):  
Jacob F. Baranoski ◽  
Tyler S. Cole ◽  
Colin J. Przybylowski ◽  
Rami O. Almefty ◽  
Dale Ding ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Artery Aneurysm ◽  
Flow Diversion ◽  
Cranial Neuropathy ◽  
Parent Vessel ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Procedural Complications ◽  
Technical Details ◽  
Cavernous Carotid Artery

Abstract: This chapter discusses issues surrounding the management of giant cavernous carotid artery aneurysms. These aneurysms most commonly present with symptoms of cranial neuropathy. They present a unique treatment challenge given their location and often large size. Endovascular flow diversion has emerged as the mainstay of treatment, although parent vessel sacrifice, high-flow bypass, and surgical trapping are important alternatives. Evaluation of the nature of collateral circulation and the tolerance of the intracranial circulation to carotid artery sacrifice should also be part of the work-up. The technical details of endovascular flow diversion strategy are described, as well as the management of known post-procedural complications.

Cavernous Carotid Artery Aneurysm Associated with Marfan's Syndrome: Treatment by Balloon Embolization Therapy

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 297-300 ◽  
Author(s):  
Randall T. Higashida ◽  
V. Van Halbach ◽  
Grant B. Hieshima ◽  
Leslie Cahan
Keyword(s):  
Carotid Artery ◽  
Intracranial Aneurysms ◽  
Alternative Therapy ◽  
Artery Aneurysm ◽  
Marfan’S Syndrome ◽  
Parent Vessel ◽  
Marfan's Syndrome ◽  
Carotid Artery Aneurysm ◽  
Cavernous Carotid Artery ◽  
Balloon Embolization

Abstract Intracranial aneurysms arising in the region of the cavernous carotid artery are difficult to manage surgically because of the surrounding cavernous sinus. With recent advances in microballoon technology and permanent solidification agents, it is now possible to treat certain intracranial aneurysms by detachable balloons and preserve the parent vessel. A patient with Marfan's syndrome presented with severe retroorbital pain, ophthalmoplegia, and headaches. Cerebral angiography demonstrated a large cavernous carotid artery aneurysm measuring 17 × 9 × 6 mm. This was successfully treated by placing three detachable balloons within the aneurysm and preserving the carotid artery via a transvascular approach. Intravascular detachable balloon embolization may offer a form of alternative therapy for the management of surgically difficult aneurysms. (Neurosurgery 22:297-300, 1988)

scholarly journals Large cavernous carotid artery aneurysm with spontaneous thrombosis: is there more to a change in morphology than there seems to be? Illustrative case

2021 ◽  
Vol 2 (7) ◽  
Author(s):  
Yoriko Kato ◽  
Wataro Tsuruta ◽  
Hisayuki Hosoo ◽  
Tetsuya Yamamoto
Keyword(s):  
Carotid Artery ◽  
Endovascular Treatment ◽  
Laboratory Data ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Illustrative Case ◽  
Hemorrhagic Diathesis ◽  
Unruptured Cerebral Aneurysm ◽  
Cavernous Carotid Artery ◽  
The Right

BACKGROUND The pathogenesis and endovascular treatment strategy for spontaneously thrombosed unruptured cerebral aneurysms have not yet been comprehensively described. OBSERVATIONS The authors reported on a 78-year-old woman who had large bilateral unruptured cavernous carotid artery aneurysms that induced chronic disseminated intravascular coagulation and acquired factor XIII deficiency. The right aneurysm was symptomatic and partially thrombosed. Hemorrhagic diathesis and abnormal values of laboratory data improved after administration of recombinant human thrombomodulin followed by endovascular treatment in which three pipeline embolization devices were deployed for the right aneurysm. LESSONS To the best of the authors’ knowledge, this was the first report of an unruptured cerebral aneurysm leading to coagulation disorders with clinical manifestation that was treated successfully by endovascular intervention after intensive perioperative management.

EXPRESS: Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion, a systematic review and meta-analysis

2021 ◽  
pp. 174749302110125
Author(s):  
Mingming Zha ◽  
Qingwen Yang ◽  
Shuo Liu ◽  
Min Wu ◽  
Kangmo Huang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Working Hours ◽  
Good Prognosis ◽  
Large Vessel ◽  
Cochrane Library ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Difference

Background There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). Aims This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. Summary of review Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through February 23rd, 2021. The primary outcomes were onset to door, door to imaging, door to puncture, puncture to recanalization, procedural time, successful recanalization, symptomatic intracerebral hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale [mRS] score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture, onset to puncture, onset to recanalization, door to recanalization time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer onset to door (WMD [95%CI], 12.83 [1.84-23.82] min), door to puncture (WMD [95%CI], 11.45 [5.93-16.97] min), imaging to puncture (WMD [95%CI], 10.39 [4.61-16.17] min), onset to puncture (WMD [95%CI], 25.30 [13.11-37.50] min), onset to recanalization (WMD [95%CI], 25.16 [10.28-40.04] min), and door to recanalization (WMD [95%CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95%CI], 0.85 [0.76-0.95]; P=0.004; I2=0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend towards lower OR of good prognosis was witnessed in the off-hour group (OR [95%CI], 0.92 [0.84-1.01]; P=0.084; I2=0%). Conclusions Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend towards worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.

scholarly journals Ruptured Petrous Carotid Pseudoaneurysm Due to Tuberculous Otitis: Endovascular Treatment

2006 ◽  
Vol 12 (1) ◽  
pp. 53-56 ◽  
Author(s):  
A.B. Yagci ◽  
F.N. Ardiç ◽  
I. Oran ◽  
F. Bir ◽  
N. Karabulut
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Unusual Case ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
Imaging Findings ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Artery Pseudoaneurysm

We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils.

scholarly journals Workflow Intervals of Endovascular Acute Stroke Therapy During On- Versus Off-Hours

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2842-2850 ◽  
Author(s):  
Wouter H. Hinsenveld ◽  
Inger R. de Ridder ◽  
Robert J. van Oostenbrugge ◽  
Jan A. Vos ◽  
Adrien E. Groot ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Large Vessel ◽  
Complication Rates ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Significant Difference

Background and Purpose— Endovascular treatment (EVT) of patients with acute ischemic stroke because of large vessel occlusion involves complicated logistics, which may cause a delay in treatment initiation during off-hours. This might lead to a worse functional outcome. We compared workflow intervals between endovascular treatment–treated patients presenting during off- and on-hours. Methods— We retrospectively analyzed data from the MR CLEAN Registry, a prospective, multicenter, observational study in the Netherlands and included patients with an anterior circulation large vessel occlusion who presented between March 2014 and June 2016. Off-hours were defined as presentation on Monday to Friday between 17:00 and 08:00 hours, weekends (Friday 17:00 to Monday 8:00) and national holidays. Primary end point was first door to groin time. Secondary end points were functional outcome at 90 days (modified Rankin Scale) and workflow time intervals. We stratified for transfer status, adjusted for prognostic factors, and used linear and ordinal regression models. Results— We included 1488 patients of which 936 (62.9%) presented during off-hours. Median first door to groin time was 140 minutes (95% CI, 110–182) during off-hours and 121 minutes (95% CI, 85–157) during on-hours. Adjusted first door to groin time was 14.6 minutes (95% CI, 9.3–20.0) longer during off-hours. Door to needle times for intravenous therapy were slightly longer (3.5 minutes, 95% CI, 0.7–6.3) during off-hours. Groin puncture to reperfusion times did not differ between groups. For transferred patients, the delay within the intervention center was 5.0 minutes (95% CI, 0.5–9.6) longer. There was no significant difference in functional outcome between patients presenting during off- and on-hours (adjusted odds ratio, 0.92; 95% CI, 0.74–1.14). Reperfusion rates and complication rates were similar. Conclusions— Presentation during off-hours is associated with a slight delay in start of endovascular treatment in patients with acute ischemic stroke. This treatment delay did not translate into worse functional outcome or increased complication rates.

scholarly journals Endovascular treatment of intracranial ‘blister’ and dissecting aneurysms

2019 ◽  
Vol 32 (5) ◽  
pp. 353-365 ◽  
Author(s):  
Marius G Kaschner ◽  
Bastian Kraus ◽  
Athanasios Petridis ◽  
Bernd Turowski
Keyword(s):  
Endovascular Treatment ◽  
Favourable Outcome ◽  
Modified Rankin Scale ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Parent Vessel Occlusion ◽  
Aneurysm Occlusion ◽  
Vessel Reconstruction ◽  
Dissecting Aneurysms

IntroductionBlister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging.PurposeThe purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms.MethodsWe retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004–2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed.ResultsThirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy ( n = 9), stent-assisted coiling ( n = 7), flow diverting stents ( n = 13) and coiling + Onyx embolization ( n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%.ConclusionTreatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.

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