A Surgical Case of Delayed Coil Migration After Balloon-Assisted Embolization of an Intracranial Broad-Neck Aneurysm: Case Report

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. onsE516-onsE521 ◽  
Author(s):  
Hiroaki Motegi ◽  
Masanori Isobe ◽  
Toyohiko Isu ◽  
Hiroyasu Kamiyama
Keyword(s):  
Coil Embolization ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Tension Headache ◽  
Temporal Artery ◽  
Carotid Bifurcation ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Ischemic Attack ◽  
Coil Migration

ABSTRACT BACKGROUND AND IMPORTANCE: Balloon-assisted coil placement is an important technique for coil embolization of broad-neck aneurysms. With this technique, we can prevent coil migration into a parent artery during a procedure. Complications of intraprocedural coil migration have been reported in the literature. However, delayed coil migration is extremely rare. We present a case of delayed coil migration after balloon-assisted coil embolization and describe our management of this complication. CLINICAL PRESENTATION: A 59-year-old man presented with hypertension and a tension headache. Clinical evaluation incidentally discovered an unruptured broad-neck aneurysm at the left internal carotid bifurcation. Endovascular embolization of the aneurysm was performed with a balloon-assisted technique. The patient had a transient ischemic attack, and a skull radiograph showed coil migration 3 months after the procedure. We performed an operation to remove the coils and to clip the aneurysm with superficial temporal artery and middle cerebral artery bypass. The patient was discharged without neurological deficit. CONCLUSION: This is a rare case in which delayed coil migration into the parent artery occurred after balloon-assisted coil embolization, highlighting the importance of surgical management of delayed coil migration.

scholarly journals Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

2013 ◽  
Vol 19 (2) ◽  
pp. 222-227 ◽  
Author(s):  
S.H. Shin ◽  
I.S. Choi ◽  
K. Thomas ◽  
C.A. David
Keyword(s):  
Pediatric Patient ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Giant Aneurysm ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Endovascular Management ◽  
Excellent Outcome ◽  
Parent Artery Occlusion

Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion

2014 ◽  
Vol 14 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Adib A. Abla ◽  
Hasan A. Zaidi ◽  
R. Webster Crowley ◽  
Gavin W. Britz ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Thrombus Formation ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Mass Effect ◽  
Parent Artery ◽  
Parent Vessel ◽  
Vessel Occlusion ◽  
Unsuccessful Treatment ◽  
Parent Artery Occlusion

Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery–middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm. Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED.

Dural Arteriovenous Fistulae After Cerebral Infarction

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E575-E580 ◽  
Author(s):  
Mami Hanaoka ◽  
Shunji Matsubara ◽  
Koichi Satoh ◽  
Shinji Nagahiro
Keyword(s):  
Cerebral Infarction ◽  
Moyamoya Disease ◽  
De Novo ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Sigmoid Sinus ◽  
Arteriovenous Fistulae ◽  
One Year ◽  
Ischemic Attack

Abstract BACKGROUND AND IMPORTANCE: We first report 2 patients in whom dural arteriovenous fistulae (dAVFs) developed after cerebral infarction. CLINICAL PRESENTATION: One patient was a 49-year-old man who had a right embolic stroke 6 months after his first ischemic attack. Angiograms showed a de novo left transverse sigmoid sinus dAVF. One year later, shunt flow through the dAVF was increased. The second patient was a 45-year-old woman who presented with right cerebral infarction and moyamoya disease. Three weeks later, she underwent right superficial temporal artery–middle cerebral artery bypass. Ten months after the operation, angiograms showed the development of dAVFs in the left transverse sigmoid sinus and progressive moyamoya disease. CONCLUSION: We document the first patients with cerebral infarction and progressive moyamoya disease in whom a de novo dAVF developed. Moyamoya disease and dAVF are associated with an increase in dural angiogenic factors, and ischemia induces their increase. This may be the mechanism by which vaso-occlusive ischemia contributes to the formation of de novo dAVFs.

Intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis: A case report

2020 ◽  
pp. 159101992096535
Author(s):  
Ken Uekawa ◽  
Yasuyuki Kaku ◽  
Toshihiro Amadatsu ◽  
Hiroaki Matsuzaki ◽  
Yuki Ohmori ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Coil Embolization ◽  
De Novo ◽  
Superficial Temporal Artery ◽  
Vascular Complications ◽  
Temporal Artery ◽  
Left Internal Carotid Artery ◽  
Parent Artery ◽  
Parent Artery Occlusion ◽  
Dissecting Aneurysms

Objective We describe a case of intracranial and extracranial multiple arterial dissecting aneurysms in rheumatoid arthritis (RA). Case Presentation A 29-year-old man with a medical history of RA since 18 years of age was admitted to our hospital for vomiting, dysarthria, and conscious disturbance. At 23, he underwent ligation of the left internal carotid artery (ICA) with superficial temporal artery to middle cerebral artery anastomosis because of acute infarct of the left hemisphere caused by arterial dissection of the left ICA. During the current admission, computed tomography (CT) revealed subarachnoid hemorrhage, and digital subtraction angiography (DSA) demonstrated dissecting aneurysms of the left intracranial vertebral artery (VA) and right extracranial VA. We diagnosed him with a ruptured dissecting aneurysm of the left intracranial VA and performed endovascular parent artery occlusion on the left VA. For the right unruptured VA aneurysm, we performed coil embolization simultaneously. At 2 weeks after the endovascular treatment, follow-up DSA revealed that multiple de novo dissecting aneurysms developed on the origin of the left VA and left and right internal thoracic arteries. Those aneurysms were treated with coil embolization. Other remaining aneurysms on the left thyrocervical trunk, right transverse cervical artery, and both common iliac arteries were treated by conservative therapy. While continuing medical treatment for RA, the patient recovered and was discharged to a rehabilitation hospital. Conclusion Considering that RA-induced vasculitis can be a potential risk of vascular complications including multiple arterial dissections, physicians should carefully perform endovascular interventional procedures for patients with long-term RA.

scholarly journals Superficial temporal artery–superior cerebellar artery bypass and trapping of a fusiform aneurysm using intradural anterior petrosectomy: technical case report and anatomical study

2019 ◽  
Vol 46 (2) ◽  
pp. E9
Author(s):  
Soichi Oya ◽  
Masahiro Indo ◽  
Masabumi Nagashima ◽  
Toru Matsui
Keyword(s):  
Artery Bypass ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Anatomical Study ◽  
Temporal Artery ◽  
Distal Portion ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Cerebellar Artery ◽  
Anterior Petrosectomy

Aneurysms at the distal portion of the superior cerebellar artery (SCA) are very rare. Because of the deep location and a propensity for nonsaccular morphology, aneurysm trapping or endovascular occlusion of the parent artery are the usual treatment options, which are associated with varying risks of ischemic complications. The authors report on a 60-year-old woman who had a 3.5-mm unruptured aneurysm in the lateral pontomesencephalic segment of the SCA with a significant interval growth to 8 mm. Direct surgical intervention comprising trapping of the aneurysm through a subtemporal approach and intradural anterior petrosectomy combined with revascularization of the distal SCA using the superficial temporal artery (STA) was performed. This approach provided sufficient space for the bypass instruments to be introduced into the deep surgical field at a more favorable angle to enhance microscopic visualization of the anastomosis with minimal retraction of the temporal lobe. The patient was discharged with no neurological deficit. Preservation of the blood flow in the distal SCA should be attempted to minimize the risk of ischemic injury, particularly when the aneurysms arise in the anterior or lateral segment of the SCA. The authors demonstrate the safety and effectiveness of the intradural anterior petrosectomy for STA-SCA bypass along with a relevant anatomical study.

scholarly journals Patients Receiving Extracranial to Intracranial Bypass for Atherosclerotic Vessel Occlusion Today Differ Significantly From the COSS Population

Stroke ◽  
2021 ◽  
Vol 52 (10) ◽  
Author(s):  
Lars Wessels ◽  
Nils Hecht ◽  
Peter Vajkoczy
Keyword(s):  
Cerebrovascular Disease ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Multivessel Disease ◽  
Vessel Occlusion ◽  
Ischemic Attack

Background and Purpose: Despite the findings reported in the COSS (Carotid Occlusion Surgery Study), patients with atherosclerotic cerebrovascular disease continue to be referred for superficial temporal artery to middle cerebral artery bypass surgery. Here, we determined how today’s patients differ from the population reported in COSS. Methods: We retrospectively analyzed all patients that were referred to our Department for superficial temporal artery to middle cerebral artery bypass surgery of atherosclerotic cerebrovascular disease following the publication of COSS. Results: Between 2012 and 2019, 179 patients were referred for 186 bypass surgeries. Ninety-one (51%) patients suffered atherosclerotic, unilateral internal carotid occlusion and 88 (49%) atherosclerotic multivessel disease. All patients had received intensive medical management. A single transitory ischemic attack or ischemic stroke within the last 120 days according to the inclusion criteria of COSS occurred in only 36 out of 179 (20%) patients, whereas 27 out of 179 (15%) suffered >1 transitory ischemic attack within 120 days, 109 out of 179 (61%) had recurrent minor ischemic stroke, and 7 out of 179 (4%) were hemodynamically unstable and required blood pressure maintenance. The distribution of symptoms did not differ between atherosclerotic unilateral internal carotid artery occlusion and atherosclerotic multivessel disease ( P =0.376) but hemodynamic impairment was significantly greater in atherosclerotic multivessel disease ( P <0.001 for atherosclerotic multivessel disease versus atherosclerotic unilateral internal carotid artery occlusion). The overall perioperative stroke rate was 4.3%. Conclusions: Patients referred for flow augmentation surgery today appear to suffer more severe symptoms and vessel occlusion patterns than patients reported in COSS. A new, carefully designed randomized controlled trial appears warranted, considering the still poor prognosis of severe atherosclerotic cerebrovascular disease.

Revascularization and Parent Artery Occlusion for Giant Internal Carotid Artery Aneurysms in the Intracavernous Portion Using Intraoperative Monitoring of Cerebral Hemodynamics

Neurosurgery ◽  
2006 ◽  
Vol 58 (1) ◽  
pp. 43-50 ◽  
Author(s):  
Yoshitaka Kubo ◽  
Kuniaki Ogasawara ◽  
Nobuhiko Tomitsuka ◽  
Yasunari Otawara ◽  
Shunsuke Kakino ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Artery Occlusion ◽  
High Flow ◽  
Parent Artery ◽  
Bypass Grafting ◽  
Parent Artery Occlusion

Abstract OBJECTIVE: Therapeutic parent artery occlusion with or without revascularization is a useful surgical technique for the management of a giant aneurysm located in the intracavernous portion of the internal carotid artery (ICA). The purpose of the present study was to determine whether intraoperative cortical blood flow (CoBF) monitoring during surgical parent artery occlusion could identify patients who required bypass with a saphenous vein graft (high flow bypass). METHODS: Eleven patients with a giant aneurysm located in the intracavernous portion of the ICA underwent superficial temporal artery-middle cerebral artery bypass. CoBF was monitored intraoperatively in all patients using a thermal diffusion flow probe. The lowest CoBF during test occlusion of the ICA under functioning superficial temporal artery-middle cerebral artery bypass was determined, and the ratio of the value to the CoBF immediately before test occlusion of the ICA was calculated in the frontal and temporal lobes. When the CoBF ratio in the frontal or temporal lobe was less than 0.9, high flow bypass grafting was elected. RESULTS: Of the eleven patients undergoing superficial temporal artery-middle cerebral artery bypass, five patients underwent concomitant high flow bypass grafting. Postoperative cerebral ischemic events did not occur in any patient over a follow-up period ranging from 3 to 60 months. Postoperative cerebral angiography showed resolution of the aneurysm and patency of the bypass in all patients. CONCLUSION: Intraoperative CoBF monitoring using a thermal diffusion flow probe during surgical parent artery occlusion for giant intracavernous carotid artery aneurysms can identify patients who require concomitant high flow bypass grafting.

scholarly journals Superficial temporal artery-superior cerebellar artery bypass and direct clipping of a large unruptured superior cerebellar artery aneurysm through subtemporal approach: Surgical video

2019 ◽  
Vol 10 ◽  
pp. 225
Author(s):  
Jiangyu Xue ◽  
Hugo Andrade-Barazarte ◽  
Gangqin Xu ◽  
Dongyang Cai ◽  
Yang Bowen ◽  
...  
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Superior Cerebellar Artery ◽  
Parent Artery ◽  
Subtemporal Approach ◽  
Cerebellar Artery

Background: Superior cerebellar artery (SCA) aneurysms are rare. Current treatments include: direct clipping, trapping ± bypass, and endovascular methods (coiling, stenting, or flow diversion). Due to specific characteristics (wide base, location, and shape), a major challenge while dealing with SCA aneurysms is to preserve the flow of the parent artery and perforators. This video demonstrates a revascularization procedure, and clip reconstruction of a large unruptured basilar artery (BA)/SCA aneurysm performed through the subtemporal approach. Case Description: A 60-year-old woman presented with dizziness and headaches. Computed tomography angiography (CTA) and digital subtraction angiography showed a right unruptured large BA/SCA aneurysm. After multidisciplinary discussion, and considering gender, age, risk factors of the patient. Endovascular treatment was considered with a high risk of ischemic complications. Therefore, the patient was consented for a superficial temporal artery (STA)-SCA bypass through subtemporal approach followed by direct clipping/ trapping of the aneurysm. Postoperative CTA showed occlusion of the aneurysm and patency of the parent vessels. Postoperatively, the patient experienced immediate transient left mild monoparesis and right IV nerve palsy, which recovered completely at 6-months follow-up. Results: Surgical treatment of SCA aneurysms is decreasing due to the existence of endovascular therapies such as stents and flow diverters. However, some cases may necessitate surgical treatment and revascularization procedures to maintain the blood flow of the parent artery and to treat the previous lesion. Conclusion: The STA-SCA bypass through the subtemporal approach is a feasible option to maintain the blood flow of the parent artery in cases of SCA requiring surgical treatment and trapping/direct clipping of the aneurysm.

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