Microneurosurgical Management of Ophthalmic Segment of the Internal Carotid Artery Aneurysms

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. 355-371 ◽  
Author(s):  
Anil Nanda ◽  
Vijayakumar Javalkar
Keyword(s):  
Carotid Artery ◽  
Clinical Outcome ◽  
Internal Carotid Artery ◽  
Effective Treatment ◽  
Internal Carotid ◽  
Predictors Of Outcome ◽  
Surgical Clipping ◽  
Poor Grade ◽  
Ophthalmic Segment Aneurysms

Abstract BACKGROUND: Surgical clipping of ophthalmic segment aneurysms is more technically challenging than other anterior circulation aneurysms. OBJECTIVE: To analyze whether surgical clipping is an effective treatment for ophthalmic segment aneurysms with good clinical outcomes and acceptable complication rates. METHODS: From 1994 to 2009, a total of 86 aneurysms of the ophthalmic segment of the internal carotid artery were surgically clipped in 80 patients. We retrospectively reviewed the records of these patients to analyze the clinical outcome. RESULTS: Of the 86 aneurysms, 68 (79%) were large or giant. Cranial base modification was required in 28 operations. Drilling of the anterior clinoid process was performed in 49 operations. The mean follow-up was 27.38 months. Of the 80 patients, 76 were assessable for clinical outcome. At the last follow-up, 5 patients had a Glasgow Outcome Scale (GOS) score of 1, 4 had a GOS score of 3, 10 had a GOS score of 4, and 57 had a GOS score of 5. Thus, the clinical outcome was good (GOS scores of 5 and 4) in the majority (88%) of patients. Of the 15 patients who presented with visual problems before surgery, 77% showed improvement after surgical clipping. The overall visual morbidity rate was 2.5%. Outcome assessment indicated that infarcts (P = .000), hydrocephalus (P = .001), and poor grade (P = .000) were significant negative predictors of outcome. CONCLUSION: Surgical clipping is an effective treatment for ophthalmic segment of the internal carotid artery aneurysms with excellent or good clinical outcome. Infarcts, hydrocephalus, and poor grade were significant negative predictors of outcome. Surgical clipping may facilitate improvement in vision by decompression of the visual apparatus.

scholarly journals Clinical outcome of patients with internal carotid artery occlusion: A prospective follow-up study

2000 ◽  
Vol 32 (2) ◽  
pp. 293-298 ◽  
Author(s):  
Fabio Verlato ◽  
Giuseppe Camporese ◽  
Enrico Bernardi ◽  
Giovanna Salmistraro ◽  
Stefano Rocco ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Clinical Outcome ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Internal Carotid Artery Occlusion ◽  
Follow Up Study

Abstract WMP19: Pattern of Internal Carotid Artery Calcification Modifies the Effect of Intravenous Thrombolysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Frans Kauw ◽  
Pim A de Jong ◽  
Richard A Takx ◽  
Hugo W de Jong ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Artery ◽  
Clinical Outcome ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Carotid Artery Calcification

Introduction: The pattern of intracranial internal carotid artery calcification (ICAC) has been identified as an effect modifier of endovascular treatment in patients with acute ischemic stroke, but it is unclear whether it modifies the effect of intravenous thrombolysis. We evaluated the association between intravenous thrombolysis and 90-day clinical outcome, follow-up infarct volume and recanalization across different patterns of ICAC. Methods: Three groups from the Dutch acute stroke study, a prospective multicentre observational cohort study, were analyzed: patients with ischemic stroke, a subgroup (1) of patients with intracranial anterior circulation occlusions and a subgroup (2) of patients with M1 occlusions. ICAC pattern was determined on admission thin-slice non-contrast CT and categorized as absent, intimal, medial or indistinguishable. The primary outcome was 90-day modified Rankin scale. Other outcomes included follow-up infarct volume, recanalization and collateral status. Associations were quantified with regression analyses and stratified by ICAC pattern. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for demographics, cardiovascular risk factors, stroke severity, occlusion site and collateral status. Results: Of the 982 patients 609 (62%) received intravenous thrombolysis and 381 (39%) had unfavorable clinical outcome. Intravenous thrombolysis was associated with a lower modified Rankin scale in the groups without ICAC (adjusted OR 0.3; 95% CI 0.1-0.9) and with a medial ICAC pattern (adjusted OR 0.5; 95% CI 0.3-0.8), but not in the groups with an intimal (adjusted OR 0.9;95%-CI:0.5-1.5) or indistinguishable pattern (adjusted OR 0.6; 95% CI 0.2-1.8). In subgroup 1 (n=220), intravenous thrombolysis was associated with recanalization only in the group with a medial ICAC pattern (adjusted OR 3.5; 95% CI 1.2-11.0). In subgroup 2 (n=148), compared to an intimal ICAC pattern a medial ICAC pattern was associated with good collateral status (adjusted OR 2.6; 95% CI 1.1-6.0). Conclusions: Intravenous thrombolysis was significantly related to favorable clinical outcome and recanalization in the group with a medial ICAC pattern, but not in the groups with other ICAC patterns.

Unruptured intracranial aneurysms in children: 18 years’ experience in a tertiary care pediatric institution

2019 ◽  
Vol 24 (2) ◽  
pp. 184-189 ◽  
Author(s):  
Daniel-Alexandre Bisson ◽  
Peter Dirks ◽  
Afsaneh Amirabadi ◽  
Manohar M. Shroff ◽  
Timo Krings ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Natural History ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Tertiary Care ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Mean Size

OBJECTIVEThere are little data in the literature on the characteristics and natural history of unruptured intracranial aneurysms in children. The authors analyzed their experience with unruptured intracranial aneurysms in the pediatric population at their tertiary care pediatric institution over the last 18 years. The first objective was to assess the imaging characteristics and natural history of these aneurysms in order to help guide management strategies in the future. A second objective was to evaluate the frequency of an underlying condition when an incidental intracranial aneurysm was detected in a child.METHODSThe authors conducted a Research Ethics Board–approved retrospective review of incidental intracranial aneurysms in patients younger than 18 years of age who had been treated at their institution in the period from 1998 to 2016. Clinical (age, sex, syndrome) and radiological (aneurysm location, type, size, thrombus, mass effect) data were recorded. Follow-up imaging was assessed for temporal changes.RESULTSSixty intracranial aneurysms occurred in 51 patients (36 males, 15 females) with a mean age of 10.5 ± 0.5 years (range 9 months–17 years). Forty-five patients (88.2%) had a single aneurysm, while 2 and 3 aneurysms were found in 3 patients each (5.8%). Syndromic association was found in 22 patients (43.1%), most frequently sickle cell disease (10/22 [45.5%]). Aneurysms were saccular in 43 cases (71.7%; mean size 5.0 ± 5.7 mm) and fusiform in the remaining 17 (28.3%; mean size 6.5 ± 2.7 mm). Thirty-one aneurysms (51.7%) arose from the internal carotid artery (right/left 1.4), most commonly in the cavernous segment (10/31 [32.3%]). Mean size change over the entire follow-up of 109 patient-years was a decrease of 0.6 ± 4.2 mm (range −30.0 to +4.0 mm, rate −0.12 ± 9.9 mm/yr). Interval growth (2.0 ± 1.0 mm) was seen in 8 aneurysms (13.3%; 4 saccular, 4 fusiform). An interval decrease in size (8.3 ± 10.7 mm) was seen in 6 aneurysms (10%). There was an inverse relationship between aneurysm size and growth rate (r = −0.82, p < 0.00001). One aneurysm was treated endovascularly with internal carotid artery sacrifice.CONCLUSIONSUnruptured pediatric intracranial aneurysms are most frequently single but can occur in multiples in a syndromic setting. None of the cases from the study period showed clinical or imaging signs of rupture. Growth over time, although unusual and slow, can occur in a proportion of these patients, who should be identified for short-term imaging surveillance.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

2020 ◽  
pp. 1-4
Author(s):  
Madeline B. Karsten ◽  
R. Michael Scott
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Internal Carotid ◽  
Imaging Finding ◽  
Neurological Status ◽  
Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

scholarly journals Pipeline embolization device retraction and foreshortening after internal carotid artery blister aneurysm treatment

2017 ◽  
Vol 23 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Jeremy J Heit ◽  
Nicholas A Telischak ◽  
Huy M Do ◽  
Robert L Dodd ◽  
Gary K Steinberg ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
High Morbidity ◽  
Case Description ◽  
Digital Subtraction ◽  
Pipeline Embolization Device ◽  
Aneurysm Occlusion ◽  
New Treatment

Background Subarachnoid hemorrhage (SAH) secondary to rupture of a blister aneurysm (BA) results in high morbidity and mortality. Endovascular treatment with the pipeline embolization device (PED) has been described as a new treatment strategy for these lesions. We present the first reported case of PED retraction and foreshortening after treatment of a ruptured internal carotid artery (ICA) BA. Case description A middle-aged patient presented with SAH secondary to ICA BA rupture. The patient was treated with telescoping PED placement across the BA. After 5 days from treatment, the patient developed a new SAH due to re-rupture of the BA. Digital subtraction angiography revealed an increase in caliber of the supraclinoid ICA with associated retraction and foreshortening of the PED that resulted in aneurysm uncovering and growth. Conclusions PED should be oversized during ruptured BA treatment to prevent device retraction and aneurysm regrowth. Frequent imaging follow up after BA treatment with PED is warranted to ensure aneurysm occlusion.

Pipeline embolization device treatment of internal carotid artery terminus aneurysms

2018 ◽  
Vol 11 (5) ◽  
pp. 485-488 ◽  
Author(s):  
Amit Pujari ◽  
Brian Matthew Howard ◽  
Thomas P Madaelil ◽  
Susana Libhaber Skukalek ◽  
Anil K Roy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Maximum Diameter ◽  
Class Iii ◽  
Pipeline Embolization Device ◽  
Proximal Internal Carotid Artery ◽  
The Mean

BackgroundThe pipeline embolization device (PED) is approved for the treatment of large aneurysms of the proximal internal carotid artery (ICA). Its off-label application in treating aneurysms located specifically at the ICA terminus (ICA-T) has not been studied.MethodsWe conducted a retrospective chart review of patients from 2011 to 7 treated with PEDs. Out of 365 patients, 10 patients with ICA-T aneurysms were included. Patient demographics, procedural information, follow-up imaging, and clinical assessments were recorded.ResultsMean age was 46.9 years (± 8.8), and 6 (60%) patients were women. The mean maximum diameter of the aneurysms treated was 14.7 mm (± 10.7) and the mean neck diameter was 9.3 mm (± 6.6). Reasons for presentation included six incidental findings, one acute subarachnoid hemorrhage (SAH), and three patients with prior SAH. Kamran–Byrne Occlusion Scale scores for the treated aneurysms were as follows: three class IV (complete obliteration), four class III (<50% filling in both height and width for fusiform aneurysms or residual neck for saccular aneurysms), one class II fusiform aneurysm, 1 class 0 saccular aneurysm (residual aneurysm body), and one not classified due to pipeline thrombosis. Two clinically asymptomatic complications were noted: one patient who had a small distal cortical SAH post PED and one patient whose stent was found to be thrombosed on follow-up angiogram. All patients were seen in follow-up, and no patients were found to have worsening of their pre-procedure modified Rankin Scale score.ConclusionThe PED has potential for treating ICA-T aneurysms not amenable to conventional treatment strategies. Further studies are warranted to confirm the long term outcomes.

Long-term Follow-up of Blister Aneurysms of the Internal Carotid Artery

Neurosurgery ◽  
2013 ◽  
Vol 73 (6) ◽  
pp. 1026-1033 ◽  
Author(s):  
M. Yashar S. Kalani ◽  
Joseph M. Zabramski ◽  
Louis J. Kim ◽  
Shakeel A. Chowdhry ◽  
George A. C. Mendes ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Glasgow Outcome Scale ◽  
Internal Carotid ◽  
Radiology Reports ◽  
The Mean ◽  
Operative Notes

Abstract BACKGROUND: Blister aneurysms of the internal carotid artery (ICA) are uncommon. There is a paucity of data on the long-term outcomes of patients. OBJECTIVE: To review our experience with the treatment of these lesions. METHODS: We retrospectively reviewed all aneurysms treated at our institution between 1994 and 2005. Relevant operative notes, radiology reports, and inpatient/outpatient records were reviewed. RESULTS: Seventeen patients (3 male, 14 female) with 18 blister aneurysms of the ICA were identified. The mean age was 44.6 years (range, 17–72; median, 42 years). Twelve patients (70.6%) presented with aneurysmal subarachnoid hemorrhage. The mean admission Glasgow Outcome Scale score was 4.3 (range, 2–5; median, 5). All patients were initially treated using microsurgical technique with direct clipping (n = 15; 83.3%) or clip-wrapping with Gore-Tex (n = 3, 16.7%). There were 4 cases of intraoperative rupture, all associated with attempted direct clipping; all 4 cases were successfully clipped. Two cases rebled post-treatment. Both rebleeding episodes were managed with endovascular stenting. Follow-up angiography was available for 14 patients and revealed a new aneurysm adjacent to the site of clipping in 1 patient and in-stent stenosis in 2. At the mean follow-up of 74.5 months (median, 73; range, 7–165), the mean Glasgow Outcome Scale score was 4.6 (range, 2–5; median, 5). CONCLUSION: Microsurgical treatment of blister aneurysms of the ICA results in excellent outcome. In the evolution of treating these friable aneurysms, we have modified our clip-wrapping technique and use this technique when direct clipping is not feasible.

Follow-up of patients with proved occluded internal carotid artery

1983 ◽  
Vol 25 (3) ◽  
pp. 139-145 ◽  
Author(s):  
G. B. Bradač ◽  
B. Kaden ◽  
F. Nüssel ◽  
R. Oberson
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid
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