Discussion to 66 Giant Aneurysms of the Internal Carotid Artery

The authors report a rare case of sequentially developed bilateral internal carotid artery (ICA) fusiform giant aneurysms in a patient with pathologically confirmed intimal fibroplasia. Both ICA fusiform aneurysms were treated with multiple flow diverter insertion and were well-managed over the past 5.5 years of follow-up. The development of aneurysms in this rare disease entity appears to be a lifelong process based on the authors’ observations in serial angiographic follow-up studies. Reconstruction therapy using flow-diverting stents in this unique condition may be a safe and effective treatment modality.

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Carotid Artery Sacrifice for Unclippable and Uncoilable Aneurysms: Endovascular Occlusion Vs Common Carotid Artery Ligation

Neurosurgery ◽

10.1227/neu.0b013e3181f076ac ◽

2010 ◽

Vol 67 (5) ◽

pp. 1431-1437 ◽

Cited By ~ 43

Author(s):

Mohamed Samy Elhammady ◽

Stacey Quintero Wolfe ◽

Hamad Farhat ◽

Mohammad Ali Aziz-Sultan ◽

Roberto C Heros

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Common Carotid Artery ◽

Internal Carotid ◽

Parent Artery ◽

Giant Aneurysms ◽

Presenting Symptoms ◽

Endovascular Occlusion ◽

Large And Giant Aneurysms

Abstract BACKGROUND: Optimal treatment of intracranial aneurysms involves complete occlusion of the aneurysm with preservation of the parent artery and all of its branches. Attempts to occlude the aneurysm and preserve the parent artery may be associated with a higher level of risk than parent vessel occlusion or trapping. OBJECTIVE: To evaluate our series of patients with large and giant aneurysms who underwent treatment via endovascular coiling with parent artery sacrifice or surgical ligation of the common carotid artery (CCA) and gain insight into the advantages and risks of each of these alternatives. METHODS: We retrospectively reviewed all patients with aneurysms who underwent carotid sacrifice via endovascular occlusion or surgical CCA ligation during an 8-year period at our institution. RESULTS: Twenty-seven patients with large and giant aneurysms of the internal carotid artery underwent carotid artery sacrifice via endovascular occlusion (n = 15) or CCA ligation (n = 12). Of the patients who underwent endovascular occlusion, 3 developed groin complications, 1 developed a new sixth nerve palsy, 1 died from vasospasm related to subarachnoid hemorrhage, and 1 died secondary to rupture of an associated 3-mm anterior communicating artery aneurysm 5 days postoperatively. Of the patients undergoing CCA ligation, 1 patient developed a partial hypoglossal palsy. Clinical improvement of presenting symptoms was observed in all surviving patients regardless of the method of treatment. Complete aneurysm obliteration was documented in all patients during the initial hospital stay. The mean radiographic long-term follow-up was 14.2 months, which was available in 20 of the 25 surviving patients (80%). Complete obliteration was confirmed at follow-up in all but 2 patients with large cavernous aneurysms; 1 was initially treated with endovascular occlusion and the other with carotid ligation. CONCLUSION: Parent artery sacrifice is still a viable treatment for some complex aneurysms of the internal carotid artery. CCA ligation is a reasonable alternative to endovascular arterial sacrifice.

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