Parent Artery Occlusion for Unruptured Cerebral Aneurysms: Results of the Japanese Registry of Neuroendovascular Therapy 3

Peripheral cerebral aneurysms are difficult to treat with preservation of the parent arteries. We report the clinical and angiographic outcome of 12 patients with cerebral aneurysms located peripherally. In the past five years, 12 patients, six females and six males, presented at our institution with intracranial aneurysms distal to the circle of Willis and were treated endovascularly. The age of our patients ranged from four to 58 years with a mean age of 37 years. Seven of the 12 patients had subarachnoid and/or intracerebral hemorrhage upon presentation. Two patients with P2 dissecting aneurysms presented with mild hemiparesis and hypoesthesia, one patient with a large dissecting aneurysm complained of headaches and two patients with M3 dissecting aneurysms had mild hemiparesis and hypoesthesia of the right arm. Locations of the aneurysms were as follows: posterior cerebral artery in seven patients, anterior inferior cerebellar artery in two, posterior inferior cerebellar artery in one, middle cerebral artery in two. Twelve patients with peripheral cerebral aneurysms underwent parent artery occlusion (PAO). PAO was performed with detachable coils. No patient developed neurologic deficits. Distally located cerebral aneurysms can be treated with parent artery occlusion when selective embolization of the aneurysmal sac with detachable platinum coils or surgical clipping cannot be achieved.

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Analysis of Supplemental Surgical or Endovascular Treatment for Cerebral Aneurysms in the Endovascular Performed Cases

Interventional Neuroradiology ◽

10.1177/15910199060120s110 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 73-76

Author(s):

K. Fukui ◽

M. Watanabe ◽

N. Inoue ◽

K. Wakabayashi ◽

T. Kato ◽

...

Keyword(s):

Clinical Outcome ◽

Bypass Surgery ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Parent Artery ◽

Modified Rankin Scale ◽

Surgical Clipping ◽

Parent Artery Occlusion ◽

Treatment For Cerebral Aneurysms ◽

Surgical Treatments

In the 150 endovascular performed cases from May 1997 to Dec 2004, supplemental combination of endovascular and surgical treatments were performed in 46 cases. Characteristics of the treatments were combination for multiple aneurysms, surgical clipping for failed endovascular attempt, embolization for recurrence after clipping, bypass surgery before endovascular parent artery occlusion, surgery for recurrent aneurysms after embolization, and embolization for failed surgical attempt. Sixty seven percent of ruptured and 87% of unruptured cases showed satisfactory clinical outcome (modified Rankin scale = 0 to 2). Supplemental combination of each treatment will support the disadvantage of another treatment, and which improve the clinical outcome of cerebral aneurysm.

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Giant fusiform intracranial aneurysms: review of 120 patients treated surgically from 1965 to 1992

Journal of Neurosurgery ◽

10.3171/jns.1997.87.2.0141 ◽

1997 ◽

Vol 87 (2) ◽

pp. 141-162 ◽

Cited By ~ 240

Author(s):

Charles G. Drake ◽

Sydney J. Peerless

Keyword(s):

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Mass Effect ◽

Artery Occlusion ◽

Parent Artery ◽

Anterior Circulation ◽

Content Type ◽

Parent Artery Occlusion ◽

Collateral Vessels ◽

Proximal Occlusion

✓ The paucity of information about giant fusiform intracranial aneurysms prompted this review of 120 surgically treated patients. Twenty-five aneurysms were located in the anterior and 95 in the posterior circulation. Six patients suffered from atherosclerosis and only three others had a known arteriopathy. The remaining 111 patients presented with aneurysms resulting from an unknown arterial disorder; these patients were much younger than those harboring atherosclerotic aneurysms. Mass effect occurred in only 50% of cases and hemorrhage in 20%. Eight aneurysms caused transient ischemic attacks. Hunterian proximal occlusion or trapping were dominant among the treatment methods. In contrast to the management of giant saccular aneurysms, the usual thrombotic occlusion of a giant fusiform aneurysm after proximal parent artery occlusion requires the presence of two collateral circulations to prevent infarction, one for the end vessels and another for the perforating vessels that arise from the aneurysm. Although there was some reliance on the circle of Willis and on collateral vessels manufactured at surgery, the extent of natural leptomeningeal and perforating collateral, thalamic, lenticulostriate, and brainstem vessels was astonishing and formerly unknown to the authors. Good outcome occurred in 76% of patients with aneurysms in the anterior circulation; two of the six cases with poor results included patients who were already hemiplegic. Ninety percent of patients with posterior cerebral aneurysms fared well. Only 67% of patients with basilar or vertebral aneurysms had good outcomes, although more (17%) of these patients were in poor condition preoperatively because of brainstem compression.

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Results and Problems on Direct Embolization of Cerebral Aneurysms Using Interlocking Detachable Coils

Interventional Neuroradiology ◽

10.1177/15910199970030s234 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 162-164

Author(s):

S. Yoshimura ◽

T. Ueda ◽

Y. Kaku ◽

Y. Nishimura ◽

T. Andoh ◽

...

Keyword(s):

Cerebral Aneurysms ◽

Clinical Results ◽

Artery Occlusion ◽

Neurological Deficits ◽

Parent Artery ◽

Neck Size ◽

New Device ◽

Parent Artery Occlusion ◽

Detachable Coils ◽

Wide Neck

The clinical results of direct embolization of cerebral aneurysms using interlocking detachable coils (IDCs) were analysed. In 27 patients who underwent direct embolization of the aneurysm, 19 patients (70%) were treated uneventfully. In the other 8 patients, symptomatic or asymptomatic complications occurred; parent artery occlusion in 3 patients, rupture of the aneurysm in 2 patients, distal embolism in 2 patients, and neurological deterioration due to enlargement of the aneurysm after embolization in 1 patient. In 5 of 8 patients in whom complications occurred, neurological deficits disappeared after additional embolizations or thrombolysis therapies. Permanent deficits were observed in 3 of all patients (11%). These deficits were caused by the parent artery occlusion due to protrusion of the detached coil in wide neck aneurysms. These results suggest that indication of direct embolization of the cerebral aneurysm should be decided according to neck size. Balloon-assisted coil placement in wide-necked aneurysms was useful but unable to prevent protrusion or migration of the coils after balloon withdrawal. Development of a new device, such as a stent for intracranial use, may make it possible.

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Intravascular Treatment for Cerebral Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199980040s130 ◽

1998 ◽

Vol 4 (1_suppl) ◽

pp. 145-148

Author(s):

M. Negoro ◽

T. Okamoto ◽

S. Miyachi ◽

I. Takahashi ◽

K. Fukui ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Occlusion Rate ◽

Treatment For Cerebral Aneurysms ◽

Intravascular Treatment ◽

Wide Neck

We have treated 142 aneurysms with intrasaccular or parent artery occlusions. Selective intrasaccular occlusions were attempted on 109 cases. Total or subtotal saccular occlusion was achieved in 93 of 96 cases. Intrasaccular occlusion could not be achieved in 13 cases because of various reasons such as wide neck, branching from aneurysmal dome, difficult to catheterize, and aneurysm too small. Parent artery occlusion was attempted on 33 cases. Twenty-five patients had giant aneurysms of the internal carotid artery (ICA) at the cavernous portion. The rest of this group had dissecting or fusiform aneurysms of the vertebral artery. Parent artery occlusion was achieved in 30 cases with six ischemic symptoms. High percentage of occlusion rate and low morbidity and mortality for metallic coil embolization prove the efficacy of this endovascular treatment.

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Endovascular Treatment of AICA Flow Dependent Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991201800411 ◽

2012 ◽

Vol 18 (4) ◽

pp. 449-457 ◽

Cited By ~ 6

Author(s):

M. Mahmoud ◽

A. El Serwi ◽

M. Alaa Habib ◽

S. Abou Gamrah

Keyword(s):

Cerebral Aneurysms ◽

Neurological Complications ◽

Artery Occlusion ◽

Endovascular Embolization ◽

Anterior Inferior Cerebellar Artery ◽

Parent Artery ◽

Parent Artery Occlusion ◽

Cerebellar Artery ◽

Liquid Embolic

Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare, accounting for less than 1% of all cerebral aneurysms. To our knowledge 34 flow-related cases including the present study have been reported in the literature. Three patients harbouring four flow dependent aneurysms were referred to our institution. Two patients presented with subarachnoid hemorrhage, one presented with cerebellar manifestations. They were all treated by endovascular embolization of the aneurysm as well as the parent artery using liquid embolic material. Two cases were embolized using NBCA, Onyx was used in the third case. No bleeding or rebleeding were encountered during the follow-up period which ranged from five to nine months. One patient developed facial palsy, cerebellar symptoms and sensorineural hearing loss. The remaining two cases did not develop any post treatment neurological complications. Endovascular management of flow-dependent AICA aneurysms by parent artery occlusion is feasible and efficient in terms of rebleeding prevention. Post embolization neurological complications are unpredictable. This depends upon the adequacy of collaterals from other cerebellar arteries.

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Advances in Open Microsurgery for Cerebral Aneurysms

Neurosurgery ◽

10.1227/neu.0000000000000193 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S7-S16 ◽

Cited By ~ 56

Author(s):

Jason M. Davies ◽

Michael T. Lawton

Keyword(s):

Minimally Invasive ◽

Endovascular Therapy ◽

Posterior Inferior Cerebellar Artery ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Parent Artery ◽

Aneurysm Surgery ◽

Parent Artery Occlusion ◽

Volume Outcome ◽

Clip Occlusion

Abstract BACKGROUND: Endovascular techniques introduced strong extrinsic forces that provoked reactive changes in aneurysm surgery. Microsurgery has become less invasive, more appealing to patients, lower risk, and efficacious for complex aneurysms, particularly those unfavorable for or failing endovascular therapy. OBJECTIVE: To review specific advances in open microsurgery for aneurysms. METHODS: A university-based, single-surgeon practice was examined for the use of minimally invasive craniotomies, surgical management of recurrence after coiling, the use of intracranial-intracranial bypass techniques, and cerebrovascular volume-outcome relationships. RESULTS: The mini-pterional, lateral supraorbital, and orbital-pterional craniotomies are minimally invasive alternatives to standard craniotomies. Mini-pterional and lateral supraorbital craniotomies were used in one-fourth of unruptured patients, increasing from 22% to 28%, whereas 15% of patients underwent orbital-pterional craniotomies and trended upward from 11% to 20%. Seventy-four patients were treated for coil recurrences (2.3% of all aneurysms) with direct clip occlusion (77%), clip occlusion after coil extraction (7%), or parent artery occlusion with bypass (16%). Intracranial-intracranial bypass (in situ bypass, reimplantation, reanastomosis, and intracranial grafts) transformed the management of giant aneurysms and made the surgical treatment of posterior inferior cerebellar artery aneurysms competitive with endovascular therapy. Centralization maximized the volume-outcome relationships observed with clipping. CONCLUSION: Aneurysm microsurgery has embraced minimalism, tailoring the exposure to the patient's anatomy with the smallest possible craniotomy that provides adequate exposure. The development of intracranial-intracranial bypasses is an important advancement that makes microsurgery a competitive option for complex and recurrent aneurysms. Trends toward centralizing aneurysm surgery in tertiary centers optimize results achievable with open microsurgery.

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Delayed parent artery occlusions following use of SILK flow diverters for treatment of intracranial aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014354 ◽

2018 ◽

Vol 11 (7) ◽

pp. 690-693 ◽

Cited By ~ 2

Author(s):

Ian R Macdonald ◽

Jai J S Shankar

Keyword(s):

Intracranial Aneurysms ◽

Clinical Symptoms ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Neurological Deficits ◽

Parent Artery ◽

Contributing Factors ◽

Anterior Circulation ◽

Parent Artery Occlusion ◽

Flow Diverters

BackgroundThe efficacy of SILK flow diverters (SFD) in the management of cerebral aneurysms has been established. However, the risk of complications with parent artery occlusion (PAO) remains to be fully elucidated. The purpose of our study was to analyze intracranial aneurysms treated with SFDs and assess for occurrences and potential risk factors for PAO.Materials and methodsBetween September 2010 and September 2017, 34 patients were treated for intracranial aneurysms using SFDs at a Canadian institution. This database was retrospectively analyzed for frequency of PAOs and statistical analysis performed for potential contributing factors.ResultsFollowing treatment with SFDs, average clinical and imaging follow-ups were 31 and 22 months, respectively. PAOs were identified in 21% (7/34) of patients and occurred between 8 days and 1.5 years from intervention but only in 11.8% in those compliant to anti-platelet medications. These were all associated with anterior circulation aneurysms (P=0.131) and had no associated neurological deficits. Of these, 57% (4/7) had a fusiform morphology compared with only 19% (5/27) in non-occluded patients (P=0.039). The presence of clinical symptoms at the time of initial SFD intervention was significantly associated with PAO (P=0.021).ConclusionDelayed PAO is not an uncommon outcome of flow diverter deployment and could be seen up to 1.5 years after treatment with no associated neurological deficits. Anti-platelet non-adherence remains a risk factor for PAO. Fusiform morphology of the aneurysm and symptoms at the time of intervention were associated with subsequent occlusion.

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Management of Residual and Recurrent Aneurysms After Initial Endovascular Treatment

Neurosurgery ◽

10.1227/neu.0b013e3182350da5 ◽

2011 ◽

Vol 70 (3) ◽

pp. 537-554 ◽

Cited By ~ 54

Author(s):

Christian Dorfer ◽

Andreas Gruber ◽

Harald Standhardt ◽

Gerhard Bavinzski ◽

Engelbert Knosp

Keyword(s):

Surgical Techniques ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Parent Artery ◽

Endovascular Management ◽

Complete Occlusion ◽

Microsurgical Clipping ◽

Parent Artery Occlusion ◽

Individualized Approach ◽

Treatment Morbidity

Abstract Background: Coil instability possibly translating into higher delayed rebleeding rates remains a concern in the endovascular management of cerebral aneurysms. Objective: To report on 127 patients with endovascular aneurysmal remnants who underwent re-treatment over an 18 year period. Methods: Patients presenting with aneurysm residuals >20% of the original lesion, unstable neck remnants, aneurysmal regrowth, or new aneurysmal daughter sacs were treated by an individualized approach, using both endovascular and surgical techniques. Results: Seventy-five aneurysmal remnants (59.1%) were treated by further re-embolization. Standard coil embolization was used in 65 cases, stent-protected coiling in 9 cases, and balloon remodeled coiling in 1 case, respectively. Fifty-two (40.9%) aneurysmal remnants were treated surgically. Standard microsurgical clipping was used in 44 patients, parent artery occlusion or trapping under bypass protection in 5 cases, deliberate clipping of the basilar artery trunk in 2 cases, and aneurysm wrapping in one case, respectively. Mechanisms of aneurysm recurrence were coil compaction in 93 cases and regrowth in 34 cases. A single reembolization was sufficient to occlude 78.7% of recurrences from coil compaction, but only 14.3% of recurrences from aneurysm regrowth. Conclusion: The individualized approach resulted in complete occlusion of 114 aneurysms (89.7%), with neck remnants and residual aneurysms detectable in 11 (8.7%) and 2 (1.6%) cases, respectively. Treatment morbidity was 11.9%, without significant differences between surgical (15.6%) and endovascular (9.3%) patients (P = .09). Recurrences from coil compaction were safely treated by re-embolization, whereas recurrences from aneurysmal regrowth may best be managed surgically when technically feasible.

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