Reconstructive endovascular treatment of ruptured blood blister–like aneurysms of the internal carotid artery

2009 ◽  
Vol 110 (3) ◽  
pp. 431-436 ◽  
Author(s):  
Byung-Hee Lee ◽  
Byung Moon Kim ◽  
Moon Sun Park ◽  
Sung Il Park ◽  
Eun Chul Chung ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Stent Placement ◽  
Glasgow Outcome Scale ◽  
Internal Carotid ◽  
Covered Stent ◽  
Stent Insertion ◽  
Endovascular Methods

Object Ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA) are rare but carry a high rate of morbidity and mortality. Furthermore, BBAs are very difficult to treat surgically as well as endovascularly. The authors present their experience in treating BBAs with reconstructive endovascular methods. Methods Nine ruptured BBAs in 9 consecutive patients (2 men and 7 women; mean age 50 years, range 42–57 years) were treated using reconstructive endovascular methods between January 2006 and November 2007. Treatment methods and angiographic and clinical outcomes were retrospectively evaluated. Results All 9 BBAs were initially treated with stent-assisted coil (SAC) embolization. This was followed by a second stent insertion using the stent-within-a-stent (SWS) technique in 3, covered stent placement in 3, and SAC embolization alone in 3. All 3 patients who underwent SWS placement had excellent outcomes (Glasgow Outcome Scale Score 5) with complete angiographic resolution of the BBAs. There were no treatment-related complications in the SWS group. Two of the 3 patients who received covered stents had excellent outcomes (Glasgow Outcome Scale Score 5) and complete occlusion of the BBA was achieved. The remaining patient who received a covered stent died of ICA rupture during the procedure. Aneurysm regrowth without rebleeding occurred in the 3 patients who underwent SAC embolization. Two of the 3 recurrent BBAs were treated with coil embolization with a second stent insertion, and as a result these belonged to the SWS group. The other recurrent BBA was treated with a covered stent. Of the 8 surviving patients, 5 underwent SWS, and 3 underwent covered stent placement. All surviving patients had excellent outcomes during the clinical follow-up period (mean 11 months, range 4–26 months); complete BBA resolution and smooth reconstruction of the affected ICA segment was shown on follow-up angiography. Conclusions In the present study, the SWS and covered-stent techniques effectively prevented rebleeding and regrowth of the BBA without sacrifice of the ICA. The SWS and covered-stent techniques can be considered an alternative treatment option for BBAs in selected patients in whom ICA sacrifice is not feasible. Stent-assisted coiling alone seems insufficient to prevent BBA regrowth.

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.

scholarly journals Jostent covered stent placement for emergency reconstruction of a ruptured internal carotid artery during or after transsphenoidal surgery

2015 ◽  
Vol 122 (5) ◽  
pp. 1223-1228 ◽  
Author(s):  
Byung Moon Kim ◽  
Pyoung Jeon ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Covered Stent ◽  
Active Bleeding ◽  
Covered Stents ◽  
Surgical Suture

OBJECT Internal carotid artery (ICA) rupture during transsphenoidal surgery (TSS) is an extremely difficult complication to treat. This study aimed to evaluate the immediate and long-term outcomes of covered stent placement for emergency reconstruction of ruptured ICAs during or after TSS. METHODS Seven patients underwent covered stent placement for emergency reconstruction of a ruptured ICA during or after TSS. The safety and effectiveness of covered stent placement for emergency reconstruction of ruptured ICAs were retrospectively analyzed. RESULTS Pretreatment angiography showed active bleeding in 6 patients (5 intraoperative and 1 postoperative) and a pseudoaneurysm in 1 patient. Of the 6 patients with active bleeding, 5 were treated with a successive operation to control active bleeding. The other patient was treated just after cardiopulmonary resuscitation due to massive nasal bleeding 20 days after revision of TSS. All active bleeding was controlled immediately after covered stent insertion in these 6 patients. One patient showed a gap between the covered stent and ICA wall without active bleeding 30 minutes after glycoprotein IIb/IIIa inhibitor administration due to in-stent thrombosis. The gap was occluded with coil embolization after completion of the temporarily suspended TSS. The seventh patient, whose ICA tear was treated with surgical suture, underwent covered stent placement for a pseudoaneurysm detected on postoperative Day 2. During a mean follow-up period of 46 months (range 12–85 months), all patients had excellent outcomes (modified Rankin Scale score of 0). All the stented ICAs were patent on vascular imaging follow-up at a mean of 34 months (range 12–85 months). CONCLUSIONS Covered stents appear to be a safe and effective option for emergency reconstruction of ruptured ICAs during or after TSS.

Reconstruction of the Internal Carotid Artery After Treatment of Complex Traumatic Direct Carotid-Cavernous Fistulas With the Willis Covered Stent

Neurosurgery ◽  
2016 ◽  
Vol 79 (6) ◽  
pp. 794-805 ◽  
Author(s):  
Wu Wang ◽  
Ming-Hua Li ◽  
Yong-Dong Li ◽  
Bin-Xian Gu ◽  
Hai-Tao Lu
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Stent Placement ◽  
Internal Carotid ◽  
Covered Stent ◽  
Covered Stents ◽  
Complete Exclusion ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND: Endovascular treatment of complex traumatic direct carotid-cavernous fistulas (TDCCFs) is a challenge. OBJECTIVE: To evaluate the long-term efficacy of the Willis covered stent in endovascular treatment of complex TDCCFs, focusing on reconstruction and preservation of the internal carotid artery. METHODS: During the past 8 years, 25 patients with 27 TDCCFs who previously had unsuccessful treatment of fistulas with detachable balloons received endovascular treatment with Willis covered stents. The efficacy, complications, in-stent stenosis, angiographic, and clinical follow-up results were evaluated retrospectively between 6 and 88 months (mean, 43.8 months) after the stent placement. RESULTS: The technical success rate of stenting placement was 100%. Forty-four Willis covered stents were implanted into the target artery of 27 TDCCFs. Complete exclusion was achieved in 16 patients with 17 TDCCFs immediately after the stent placement, with transient endoleaks in 10 TDCCFs. Redilation was performed in 6 TDCCFs, and additional stents were implanted in the other 4 TDCCFs for endoleak exclusion. The initial angiographic results showed complete exclusion of fistulas with preservation of the internal carotid artery in 24 patients with 26 TDCCFs. One patient in whom complete occlusion initially was achieved subsequently experienced a delayed endoleak, which required placement of an additional stent. The angiographic follow-up results (mean, 30.3 months) demonstrated complete exclusion in all 27 TDCCFs, with patency of internal carotid artery in 23 patients. The clinical follow-up demonstrated a full recovery in 23 patients and improvement in 2 patients. CONCLUSION: The use of Willis covered stents was confirmed to be effective, safe, and a curative approach for endovascular treatment of complex TDCCFs and internal carotid artery reconstruction.

scholarly journals The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

2012 ◽  
Vol 18 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Y.K. Ihn ◽  
S.H. Kim ◽  
J.H. Sung ◽  
T-G. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Additional Treatment ◽  
Stent Insertion ◽  
Supraclinoid Internal Carotid Artery

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

Carotid Artery Stenting under Flow Arrest for the Management of Intraluminal Thrombus: Technical Case Report

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONSE87-ONSE88 ◽  
Author(s):  
Ramachandra P. Tummala ◽  
Babak S. Jahromi ◽  
Junichi Yamamoto ◽  
Elad I. Levy ◽  
Adnan H. Siddiqui ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
External Carotid ◽  
Left Internal Carotid Artery ◽  
Carotid Stent ◽  
Intraluminal Thrombus ◽  
Antegrade Flow

Abstract Objective The management of intraluminal carotid thrombus is not well defined. Medical and surgical management carry a relatively high risk of thromboembolism. Although endovascular options also carry the risk of thromboembolism from manipulation of the lesion, successful carotid stent placement using various methods of flow restriction has been reported anecdotally. We describe a technique to arrest antegrade flow before placement of carotid stents in the setting of symptomatic intraluminal thrombus. Clinical Presentation A 49-year-old woman presented with expressive dysphasia, right-upper extremity weakness, and an episode of left monocular blindness. Angiography confirmed the presence of a large intraluminal thrombus in a chronic dissection of the left internal carotid artery. Results We devised a configuration to arrest antegrade flow in the internal carotid artery before crossing the thrombus with a distal embolic protection device by inflating balloons in the common carotid artery and external carotid artery before crossing the lesion. After inflation of a balloon in the internal carotid artery, we completed overlapping stent placement to completely exclude the thrombus from the lumen. Conclusion The patient remained neurologically unchanged during and immediately after the procedure. She had mild neurological deficits at the 1 month follow-up evaluation. Follow-up ultrasonography at 1 and 3 months and computed tomographic angiography at 3 months after the procedure showed patency of the stented carotid artery, with no evidence of restenosis or thrombus. Although the risks of carotid stent placement for intraluminal thrombus remain unclear, the technique of flow arrest seems to provide a safe endovascular treatment option.

scholarly journals Ruptured dissecting aneurysm in communicating internal carotid artery segments treated using a stent-assisted endovascular technique

2018 ◽  
Vol 24 (2) ◽  
pp. 130-134 ◽  
Author(s):  
Chae Wook Huh ◽  
Sung-Chul Jin
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Glasgow Outcome Scale ◽  
Internal Carotid ◽  
Neurological Complications ◽  
Dissecting Aneurysm ◽  
Digital Subtraction ◽  
Endovascular Technique ◽  
Dissecting Aneurysms

Hemorrhagic intracranial dissecting aneurysms are known to have a poor natural history and an increased tendency to rebleed. The communicating segment of the internal carotid artery (ICA) is an infrequent site of dissection that is difficult to manage using deconstructive endovascular treatment because of the need to preserve important vascular branches. We report two cases of ruptured dissecting aneurysms that occurred in communicating segments of the ICA and treated using a reconstructive endovascular technique involving stent-assisted coiling. Case 1 was a 59-year-old woman who was diagnosed with subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) indicated a ruptured dissecting aneurysm that arose from the left communicating segment of the ICA. Stent-assisted coiling was performed and followed by a second overlapping stent technique. No deterioration was observed on DSA after one week of follow-up or on magnetic resonance angiography (MRA) after four months of follow-up. The patient was discharged without neurological complications (Glasgow Outcome Scale 5). Case 2 was a 34-year-old man who was admitted with a diagnosis of SAH. DSA revealed a suspected lesion of a ruptured dissecting aneurysm of the left communicating segment of the ICA. Stent-assisted coiling was performed, and partial occlusion was achieved. No deterioration was observed on DSA after two weeks of follow-up or on MRA after six months of follow-up. The patient was discharged without neurological complications (Glasgow Outcome Scale 5). These cases suggest that using stent-assisted coiling could be a feasible modality for treating ruptured ICA dissecting aneurysms in the communicating segment.

Self-Expanding Stent Placement for Anterior Circulation Intracranial Artery Dissection Presenting With Ischemic Symptoms

Neurosurgery ◽  
2014 ◽  
Vol 76 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Dong Joon Kim ◽  
Byung Moon Kim ◽  
Sang Hyun Suh ◽  
Dong Ik Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Scale Score ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Anterior Circulation ◽  
The Mean ◽  
Severe Degree ◽  
Recurrent Ischemia

ABSTRACT BACKGROUND: The prognosis of ischemic anterior circulation intracranial dissection (AC-ICD) is poor and its optimal management is still controversial. OBJECTIVE: To evaluate the safety and efficacy of a self-expanding stent for ischemic AC-ICD. METHODS: Eight patients (mean age, 36 years) underwent self-expanding stenting for ischemic AC-ICD. Imaging findings of ischemic AC-ICD, the reason for stenting, and the clinical and angiographic outcomes were retrospectively evaluated. RESULTS: AC-ICD involved intracranial internal carotid artery to middle cerebral artery (MCA) in 2, intracranial internal carotid artery alone in 3, and MCA alone in 3 patients. Six AC-ICDs showed complete or near occlusions while 2 had a severe degree of stenosis. Six AC-ICDs showed an intimal flap and 3 had intramural hematomas. Six patients underwent emergent stenting for acute stroke within 6 hours (n = 2) or crescendo-type stroke within 24 hours (n = 4), while 2 patients had stenting for recurrent ischemia on dual antiplatelet and/or anticoagulation after the initial attack. The mean dissection-related stenosis improved from 93.1% to 20.3% after stenting (P < .05). The mean National Institutes of Health Stroke Scale score improved from 7.5 to 1.4 (P < .05). All patients had excellent or favorable outcomes at 3 months: modified Rankin Scale score, 0 in 3, 1 in 3, and 2 in 1 patient(s). No patients had subarachnoid hemorrhage or ischemic symptom recurrence during the clinical follow-up (mean, 27 months). All stented arteries were patent without significant in-stent stenosis on angiographic follow-up (range, 3–12 months). CONCLUSION: Self-expanding stents seem to be safe and effective for AC-ICD presenting with acute/crescendo-type stroke or recurrent ischemia despite adequate medication.

Current endovascular treatment options for intracranial carotid artery atherosclerosis

2005 ◽  
Vol 18 (1) ◽  
pp. 1-4
Author(s):  
Ricardo J. Komotar ◽  
J Mocco ◽  
David A. Wilson ◽  
E. Sander Connolly ◽  
Sean D. Lavine ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Stent Placement ◽  
Multidisciplinary Approach ◽  
Internal Carotid ◽  
Treatment Options ◽  
Intracranial Atherosclerosis ◽  
Carotid Artery Atherosclerosis ◽  
Endovascular Methods

A substantial number of strokes are caused by intracranial atherosclerosis, a disease that traditionally has been treated medically. Recent technological advancements, however, have revolutionized the treatment of this condition by enabling the use of endovascular methods. In this paper the authors focus on the internal carotid artery, and review relevant studies concerning angioplasty with stent placement for the management of intracranial atherosclerosis in this vessel. With continued experience and a multidisciplinary approach in the evaluation of these patients, favorable outcomes may be achieved.

Sign in / Sign up

Export Citation Format

Share Document