Late complications of carotid ligation in the treatment of intracranial aneurysms

1981 ◽  
Vol 54 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Richard A. Roski ◽  
Robert F. Spetzler ◽  
Frank E. Nulsen
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Late Complication ◽  
Late Complications ◽  
Content Type ◽  
Carotid Ligation ◽  
History Of ◽  
Ischemic Attack ◽  
Fine Print

✓ The results in 57 consecutive patients treated with carotid ligation for an intracranial aneurysm were analyzed to define the risks of late complications. The average age for the group was 46 years. Eighty percent of the aneurysms were located on the internal carotid artery (ICA). The acute morbidity and mortality of the treatment and the natural history of the disease was 29%. Twenty-four patients were discharged with a common carotid artery (CCA) ligation, and 21 patients with an ICA ligation. Three patients from each ligation group could not be located for review. The follow-up period for the 21 patients with CCA ligation ranged from 1 to 15 years, with an average of 8.4 years, and for the 18 patients with ICA ligation it ranged from 2 to 19.5 years, with an average of 12.5 years. Excluding deaths from unrelated causes, five of the 21 patients with CCA ligation developed a late complication. Two patients had a transient ischemic attack (TIA). Two patients had a subarachnoid hemorrhage (SAH), one of which was fatal and was preceded by a TIA. Two patients developed monocular blindness. None of the patients had a stroke. Excluding deaths from unrelated causes, five of the 18 patients with ICA ligation developed a late complication. One patient had a fatal SAH. Three patients had a TIA, two of which were followed by a stroke. One patient had a stroke in the cerebral hemisphere contralateral to the side of the carotid ligation.

Cervical-to-petrous internal carotid artery bypass procedure

1993 ◽  
Vol 79 (1) ◽  
pp. 138-141 ◽  
Author(s):  
Brian C. Fitzpatrick ◽  
Robert F. Spetzler ◽  
Jeffrey L. Ballard ◽  
Richard S. Zimmerman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Content Type ◽  
Bypass Procedure ◽  
Vein Bypass ◽  
High Cervical ◽  
Fine Print

✓ The technique for cervical-to-petrous internal carotid artery saphenous vein bypass is described. This procedure was used in the treatment of three patients with high cervical or skull base vascular injuries. All grafts were patent on follow-up angiography.

The treatment of nonobstructive (communicating) hydrocephalus by endoscopic cauterization of the choroid plexuses

1970 ◽  
Vol 33 (1) ◽  
pp. 1-18 ◽  
Author(s):  
John E. Scarff
Keyword(s):  
Personal Experience ◽  
Operative Mortality ◽  
Late Complication ◽  
Communicating Hydrocephalus ◽  
Content Type ◽  
Operative Method ◽  
Choroid Plexuses ◽  
History Of ◽  
Fine Print

✓ The author reviews his personal experience with 39 cases of nonobstructive (communicating) hydrocephalus treated by endoscopic cauterization of the choroid plexuses during the period 1942–1965. The paper includes a brief history of the development of this operative method, and a description of the author's ventriculoscope. The operative technique has been described in detail. The operative mortality was 10% overall, 5% in the last 20 cases. Hydrocephalus was initially arrested in 26 cases and has remained so in all cases, with a follow-up period of more than 10 years in 23 patients. Only one case developed a late complication requiring reoperation.

The effect of cervical carotid ligation on giant intracranial aneurysms

1970 ◽  
Vol 33 (2) ◽  
pp. 184-190 ◽  
Author(s):  
John S. Tytus ◽  
Arthur A. Ward
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Endocrine Dysfunction ◽  
Content Type ◽  
Carotid Ligation ◽  
Visual Field Deficits ◽  
The Common ◽  
Fine Print

✓ Two patients with giant aneurysms of the internal carotid artery showed progressive visual field deficits, and one, endocrine dysfunction. Neither patient had ever had symptoms suggesting subarachnoid hemorrhage. Both patients benefitted from common carotid ligation. Comparable reports are reviewed, and the application of a previously reported technique for monitoring gradual occlusion of the common carotid artery is emphasized.

Endovascular therapy for stenosis of the petrous or cavernous portion of the internal carotid artery: percutaneous transluminal angioplasty compared with stent placement

2003 ◽  
Vol 98 (3) ◽  
pp. 491-497 ◽  
Author(s):  
Tomoaki Terada ◽  
Mitsuharu Tsuura ◽  
Hiroyuki Matsumoto ◽  
Osamu Masuo ◽  
Tomoyuki Tsumoto ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Stent Placement ◽  
Percutaneous Transluminal Angioplasty ◽  
Internal Carotid ◽  
Treated Group ◽  
Transluminal Angioplasty ◽  
Content Type ◽  
Percutaneous Transluminal ◽  
Fine Print

Object. The effects of percutaneous transluminal angioplasty (PTA) and stent placement for stenosis of the petrous or cavernous portion of the internal carotid artery (ICA) were compared. Methods. Twenty-four patients with symptomatic, greater than 60% stenosis of the petrous or cavernous portion of the ICA were treated using PTA or stent placement; 15 were treated with PTA and nine with stent insertion. Initial and follow-up results (> 3 months posttreatment) were compared in each group. Stenotic portions of the ICA were successfully opened in 13 of 15 patients in the PTA group, and in all nine patients in the stent-treated group. In one case in the PTA group stent delivery was attempted; however, the device could not pass through the vessel's tortuous curve, and PTA alone was performed in this case. Postoperatively, the mean stenotic ratio decreased from 72.1 to 29.6% in the PTA group, and from 75.6 to 2.2% in the stent-treated group. In four patients in the PTA group, stenoses greater than 50% were demonstrated on follow-up angiography performed at 3 to 6 months after PTA. In the stent-treated group, no restenosis was encountered, although in one case acute occlusion of the stent occurred; the device was recanalized with PTA and infusion of tissue plasminogen activator. This case was the only one of the 24 in which any neurological deficits related to the endovascular procedure occurred. Stent placement brought a greater gain in diameter than did PTA at the initial and late follow-up period; this gain was statistically significant. Conclusions. Stent placement is more effective than PTA for stenosis of the petrous or cavernous portion of the ICA from the viewpoint of initial and late gain in diameter.

Supraclinoid internal carotid artery fenestration with an associated aneurysm

1993 ◽  
Vol 79 (3) ◽  
pp. 438-441 ◽  
Author(s):  
Michael J. Banach ◽  
Eugene S. Flamm
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Content Type ◽  
The Third ◽  
The Right ◽  
Fine Print ◽  
Supraclinoid Internal Carotid Artery

✓ The case of an aneurysm occurring at the site of fenestration of the supraclinoid portion of the left internal carotid artery (ICA) is reported. A 37-year-old woman presenting with subarachnoid hemorrhage was found to have bilateral ICA aneurysms at the level of the posterior communicating arteries (PCoA's). The patient underwent right-sided craniotomy with uneventful clipping of the right PCoA aneurysm, and attempted clip placement on the contralateral left ICA aneurysm. The follow-up angiogram revealed a residual dome on the left ICA aneurysm, which was noted to originate at the proximal end of a fenestration of the left supraclinoid ICA. This represents the third reported case of fenestration of the intracranial ICA associated with an aneurysm. Intracranial artery fenestrations and their embryological origins are also reviewed.

Endovascular treatment of an internal carotid artery pseudoaneurysm following transsphenoidal surgery

2002 ◽  
Vol 96 (3) ◽  
pp. 624-627 ◽  
Author(s):  
Nurdin A. Kadyrov ◽  
Jonathan A. Friedman ◽  
Douglas A. Nichols ◽  
Aaron A. Cohen-Gadol ◽  
Michael J. Link ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Coil Embolization ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Surgical Repair ◽  
Definitive Treatment ◽  
Content Type ◽  
Fine Print

✓ Internal carotid artery (ICA) pseudoaneurysm formation following transsphenoidal surgery is a rare but potentially lethal complication. Direct surgical repair with preservation of the ICA may be difficult. The feasibility of endovascular coil embolization with parent artery preservation for an iatrogenic ICA pseudoaneurysm is undefined. A 40-year-old man was referred to the authors' institution after identification of a pseudoaneurysm of the left ICA following transsphenoidal resection of a pituitary macroadenoma. The pseudoaneurysm was treated via an endovascular approach that included stent-assisted coil embolization of the lesion. Follow-up angiographic studies obtained 1 year later demonstrated complete occlusion of the aneurysm, and the patient remains asymptomatic. Stent-assisted coil embolization of this iatrogenic pseudoaneurysm was successful in achieving complete, angiographically confirmed aneurysm obliteration, with preservation of the ICA and short-term prevention of hemorrhage or carotid—cavernous fistula. The endovascular method provided an effective, relatively low-risk treatment for this difficult lesion, and was an excellent alternative to direct surgical repair. Nonetheless, long-term follow-up review is required before definitive treatment recommendations can be made.

Thromboendarterectomy of the symptomatic occluded internal carotid artery

1992 ◽  
Vol 76 (5) ◽  
pp. 752-758 ◽  
Author(s):  
Patrick W. McCormick ◽  
Robert F. Spetzler ◽  
Julian E. Bailes ◽  
Joseph M. Zabramski ◽  
James L. Frey
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
External Carotid ◽  
Vertebrobasilar Insufficiency ◽  
Surgical Morbidity ◽  
Content Type ◽  
The Impact ◽  
Fine Print

✓ A retrospective review of 42 patients (mean age 61.4 years) with surgically managed symptomatic internal carotid artery occlusion is reported. A standardized surgical protocol aimed at restoration of flow in the vessel was used. Presenting symptoms included hemispheric transient ischemic attacks in 68% of patients, new fixed neurological deficits in 28%, amaurosis fugax in 28%, and stroke-in-evolution in 9%. Twenty-four arteries were successfully reopened. A proximal remnant angioplasty (stumpectomy) was performed alone in nine patients or in combination with an external carotid endarterectomy in nine. In four patients with persisting symptoms who failed to achieve primary restoration of flow, a superficial temporal-to-middle cerebral artery bypass procedure was performed. The permanent surgical morbidity rate was 2% and the surgical mortality rate was 0%. Transient postoperative deficits were present in three patients (7%). Follow-up review at a mean of 40 months was obtained in 39 patients (93%). Following surgical intervention, five patients died of unrelated causes, two had neurological events consistent with a transient cerebral ischemic attack, and two had vertebrobasilar insufficiency. No patient suffered from stroke. Of the 24 successfully reopened vessels, follow-up ultrasound evaluations were obtained in 17 (73%) at a mean of 28 months after surgery. In 15 patients (88%) the vessels were widely patent, one (5.8%) had stenosis greater than 70%, and one (5.8%) showed asymptomatic reocclusion. Reopening occluded internal carotid arteries in selected patients is associated with low surgical morbidity and mortality rates. Further studies are necessary to determine the impact of this surgical therapy on the natural history of this condition.

Urgent endovascular treatment of acute symptomatic occlusion of the cervical internal carotid artery

2003 ◽  
Vol 99 (6) ◽  
pp. 972-977 ◽  
Author(s):  
Huan Wang ◽  
Giuseppe Lanzino ◽  
Kenneth Fraser ◽  
Patrick Tracy ◽  
David Wang
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Clinical Characteristics ◽  
Internal Carotid ◽  
Content Type ◽  
Endovascular Approach ◽  
Cervical Internal Carotid Artery ◽  
Fine Print

Object. The prognosis of patients with acute symptomatic cervical internal carotid artery (ICA) occlusion is generally considered to be poor. Traditionally, such patients are not considered eligible for urgent thrombolytic/endovascular treatment. Since 1998, an aggressive therapeutic approach with endovascular treatment has been adopted at the authors' institution. In this report they assess whether aggressive treatment of ICA occlusion is appropriate. Methods. The clinical characteristics and outcome of six consecutive patients treated urgently with an endovascular approach between 1998 and 2001 are reviewed and summarized. Recanalization was accomplished in all patients. At a mean follow-up period of 8 months (range 2–14 months), five of six patients had good or excellent outcomes (modified Rankin Scale [mRS] Score 0–1) and one had a poor outcome (mRS Score 4). Conclusions. With recent advancements in thrombolytic and endovascular treatments, an aggressive endovascular approach in patients with acute symptomatic cervical ICA occlusion may be successful. Further clinical data are required to determine the optimal endovascular approach in these patients.

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.

scholarly journals Neuroophthalmological outcomes associated with use of the Pipeline Embolization Device: analysis of the PUFS trial results

2015 ◽  
Vol 123 (4) ◽  
pp. 897-905 ◽  
Author(s):  
Daniel H. Sahlein ◽  
Mohammad Fouladvand ◽  
Tibor Becske ◽  
Isil Saatci ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
Prospective Trial ◽  
Maximum Diameter ◽  
Pipeline Embolization Device ◽  
Safety And Efficacy ◽  
History Of ◽  
International Multicenter ◽  
Supraclinoid Internal Carotid Artery

OBJECT Neuroophthalmological morbidity is commonly associated with large and giant cavernous and supraclinoid internal carotid artery (ICA) aneurysms. The authors sought to evaluate the neuroophthalmological outcomes after treatment of these aneurysms with the Pipeline Embolization Device (PED). METHODS The Pipeline for Uncoilable or Failed Aneurysms (PUFS) trial was an international, multicenter prospective trial evaluating the safety and efficacy of the PED. All patients underwent complete neuroophthalmological examinations both before the PED procedure and at a 6-month follow-up. All examinations were performed for the purpose of this study and according to study criteria. RESULTS In total, 108 patients were treated in the PUFS trial, 98 of whom had complete neuroophthalmological follow-up. Of the patients with complete follow-up, 39 (40%) presented with a neuroophthalmological baseline deficit that was presumed to be attributable to the aneurysm, and patients with these baseline deficits had significantly larger aneurysms. In 25 of these patients (64%), the baseline deficit showed at least some improvement 6 months after PED treatment, whereas in 1 patient (2.6%), the deficits only worsened. In 5 patients (5%), new deficits had developed at the 6-month follow-up, while in another 6 patients (6%), deficits that were not originally assumed to be related to the aneurysm had improved by that time. A history of diabetes was associated with failure of the baseline deficits to improve after the treatment. The aneurysm maximum diameter was significantly larger in patients with a new deficit or a worse baseline deficit at 6 months postprocedure. CONCLUSIONS Patients treated with the PED for large and giant ICA aneurysms had excellent neuroophthalmological outcomes 6 months after the procedure, with deficits improving in most of the patients, very few deficits worsening, and few new deficits developing.

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