Vertebrobasilar occlusion therapy of giant aneurysms

1984 ◽  
Vol 60 (3) ◽  
pp. 560-565 ◽  
Author(s):  
David M. Pelz ◽  
Fernando Viñuela ◽  
Allan J. Fox ◽  
Charles G. Drake
Keyword(s):  
Carotid Artery ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Content Type ◽  
Aneurysm Neck ◽  
Giant Aneurysms ◽  
Patient Will ◽  
Therapeutic Occlusion ◽  
Carotid Artery Compression ◽  
Fine Print

✓ The clinical and angiographic records were reviewed for 71 patients with giant aneurysms of the posterior circulation, who underwent therapeutic occlusion of the basilar artery or both vertebral arteries. This treatment is used when the aneurysm neck cannot be surgically clipped, and occlusion of the parent artery is performed to initiate thrombosis within the lumen. In these cases, collateral blood flow to the brain stem is supplied mainly by the posterior communicating arteries. Consequently, their angiographic morphology (patency, size, and number) is demonstrated as a preoperative indicator of whether the patient will be able to tolerate vertebrobasilar occlusion. Vertebral angiograms with carotid artery compression (the Allcock test) will often be needed to provide this information. The data relating posterior communicating artery morphology to clinical outcome in 71 cases of attempted vertebrobasilar occlusion are presented. The use and accuracy of carotid artery compression studies are also discussed. It is essential for the radiologist to supply the neurosurgeon with this valuable information in every case of giant posterior circulation aneurysm.

Detachable balloon embolization therapy of posterior circulation intracranial aneurysms

1989 ◽  
Vol 71 (4) ◽  
pp. 512-519 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Leslie D. Cahan ◽  
Grant B. Hieshima ◽  
Yoshifumi Konishi
Keyword(s):  
Basilar Artery ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Content Type ◽  
Aneurysm Neck ◽  
Balloon Embolization ◽  
Fine Print

✓ Treatment of complex and surgically difficult intracranial aneurysms of the posterior circulation is now being performed with intravascular detachable balloon embolization techniques. The procedure is carried out under local anesthesia from a transfemoral arterial approach, which allows continuous neurological monitoring. Under fluoroscopic guidance, the balloon is propelled by blood flow through the intracranial circulation and, in most cases, can be guided directly into the aneurysm, thus preserving the parent vessel. If an aneurysm neck is not present, test occlusion of the parent vessel is performed and, if tolerated, the balloon is detached. Twenty-six aneurysms in 25 patients have been treated by this technique. The aneurysms have involved the distal vertebral artery (five cases), the mid-basilar artery (six cases), the distal basilar artery (11 cases), and the posterior cerebral artery (four cases). The aneurysms varied in size and included three small (< 12 mm), 15 large (12 to 25 mm), and eight giant (> 25 mm). Fifteen patients (60%) presented with hemorrhage and 10 patients (40%) with mass effect. In 17 cases (65%) direct balloon embolization of the aneurysm was achieved with preservation of the parent artery. In nine cases (35%), because of aneurysm location and size, occlusion of the parent vessel was performed. Complications from therapy included three cases of transient cerebral ischemia which resolved, three cases of stroke, and five deaths due to immediate or delayed aneurysm rupture. The follow-up period has ranged from 2 months to 43 months (mean 22.5 months). In cases where posterior circulation aneurysms have been difficult to treat by conventional neurosurgical techniques, intravascular detachable balloon embolization may offer an alternative therapeutic option.

Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases

1990 ◽  
Vol 72 (6) ◽  
pp. 857-863 ◽  
Author(s):  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher Dowd ◽  
Stanley L. Barnwell ◽  
Bill Dormandy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Parent Artery ◽  
Detachable Balloon ◽  
Content Type ◽  
Embolization Therapy ◽  
Antiplatelet Medication ◽  
Therapeutic Occlusion ◽  
Balloon Embolization ◽  
Fine Print

✓ Interventional neurovascular techniques for treating patients with intracranial aneurysms are now being performed in selected cases. In certain anatomical locations that are difficult to reach surgically, such as the cavernous portion of the internal carotid artery (ICA), this technique may be especially useful. The procedure is performed from a transfemoral approach, using local anesthesia, thus permitting continuous neurological monitoring. Between 1981 and 1989, 87 patients diagnosed as having an intracavernous aneurysm were treated with endovascular detachable balloon embolization techniques. The patients ranged in age from 11 to 84 years. The presenting symptom was mass effect in 69 cases (79.3%), rupture of a preexisting aneurysm resulting in a carotid-cavernous sinus fistula in eight cases (9.2%), trauma resulting in a cavernous pseudoaneurysm in seven cases (8.0%), and hemorrhage in three cases (3.4%). Therapeutic occlusion of the ICA across or just proximal to the aneurysm neck was performed in 68 patients (78.2%). Since 1984, with the development of a permanent solidifying agent (2-hydroxyethyl methacrylate) to fill the balloon, it is now feasible in some cases to guide the balloon directly into the aneurysm and preserve the parent artery; this was achieved in 19 cases (22%). Follow-up examination has demonstrated complete thrombosis with partial or total alleviation of symptoms in all patients with therapeutic occlusion of the parent vessel. Of the 19 patients with preservation of the parent artery, follow-up studies have demonstrated total exclusion in 12 cases (63%) and subtotal occlusion of greater than 85% in seven cases (37%), with clinical improvement in all cases. Complications from therapy included transient cerebral ischemia during or after therapy requiring volume expansion in seven cases, embolic symptoms requiring antiplatelet medication in two cases, and stroke in four cases; there were no deaths. Detachable balloon embolization therapy, particularly for large and giant symptomatic aneurysms of the cavernous ICA, can be an effective mode of treatment.

Selection and combination of various endovascular techniques in the treatment of giant aneurysms

1992 ◽  
Vol 77 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Waro Taki ◽  
Shogo Nishi ◽  
Kohsuke Yamashita ◽  
Akiyo Sadatoh ◽  
Ichiro Nakahara ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
The Other ◽  
Parent Artery ◽  
Endovascular Techniques ◽  
Detachable Balloon ◽  
Content Type ◽  
Ethylene Vinyl Alcohol ◽  
Complete Occlusion ◽  
Giant Aneurysms ◽  
Fine Print

✓ Between April, 1989, and January, 1991, a total of 19 cases of giant aneurysm were treated by the endovascular approach. The patients included seven males and 12 females aged 15 to 72 years. Detachable balloons, occlusion coils, and ethylene vinyl alcohol copolymer liquid were used as embolic materials. In seven cases, thrombosis of the aneurysmal sac and/or base was achieved while sparing the parent arterial flow; complete obliteration of the aneurysm was achieved in four of these. Of these four patients, the thrombotic material was a detachable balloon in two, a combination of a detachable balloon and coils in one, and occlusion liquid in one. In the other three cases, complete occlusion was not achieved; one aneurysm was occluded with a detachable balloon and two with coils. In 11 patients, the parent artery was occluded either by trapping or by proximal arterial occlusion, and all patients showed complete occlusion of the aneurysms. In one patient, a combined bypass procedure and parent artery occlusion was performed. Among the 19 cases in this series there were four transient ischemic attacks, one reversible ischemic neurological deficit, and one death due to aneurysmal rupture during the procedure. Two patients died in the follow-up period, one from pneumonia 2 months postoperatively and the other from acute cardiac failure 2 weeks following surgery. Both deaths were unrelated to the endovascular procedure. It is concluded that the endovascular treatment of giant aneurysms remains difficult because of the large and irregular shape of the aneurysmal base and thrombus in the aneurysmal sac. The proper selection and combination of the available endovascular techniques is therefore of critical importance.

Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment

1991 ◽  
Vol 75 (4) ◽  
pp. 525-534 ◽  
Author(s):  
Mark E. Linskey ◽  
Laligam N. Sekhar ◽  
Joseph A. Horton ◽  
William L. Hirsch ◽  
Howard Yonas
Keyword(s):  
Carotid Artery ◽  
Low Risk ◽  
Ct Scans ◽  
Xenon Ct ◽  
Content Type ◽  
Giant Aneurysms ◽  
Aneurysm Embolization ◽  
Risk Patients ◽  
Fine Print

✓ Of 43 cavernous sinus aneurysms diagnosed over 6½ years, 23 fulfilled indications for treatment; of these 19 were treated, eight surgically and 11 with interventional radiological techniques. Six small and two giant aneurysms were treated surgically: four were clipped, two were repaired primarily, and two were trapped with placement of a saphenous-vein bypass graft. Seven large and four giant aneurysms were treated with interventional radiological techniques: in five cases the proximal internal carotid artery (ICA) was sacrificed; one aneurysm was trapped with detachable balloons; and five were embolized with preservation of the ICA lumen. The mean follow-up period was 25 months. At follow-up examination, three patients in the surgical group were asymptomatic, two had improved, and three had worsened. Three of these patients had asymptomatic infarctions apparent on computerized tomography (CT) scans. At follow-up examination, four radiologically treated patients were asymptomatic, five had improved, two were unchanged, and none had worsened. One patient had asymptomatic and one minimally symptomatic infarction apparent on CT scans; both lesions were embolic foci after aneurysm embolization with preservation of the ICA. It is concluded that treatment risk depends more on the adequacy of collateral circulation than on the size of the aneurysm. A multidisciplinary treatment protocol for these aneurysms is described, dividing patients into high-, moderate-, and low-risk groups based on pretreatment evaluation of the risk of temporary or permanent ICA occlusion using a clinical balloon test occlusion coupled with an ICA-occluded stable xenon/CT cerebral blood flow study. Radiological techniques are suggested for most low-risk patients, while direct surgical techniques are proposed for most moderate- and high-risk patients.

A newly designed puncture needle for suction decompression of giant aneurysms

1992 ◽  
Vol 76 (5) ◽  
pp. 880-882 ◽  
Author(s):  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi ◽  
Kenji Wakui ◽  
Yoshiki Ichinose ◽  
Hiroshi Okudera
Keyword(s):  
Operating Room ◽  
Parent Artery ◽  
Intravenous Catheter ◽  
Suction System ◽  
Content Type ◽  
Giant Aneurysms ◽  
Puncture Needle ◽  
Fine Print

✓ A newly designed puncture needle for aspirating large or giant aneurysms is described. This puncture needle represents a modification of an intravenous catheter with an internal needle. It is designed to prevent blood from leaking when the internal needle is removed and has a lateral tube for aspiration. Following aneurysm puncture with the parent artery temporarily trapped, the catheter is positioned on the head frame with a brain spatula and a self-retaining retractor. Blood is suctioned through the lateral tube with a syringe or the suction system normally used in the operating room.

Fenestrated clips for internal carotid artery aneurysms

1986 ◽  
Vol 65 (1) ◽  
pp. 122-123 ◽  
Author(s):  
Shigekiyo Fujita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Parent Artery ◽  
Content Type ◽  
Aneurysm Clip ◽  
Fine Print

✓ A new aneurysm clip has been developed specifically for internal carotid artery (ICA) aneurysms. This fenestrated clip's occluding blades deviate laterally, since the majority of ICA aneurysms protrude posterolateral to the parent artery. The clip was applied safely in seven recent patients with ICA aneurysms.

Multiple clipping technique for large and giant internal carotid artery aneurysms and complications: angiographic analysis

1994 ◽  
Vol 80 (4) ◽  
pp. 635-642 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Shigeaki Kobayashi ◽  
Kazuhiko Kyoshima ◽  
Kenichiro Sugita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Middle Cerebral Artery ◽  
Internal Carotid ◽  
Parent Artery ◽  
Surgical Clipping ◽  
Content Type ◽  
Clipping Technique ◽  
Fine Print

✓ Experience with surgical clipping of 16 large and nine giant aneurysms of the intradural internal carotid artery (ICA) is described. Reconstruction of the parent artery with part of the aneurysmal wall was necessary in the majority of cases. Multiple clips were required for satisfactory clipping in 20 cases. Complications related to the clipping procedure comprised occlusion and stenosis of the parent carotid artery in isolated cases. Straightening of the parent carotid artery with consequent kinking of the middle cerebral artery was seen in three cases of an aneurysm with a dome directed ventrally in the proximal segment of the ICA. The factors that caused straightening of the ICA are analyzed. It was observed that an excessive change in the direction of the ICA can cause cerebral infarction.

Endovascular treatment of ruptured posterior circulation aneurysms using electrolytically detachable coils

1997 ◽  
Vol 87 (3) ◽  
pp. 374-380 ◽  
Author(s):  
Douglas A. Nichols ◽  
Robert D. Brown ◽  
Kent R. Thielen ◽  
Fredric B. Meyer ◽  
John L. D. Atkinson ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Balloon Occlusion ◽  
Additional Treatment ◽  
Posterior Circulation ◽  
Parent Artery ◽  
Content Type ◽  
Detachable Coils ◽  
Posterior Circulation Aneurysms ◽  
Fine Print

✓ The authors report their experience using electrolytically detachable coils for the treatment of ruptured posterior circulation aneurysms. Twenty-six patients with 28 posterior circulation aneurysms were treated. All patients were referred for endovascular treatment by experienced vascular neurosurgeons. Patients underwent follow-up angiography immediately after treatment, 1 to 6 weeks posttreatment, and 6 months posttreatment. Six-month follow-up angiograms obtained in 19 patients with 20 aneurysms demonstrated that 18 (90%) of the 20 aneurysms were 99 to 100% occluded, one aneurysm (5%) was approximately 90% occluded, and one aneurysm (5%) was approximately 75% occluded. The patient with the aneurysm that was approximately 75% occluded needed additional treatment, consisting of parent artery balloon occlusion, and was considered a treatment failure (3.8% of patients). There was one treatment-associated mortality (3.8%) but no treatment-associated serious neurological or nonneurological morbidity in the patient group. There was no recurrent aneurysm rupture during treatment or during the mean 27-month follow-up period. Endovascular treatment of ruptured posterior circulation aneurysms with electrolytically detachable coils can be accomplished with low morbidity and mortality rates. The primary goal of treatment—preventing recurrent aneurysm—can be achieved over the short term. Endovascular coil occlusion will play an important role in the treatment of ruptured posterior circulation aneurysms, particularly if long-term efficacy in preventing recurrent aneurysm hemorrhage can be documented.

Bilateral giant carotid-ophthalmic aneurysms

1975 ◽  
Vol 42 (5) ◽  
pp. 589-592 ◽  
Author(s):  
Francisco Garcia-Bengochea ◽  
Frank H. Deland
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Giant Aneurysms ◽  
Unusual Combination ◽  
Fine Print

✓ The authors describe a patient with bilateral giant aneurysms of the internal carotid artery in the region of the ophthalmic artery. This case illustrates the feasibility of successful intracranial surgical treatment for this unusual combination.

Flow changes caused by the sequential placement of stents across the neck of sidewall cerebral aneurysms

2005 ◽  
Vol 103 (5) ◽  
pp. 891-902 ◽  
Author(s):  
Gádor Cantón ◽  
David I. Levy ◽  
Juan C. Lasheras ◽  
Peter K. Nelson
Keyword(s):  
Shear Stress ◽  
Velocity Field ◽  
Cerebral Aneurysms ◽  
Parent Artery ◽  
Shear Stresses ◽  
Content Type ◽  
Aneurysm Neck ◽  
Aneurysm Wall ◽  
Aneurysm Model ◽  
Fine Print

Object. The goal of this study was to quantify the reduction in velocity, vorticity, and shear stresses resulting from the sequential placement of stents across the neck of sidewall cerebral aneurysms. Methods. A digital particle image velocimetry (DPIV) system was used to measure the pulsatile velocity field within a flexible silicone sidewall intracranial aneurysm model and at the aneurysm neck–parent artery interface in this model. The DPIV system is capable of providing an instantaneous, quantitative two-dimensional measurement of the velocity vector field of “blood” flow inside the aneurysm pouch and the parent vessel, and its changes at varying stages of the cardiac cycle. The corresponding vorticity and shear stress fields are then computed from the velocity field data. Three Neuroform stents (Boston Scientific/Target), each with a strut thickness between 60 and 65 µm, were subsequently placed across the neck of the aneurysm model and measurements were obtained after each stent had been placed. The authors measured a consistent decrease in the values of the maximal averaged velocity, vorticity, and shear stress after placing one, two, and three stents. Measurements of the circulation inside the sac demonstrated a systematic reduction in the strength of the vortex due to the stent placement. The decrease in the magnitude of the aforementioned quantities after the first stent was placed was remarkable. Placement of two or three stents led to a less significant reduction than placement of the first stent. Conclusions. The use of multiple flexible intravascular stents effectively reduces the strength of the vortex forming in an aneurysm sac and results in a decrease in the magnitude of stresses acting on the aneurysm wall.

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