Balloon-assisted microvascular clipping of paraclinoid aneurysms

2004 ◽  
Vol 100 (4) ◽  
pp. 713-716 ◽  
Author(s):  
William Thorell ◽  
Peter Rasmussen ◽  
John Perl ◽  
Thomas Masaryk ◽  
Marc Mayberg
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Direct Result ◽  
Parent Vessel ◽  
Content Type ◽  
Complex Aneurysms ◽  
Microsurgical Clipping ◽  
Paraclinoid Aneurysms ◽  
Fine Print

✓ Paraclinoid aneurysms represent a significant surgical challenge. Multiple techniques have been developed to maximize the effectiveness and safety of excluding these aneurysms from the cerebral circulation. Endovascular balloons have been used for proximal control of parent arteries during the treatment of aneurysms. In this report the authors describe the technique of navigating an endovascular balloon across the neck of paraclinoid aneurysms in four patients to gain proximal control, improve the accuracy of clip placement, and reduce the risk of distal embolization of intraluminal thrombus. Six consecutive patients with giant or complex aneurysms of the ophthalmic or paraclinoid internal carotid artery that were not amenable to endovascular obliteration were retrospectively analyzed. In all six patients, the aneurysm was exposed and dissected for microsurgical clipping, and attempts were made to navigate a nondetachable, compliant silicone balloon across the neck of the aneurysm. If successfully placed, the balloon was inflated during clip placement. In four patients, the balloon was successfully navigated across the neck of the aneurysm and was inflated during clip application. Internal carotid artery tortuosity precluded navigation of the balloon into the intracranial circulation in two patients. All aneurysms were completely excluded from the parent vessel according to postoperative angiography studies. No complication occurred as a direct result of the endovascular portion of the procedure. Endovascular balloon stenting of complex paraclinoid aneurysms during microvascular clipping may provide an adjunctive therapy that facilitates safe and accurate clip placement.

Carotid paraclinoid aneurysms with intradural origin and intracavernous location

1978 ◽  
Vol 48 (4) ◽  
pp. 526-533 ◽  
Author(s):  
Stephen Nutik
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Precise Definition ◽  
Separate Entity ◽  
Content Type ◽  
Paraclinoid Aneurysms ◽  
Planning Treatment ◽  
Definition Of ◽  
Fine Print

✓ Five cases of a congenital berry aneurysm of the internal carotid artery with origin partially intradural and fundus mainly intracavernous are presented. Angiography does not allow a precise definition of the amount of aneurysm that is intradural, a fact of importance when planning treatment of these cases. However, the angiographic features are characteristic of the type and suggest that these aneurysms be grouped together as a separate entity.

Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms

2004 ◽  
Vol 101 (6) ◽  
pp. 989-995 ◽  
Author(s):  
Hiroyuki Kinouchi ◽  
Toshiharu Yanagisawa ◽  
Akira Suzuki ◽  
Tohru Ohta ◽  
Yoshitaka Hirano ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Bone Structure ◽  
Surgical Complication ◽  
Artery Aneurysm ◽  
Content Type ◽  
Paraclinoid Aneurysms ◽  
Perforating Arteries ◽  
Fine Print

Object. The authors of this study evaluated the efficacy of simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery (ICA) aneurysms. Methods. The endoscopic technique was applied during microsurgery in 11 patients with 13 aneurysms. Nine of these lesions were located on the posterior communicating artery (PCoA), three in the paraclinoid region, and one on the anterior choroidal artery (AChA). Eight patients had unruptured aneurysms and three had ruptured aneurysms. The endoscope was introduced after first exposing the aneurysm through the microscope and was gripped firmly by an air-locked holding arm fitted with a steering system throughout the entire surgery, including dissection of the perforating arteries and application of the aneurysm clips. Regarding paraclinoid aneurysms, clips were applied through direct visualization of the ophthalmic artery and the proximal neck. In a case involving a superior hypophyseal artery aneurysm in the paraclinoid segment, a ring clip was applied without removing the bone structure around the optic canal. In all aneurysms of the PCoA and the AChA, perforating arteries behind the lesion were identified and dissected using endoscopic control. The aneurysm clip was applied in the best position in a single attempt in 10 of 11 patients. There was no surgical complication related to the endoscopic procedures. Conclusions. Simultaneous monitoring with the microscope and endoscope is extremely useful in applying clips to ICA aneurysms. This combined method allows for direct dissection of the aneurysm, perforating vessels, and the main trunk in an area not visible through the microscope's eyepiece and promises better surgical results.

Enlarged anterior spinal artery as collateral circulation

1974 ◽  
Vol 41 (3) ◽  
pp. 356-359 ◽  
Author(s):  
Jun Karasawa ◽  
Haruhiko Kikuchi ◽  
Seiji Furuse ◽  
Toshisuke Sakaki ◽  
Yasumasa Makita
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Collateral Circulation ◽  
Internal Carotid ◽  
Vascular Malformations ◽  
Anterior Spinal Artery ◽  
Left Internal Carotid Artery ◽  
Content Type ◽  
Vertebral Arteries ◽  
Fine Print

✓The authors report and discuss two cases in which collateral circulation could be angiographically demonstrated passing through the anterior spinal artery. Case 1 proved to have occlusions of the left internal carotid artery and both vertebral arteries. The basilar artery was visualized via the anterior spinal, the primitive trigeminal, and primitive otic arteries. The presence of multiple vascular malformations and an abnormal anterior spinal artery suggested that the latter had been functioning as collateral circulation since an embryonic stage. In Case 2, both internal carotids and both vertebral arteries were occluded by arteriosclerotic changes. It was assumed that the deleted anterior spinal artery visualized angiographically had developed into a collateral circulation with increasing age.

Patient presentation, angiographic features, and treatment of strangulation-induced dissection of the internal carotid artery

2000 ◽  
Vol 92 (3) ◽  
pp. 481-487 ◽  
Author(s):  
Adel M. Malek ◽  
Randall T. Higashida ◽  
Van V. Halbach ◽  
Christopher F. Dowd ◽  
Constantine C. Phatouros ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Stent Placement ◽  
Internal Carotid ◽  
Artery Dissection ◽  
Percutaneous Angioplasty ◽  
Consistent Finding ◽  
Content Type ◽  
Fine Print

✓ Domestic violence leading to strangulation by an abusive spouse can cause carotid artery dissection. This phenomenon is rare and has been described in only three previous instances. The authors present their management strategies in three additional cases.Three young women aged 24 to 43 years were victims of manual strangulation committed by their spouses 3 months to 1 year before presentation. Two of the patients suffered delayed cerebral infarctions before presentation and angiography demonstrated focal, mirror-image severe residual stenoses in the high-cervical internal carotid artery (ICA), which were characteristic of a healed chronic dissection; there was no evidence of fibromuscular dysplasia. One of these patients underwent unilateral percutaneous angioplasty with stent placement, and the other underwent bilateral percutaneous angioplasty. Both patients have recovered from their strokes and remain clinically stable at 8 and 20 months posttreatment, respectively. The third patient presented with bilateral ischemic frontal watershed infarctions resulting from an occluded left ICA and a severely narrowed right ICA. Given the extent of the established infarctions, this case was managed with a long-term regimen of anticoagulation medications, and the patient remains neurologically impaired.These cases illustrate the susceptibility of the manually compressed ICA to traumatic injury as a result of domestic violence. They identify bilateral symmetrical ICA dissection as a consistent finding and the real danger of delayed stroke as a consequence of strangulation. Endovascular therapy in which percutaneous angioplasty and/or stent placement are used can be useful in treating residual focal stenoses to improve cerebral perfusion and to lower the risk of embolic or ischemic stroke.

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.

Carotid control for intracranial aneurysms

1988 ◽  
Vol 69 (1) ◽  
pp. 142 ◽  
Author(s):  
Milton D. Heifetz
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Control Mechanism ◽  
Content Type ◽  
Flexible Cable ◽  
Cervical Internal Carotid Artery ◽  
Fine Print

✓ A new clamp with a flexible cable control mechanism for temporary intraoperative occlusion of the cervical internal carotid artery is described.

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.

Reconstitution of “totally” occluded internal carotid arteries

1979 ◽  
Vol 50 (6) ◽  
pp. 747-757 ◽  
Author(s):  
Roger W. Countee ◽  
Thurairasah Vijayanathan
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Injection Technique ◽  
Complete Relief ◽  
Content Type ◽  
Internal Carotid Arteries ◽  
Angiographic Technique ◽  
Fine Print

✓ The authors describe their experiences with five patients with delayed transient ischemic symptoms homolateral to internal carotid artery (ICA) occlusions. In each instance, initial arteriograms were interpreted as showing irreversible occlusions of these arteries in the neck and microvascular bypass procedures were contemplated. However, after repeat arteriographic evaluations with a modified injection technique, certain angiographic features were identified that suggested the mechanism of the symptoms in these patients and that their ICA's could be reconstituted in the neck. This was successfully accomplished in each patient with complete relief of ischemic symptoms. The angiographic technique employed and the arterial flow patterns identified in these patients are discussed. The details of the operative technique are described. It is concluded that routine arteriographic techniques may be inadequate to identify the reversible carotid occlusion. This may account for some of the confusion which surrounds the surgery of these vessels as well as the failure of extracranial-intracranial bypass to relieve recurrent ischemic symptoms in these individuals.

Fenestrated clips for unusual aneurysms of the carotid artery

1982 ◽  
Vol 57 (2) ◽  
pp. 240-246 ◽  
Author(s):  
Kenichiro Sugita ◽  
Shigeaki Kobayashi ◽  
Kazuhiko Kyoshima ◽  
Fukuo Nakagawa
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Vertebral Artery ◽  
Internal Carotid ◽  
Content Type ◽  
Actual Use ◽  
Fine Print

✓ Twenty-four different kinds of fenestrated clips are introduced for the obliteration of unusual aneurysms. The clips were used for eight aneurysms of the internal carotid artery and 10 aneurysms of the vertebral artery. All but one of the aneurysms were successfully obliterated. Recommendations are made concerning the actual use of the clips.

Proatlantal intersegmental artery and trigeminal artery associated with an aneurysm

1983 ◽  
Vol 59 (3) ◽  
pp. 520-523 ◽  
Author(s):  
Yuichiro Tanaka ◽  
Hideaki Hara ◽  
Genki Momose ◽  
Shigeru Kobayashi ◽  
Shigeaki Kobayashi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Incidental Findings ◽  
Internal Carotid ◽  
Trigeminal Artery ◽  
Content Type ◽  
Primitive Trigeminal Artery ◽  
Fine Print

✓ A case of coexisting proatlantal intersegmental artery and primitive trigeminal artery is described. These anomalies were incidental findings in a patient with hemiparesis due to occlusion of the middle cerebral artery. The primitive trigeminal artery had an asymptomatic aneurysm at its origin from the internal carotid artery.

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