"Double Protection Closed Compartment" Aspiration Technique for Left Internal Carotid Artery (ICA) Free Floating Thrombus

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

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Free-Floating Thrombus in the Distal Internal Carotid Artery Causing a Stroke

International Journal of Angiology ◽

10.1055/s-0040-1720973 ◽

2020 ◽

Author(s):

Spyros Papadoulas ◽

Konstantinos Moulakakis ◽

Natasa Kouri ◽

Petros Zampakis ◽

Stavros K. Kakkos

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Medical Management ◽

Internal Carotid ◽

Treatment Strategies ◽

Rare Condition ◽

Residual Stenosis ◽

Floating Thrombus ◽

Distal Internal Carotid Artery ◽

Carotid Bulb

AbstractWe present a patient suffering from a stroke with a free-floating thrombus extending up to the distal internal carotid artery. The thrombus was totally resolved after a 2-week anticoagulation regimen without leaving behind any severe residual stenosis in the carotid bulb. The optimal treatment of this rare condition remains uncertain. We report some important treatment strategies that have been used in the literature, emphasizing the anticoagulation as the mainstay of therapy. Immediate surgical and interventional manipulations carry the risk of thrombus dislodgement and embolization and should be considered if there are recurrent symptoms despite medical management.

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Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1727124 ◽

2021 ◽

Author(s):

Walid Elshamy ◽

Burcak Soylemez ◽

Sima Sayyahmelli ◽

Nese Keser ◽

Mustafa K. Baskaya

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Skull Base ◽

Internal Carotid ◽

Gross Total Resection ◽

Petrous Apex ◽

Left Internal Carotid Artery ◽

Total Resection ◽

Complete Occlusion ◽

Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

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Successful Bridging Therapy in a 103-Year-Old Woman with Acute Terminal Internal Carotid Artery Occlusion

Case Reports in Neurology ◽

10.1159/000507693 ◽

2020 ◽

Vol 12 (Suppl. 1) ◽

pp. 9-14

Author(s):

Trung Quoc Nguyen ◽

Hoang Thi Phan ◽

Tinh Quang Dang ◽

Vu Thanh Tran ◽

Thang Huy Nguyen

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Intravenous Thrombolysis ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Left Internal Carotid Artery ◽

Bridging Therapy ◽

Nihss Score ◽

Current Guidelines

The efficacy of intravenous thrombolysis and endovascular therapy and their favorable treatment outcomes have been established in clinical trials irrespective of age. Current guidelines do not recommend an age limit in selecting eligible patients for reperfusion treatment as long as other criteria are satisfied. A 103-year-old woman was admitted at our hospital within 1 h of stroke onset secondary to a left internal carotid artery terminus occlusion. On admission, her National Institutes of Health Stroke Scale (NIHSS) score was 30, with a small left thalamic diffusion restriction lesion on MRI. Her medical history included paroxysmal atrial fibrillation, prior myocardial infarction, hypertension, chronic kidney disease, and diabetes mellitus. Her pre-stroke modified Rankin Scale score was 0, and she was fully independent before stroke. Once intravenous thrombolysis was started, the patient successfully underwent mechanical thrombectomy, and thrombolysis in cerebral infarction-3 recanalization was achieved 225 min after symptom onset. She showed dramatic recovery (NIHSS score of 5 after 48 h) and was discharged on day 7 with a modified Rankin Score of 1. To our knowledge, our patient is the second oldest documented patient who successfully underwent bridging therapy for stroke.

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Management of Mobile Thrombus With Distal Protection Devices During Carotid Artery Angioplasty: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab131 ◽

2021 ◽

Author(s):

Salomon Cohen-Cohen ◽

Giuseppe Lanzino ◽

Waleed Brinjikji ◽

Adam Arthur ◽

Mark Bain ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Internal Carotid ◽

Mechanical Thrombectomy ◽

Standard Of Care ◽

Video Production ◽

Left Internal Carotid Artery ◽

Left Middle Cerebral Artery ◽

Cerebral Angiogram ◽

Protection Devices

Abstract Embolic protection devices (EPDs) have become a standard of care during internal carotid artery revascularization.1,2 This video is about a 57-yr-old-male who presented with a wake-up stroke with a left hemispheric syndrome. Head computed tomography angiography (CTA) revealed tandem occlusions of the proximal left internal carotid artery (ICA) and of the distal left middle cerebral artery (MCA) with an ASPECT (Alberta Stroke Program Early CT Score) score of 6. The patient underwent a cerebral angiogram and was treated with balloon angioplasty with a distal EPD and mechanical thrombectomy. The EPD became occluded with thrombus from the ICA and was retrieved through a 6-Fr Sofia (MicroVention) under continuous aspiration. Successful revascularization of the proximal ICA and distal MCA was achieved. No procedure-related complications occurred, and the patient's neurological exam improved. Tandem occlusions can occur in up to 15% of strokes. The optimal treatment can be controversial, but mechanical thrombectomy and ICA revascularization with a distal EPD appear to be safe and effective in selected patients.3 Consent was obtained for the procedure and for the video production.

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Trigeminal Neuralgia Associated with a Primitive Trigeminal Artery Variant: Case Report

Neurosurgery ◽

10.1093/neurosurgery/52.5.1217 ◽

2003 ◽

Vol 52 (5) ◽

pp. 1217-1220

Author(s):

Yoji Tamura ◽

Hiroshi Shimano ◽

Toshihiko Kuroiwa ◽

Yoshihito Miki

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Trigeminal Neuralgia ◽

Internal Carotid ◽

Left Internal Carotid Artery ◽

Decompression Surgery ◽

Trigeminal Artery ◽

Cerebellar Artery ◽

Primitive Trigeminal Artery ◽

Perforating Arteries

Abstract OBJECTIVE AND IMPORTANCE A variant type of the primitive trigeminal artery (PTA) is a rare anomalous vessel that originates from the internal carotid artery and directly supplies the territory of the anteroinferior cerebellar artery and/or the superior cerebellar artery. We report a case of trigeminal neuralgia associated with this PTA variant, and we discuss the characteristics of this vessel. CLINICAL PRESENTATION A 51-year-old woman presented with a 10-year history of left paroxysmal facial pain. Magnetic resonance angiography and cerebral angiography demonstrated that an aberrant vessel originating from the left internal carotid artery directly supplied the cerebellum, without a basilar artery anastomosis. INTERVENTION Surgical exploration was performed via a left retrosigmoid approach. A loop of the aberrant vessel, which entered the posterior fossa through the isolated dural foramen, was compressing the trigeminal nerve. This aberrant vessel was displaced medially from the nerve with a prosthesis, with care to avoid kinking and avulsion of the perforating arteries. The patient's neuralgia resolved postoperatively. CONCLUSION Although the PTA variant is frequently associated with intracranial aneurysms, it is extremely rare for the variant to lead to trigeminal neuralgia. During microvascular decompression surgery, surgeons should be careful to prevent injury of the perforating arteries arising from the PTA variant.

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Anatomical Predictors of Left Internal Carotid Artery Catheterization in Transradial Angiography

10.1101/2021.10.07.21264684 ◽

2021 ◽

Author(s):

Seon Woong Choi ◽

Hoon Kim ◽

Seong Rim Kim ◽

Ik Seong Park ◽

Sunghan Kim

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Aortic Arch ◽

Subclavian Artery ◽

Internal Carotid ◽

Multivariable Analysis ◽

Innominate Artery ◽

Left Internal Carotid Artery ◽

Arch Height ◽

Contrast Enhanced

ABSTRACTIntroductionTransradial angiography (TRA) has received considerable attention in the field of neurointervention owing to its advantages over transfemoral approaches. However, the difficulty of left internal carotid artery (ICA) catheterization under certain anatomical conditions of the aortic arch and its branches is a limitation of TRA. This study aimed to investigate the anatomical predictors of successful catheterization of the left ICA in TRA.Materials and MethodsFrom January 2020 to October 2020, 640 patients underwent TRA at a single institute. Among them, 263 consecutive patients who were evaluated by contrast-enhanced MRI before TRA were included in our study and assigned to success and failure groups, according to whether left ICA catheterization was possible or not. Anatomical predictors that may affect the success of left ICA catheterization in TRA were investigated for the purposes of our study.ResultsThe multivariable analysis included variables that demonstrated significant univariate associations with ICA catherization (P<0.0001). Variables included in the model were the type of aortic arch, height of right subclavian artery, turn-off angle of the left common carotid artery (CCA), distance between innominate artery to the left CCA, angulation of right subclavian artery, and angulation of the left CCA, which we identified as significant predictors of left ICA catheterization.ConclusionSuccess of left ICA catheterization in TRA was related to the vascular geometry of the aortic arch and its branches. Evaluating the anatomical predictors identified in this study using pre-procedure imaging may enhance the success rate of left ICA catheterization in TRA.

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