Cerebral hemodynamic evaluation of parent artery occlusion for giant intracranial aneurysm in patients who tolerated balloon test occlusion: two case reports

Typical treatment of intracranial aneurysm includes: surgical clipping, intrasacular packing, and parent artery occlusion. The treatment of a fusiform aneurysm is often parent artery occlusion, and keeping patency of the parent artery is difficult. We report our experience in the treatment of 3 cases of intracranial fusiform aneurysm with stent placement inside the parent artery only, without coil packing of the aneurysm lumen. All 3 patients had a non-hemorrhagic dissecting aneurysm in the vertebral artery. They were treated with 2 Helistents, 3 Neuroform stents, and 2 Neuroform stents, respectively. These aneurysms disappeared after treatment at their follow-up angiograms. Treatment with a bare stent may induce obliteration or reduction in the size of some aneurysms. This technique is useful in the treatment of non-hemorrhagic fusiform-shaped aneurysms or non-hemorrhagic dissecting aneurysms to preserve the patency of these parent arteries.

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Parent Artery Occlusion for Posterior Cerebral Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/15910199060120s120 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 125-128 ◽

Cited By ~ 4

Author(s):

K. Hoya ◽

M. Nagaishi ◽

Y. Yoshimoto ◽

E. Morikawa ◽

H. Takahashi

Keyword(s):

Cerebral Artery ◽

Posterior Cerebral Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Balloon Test Occlusion ◽

Parent Artery Occlusion ◽

Permanent Occlusion

We review four cases of posterior cerebral artery (PCA) aneurysm, of which three showed intolerance of parent artery occlusion. In two, balloon test occlusion (BTO) indicated poor opacification of the PCA branches from the anastomoses, and therefore, permanent occlusion was not attempted.

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Traumatic Pseudoaneurysms of the Common Carotid and Vertebral Artery in a Four-Year-Old Child

Interventional Neuroradiology ◽

10.1177/159101991201800316 ◽

2012 ◽

Vol 18 (3) ◽

pp. 348-352 ◽

Cited By ~ 8

Author(s):

M. Mahmoud ◽

E. Roshdi ◽

D. Benderbous

Keyword(s):

Vertebral Artery ◽

Carotid Arteries ◽

Case Reports ◽

Artery Occlusion ◽

Parent Artery ◽

Child Victim ◽

Parent Artery Occlusion ◽

Unusual Occurrence ◽

The Common ◽

Common Carotid Arteries

Pseudoaneurysms of the neck arteries are rare lesions usually traumatic and less frequently infectious in origin. They are often described as case reports. We describe here an unusual occurrence of pseudoaneurysms in the common carotid and vertebral artery in a four-year-old child victim of a stab wound in the neck treated by parent artery occlusion of the vertebral and common carotid arteries.

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Endovascular Parent Artery Occlusion for Intracranial Aneurysms is a Viable, Cost-Effective Alternative: An Institutional Experience from Northeast India

Acta medica Lituanica ◽

10.15388/amed.2021.28.2.6 ◽

2021 ◽

Vol 28 (2) ◽

pp. 6

Author(s):

Pranjal Phukan ◽

Kalyan Sarma ◽

Donboklang Lynser ◽

Barun Kumar Sharma ◽

Deb Kumar Baruah ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Intracranial Aneurysms ◽

Cerebral Aneurysms ◽

Artery Occlusion ◽

Parent Artery ◽

Complete Occlusion ◽

Parent Artery Occlusion ◽

Long Term Follow Up

Purpose. Endovascular parent artery occlusion (PAO) may be an alternative approach for complex intracranial aneurysm with potentially life-threatening complications. Moreover, the long-term follow-up of the PAO for an intracranial aneurysm is reported sparingly, limited to the case series. It is therefore important to carry out more research on long-term follow-up of the implication of PAO of intracranial aneurysm. The aim of the study was to analyses our experience of PAO for intracranial aneurysms with emphasis on long-term follow-up.Materials and Methods. The data of patients treated with PAO for intracranial aneurysms were reviewed. The outcome was evaluated based on aneurysmal occlusion on immediate angiography, follow-up magnetic resonance angiography (MRA), and complications. The modified Rankin score (mRS) was used to evaluate the functional outcome during the last follow-up. The mean, range, and standard deviation were reported for other variables – the patient’s age, number, and percentage.Results. Endovascular treatment was performed in 178 patients including PAO in 18 patients. Of these 18 (eighteen) patients, there were 13 dissecting aneurysms, 4 mycotic aneurysms, and one traumatic aneurysm.10 (ten) patients underwent PAO for proximal intracranial artery aneurysm and 8 (eight) patients for distal cerebral aneurysms. Complete occlusion of the aneurysm was achieved in 16patients (88.89%) and retrograde filling of the aneurysm was seen in 2 (11.11%) patients. One patient had intraprocedural coil migration resulting in a major infarct with an mRS of 2. Another patient (5.56%) had recanalization of the aneurysm and presented with rupture and intracranial hemorrhage with an mRS score of 4. The mRS of the other 16 patients (88.89%) was zero.Conclusions. Endovascular PAO for cerebral aneurysms was highly feasible and achieved complete occlusion. The morbidity and mortality rates were at the long-term follow-up also acceptable with negligible complications.

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Completely Thrombosed Giant Intracranial Aneurysm with Spontaneous Thrombosis of the Parent Artery: Is It Nature's Divine Intervention and a Self-Cure?

World Neurosurgery ◽

10.1016/j.wneu.2018.07.072 ◽

2018 ◽

Vol 118 ◽

pp. 132-138 ◽

Cited By ~ 2

Author(s):

Kuntal Kanti Das ◽

Gagandeep Singh ◽

Satyadeo Pandey ◽

Kamlesh Singh Bhaisora ◽

Awadhesh Jaiswal ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Parent Artery ◽

Spontaneous Thrombosis ◽

Divine Intervention ◽

Giant Intracranial Aneurysm

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Peripheral intracranial aneurysms: management challenges in 60 consecutive cases

Journal of Neurosurgery ◽

10.3171/2008.6.jns0814 ◽

2009 ◽

Vol 110 (1) ◽

pp. 7-13 ◽

Cited By ~ 28

Author(s):

Eric S. Nussbaum ◽

Michael T. Madison ◽

James K. Goddard ◽

Jeffrey P. Lassig ◽

Leslie A. Nussbaum

Keyword(s):

Intracranial Aneurysms ◽

Artery Occlusion ◽

Neurological Deficits ◽

Parent Artery ◽

Branch Points ◽

Aneurysm Neck ◽

Vertebrobasilar System ◽

Parent Artery Occlusion ◽

Major Branch ◽

Proximal Occlusion

Object The authors report the management and outcomes of 55 patients with 60 intracranial aneurysms arising distal to the major branch points of the circle of Willis and vertebrobasilar system. Methods Between July 1997 and December 2006, the authors' neurovascular service treated 2021 intracranial aneurysms in 1850 patients. The database was reviewed retrospectively to identify peripherally located intracranial aneurysms. Aneurysms that were mycotic and aneurysms that were associated with either an arteriovenous malformation or an atrial myxoma were excluded from review. Results The authors encountered 60 peripheral intracranial aneurysms in 55 patients. There were 42 small, 7 large, and 11 giant lesions. Forty-one (68%) were unruptured, and 19 (32%) had bled. Fifty-three aneurysms were treated surgically by using direct clip reconstruction in 26, trapping or proximal occlusion with distal revascularization in 21, excision with end-to-end anastomosis in 3, and circumferential wrap/clip reconstruction in 3. Coils were used to treat 6 aneurysms, and 1 was treated by endovascular parent artery occlusion. Overall, 49 patients had good outcomes, 4 were left with new neurological deficits, and 2 died. Conclusions Peripherally situated intracranial aneurysms are rare lesions that present unique management challenges. Despite the fact that in the authors' experience these lesions were rarely treatable with simple clipping of the aneurysm neck or endovascular coil occlusion, preservation of the parent artery was possible in most cases, and the majority of patients had a good outcome.

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Treatment of giant and large internal carotid cavernous aneurysms. Effect of aneurysm obliteration and parent artery occlusion

Clinical Neurology and Neurosurgery ◽

10.1016/s0303-8467(97)81698-8 ◽

1997 ◽

Vol 99 ◽

pp. S96-S97

Author(s):

S. Kato ◽

M. Fujii ◽

K. Kashiwagi ◽

K. Yamashita ◽

H. Ito ◽

...

Keyword(s):

Internal Carotid ◽

Artery Occlusion ◽

Parent Artery ◽

Parent Artery Occlusion

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Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017554.rep ◽

2021 ◽

pp. neurintsurg-2021-017554.rep

Author(s):

Giovanni Barchetti ◽

Loris Di Clemente ◽

Mauro Mazzetto ◽

Mariano Zanusso ◽

Paola Ferrarese ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Successful Treatment ◽

Expectant Management ◽

Flow Diverter ◽

Artery Occlusion ◽

Parent Artery ◽

Microsurgical Clipping ◽

Parent Artery Occlusion ◽

The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

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A Combined Approach to Treatment of the Dissecting Middle Cerebral Artery Fusiform Aneurysm

Interventional Neuroradiology ◽

10.1177/159101990901500314 ◽

2009 ◽

Vol 15 (3) ◽

pp. 349-354 ◽

Cited By ~ 3

Author(s):

T. Hrbáč ◽

P. Drábek ◽

P. Klement ◽

V. Procházka

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Artery Occlusion ◽

Parent Artery ◽

Fusiform Aneurysm ◽

Neurological Sequelae ◽

Parent Artery Occlusion ◽

Aneurysm Embolization ◽

Mca Aneurysm ◽

One Year

A fusiform aneurysm in the terminal M1 middle cerebral artery (MCA) segment was treated by a construction of a high-flow arterial extracranial-intracranial (EC-IC) bypass. Due to severe bypass vasospasms, local vasodilating agents together with percutaneous angioplasty and stent implantation were applied, but failed due to subsequent bypass occlusion. To remedy this complication a new bypass was created from a segment of the saphenous vein, followed by MCA aneurysm embolization and parent artery occlusion. One year after the surgery, the venous bypass remains patent and the aneurysm occluded, with the patient fully active, without any neurological sequelae.

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