“Clip Anchor-Assisted Coil Embolization” for Endovascular Parent Artery Occlusion of Intracranial Traumatic Aneurysm

Fukuda, Hitoshi; Yanagawa, Toshio; Horikawa, Fumihiko; Nakajima, Norio; Kitagawa, Masashi; Lo, Benjamin; Yamada, Keisuke

doi:10.1016/j.jstrokecerebrovasdis.2019.104374

Cited by 3 publications

(3 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, we were able to minimize the retrograde ICA blood flow by choosing the tiny PCoA as an outflow conduit of the flow alteration strategy, rather than choosing the larger ophthalmic artery. [ 5 , 7 ] PCoA preservation also contributed to avoiding blind alley formation for the retrograde flow at the distal end of the coil mass, which may cause delayed AchA thrombosis. [ 9 , 10 ] Even though sufficient blood flow is provided through the extracranial-intracranial bypass, endovascular supraclinoid ICA obliteration is associated with ischemic complications, presumably because of distal coil migration to the AchA and PCoA.…”

Section: Discussionmentioning

confidence: 99%

“…The external carotid artery-radial artery interposition graft-M2 portion of middle cerebral artery (EC-RA-M2) high-flow bypass was performed, as previously described [ Figures 2b and c ]. [ 5 , 12 ] Immediately after high-flow bypass completion, a tourniquet was placed at the cervical ICA to control anterograde blood flow and squeezed as appropriate. Endovascular parent artery occlusion was performed under retrograde blood flow provided by the high-flow bypass and proximal ICA clamping.…”

Section: Case Presentationmentioning

confidence: 99%

See 1 more Smart Citation

Flow alteration therapy for impending rupture of intracranial giant aneurysm after flow diverter placement

Yamasaki

Fukuda

Hamada

et al. 2022

Surgical Neurology International

Self Cite

View full text Add to dashboard Cite

Background: Flow diverter (FD) placement is generally effective for intractable internal carotid artery (ICA) aneurysms. However, salvage treatment for the aneurysm enlarging even after FD placement remains to be elucidated. Additional overlapping FD placement is considered the first-line treatment for residual or recurrent aneurysms. However, it is unclear whether overlapping FD is also effective for enlarging giant aneurysms that are considered impending rupture status. Although parent artery occlusion is a promising option, treatment strategy must be optimized, especially when a critical perforating artery is involved. Case Description: A 74-year-old woman experienced rapid symptomatic growth of her giant supraclinoid ICA aneurysm 10 months after FD placement. We assumed that reinforcement of flow diverting effect alone would be less effective for this extremely intractable aneurysm with more aggressive clinical feature so that surgical bailout by parent artery occlusion was planned. Complete ICA obliteration underneath the aneurysm was unavailable due to the presence of anterior choroidal artery. Thus, we took a flow alteration strategy, where we created minimal retrograde flow through the parent artery by a combination of an extracranial-intracranial bypass and targeted endovascular proximal parent artery obliteration, resulting in prevention of aneurysmal rupture and further growth. Conclusion: Impending rupture of the intracranial giant aneurysm after FD placement may be controllable with a tailor-made parent artery occlusion strategy even when a critical perforating artery is involved.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

Flow alteration therapy for impending rupture of intracranial giant aneurysm after flow diverter placement

Yamasaki

Fukuda

Hamada

et al. 2022

Surgical Neurology International

Self Cite

View full text Add to dashboard Cite

show abstract

“…A literature review was performed including 17 studies on cranial aneurysms treated with endovascular embolization and arterial bypass; the overall success rate was 84%, with 16% of patients experiencing postoperative infarction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] This video article and literature review provide valuable insights into the treatment of complex giant fusiform aneurysms with superficial temporal artery to middle cerebral artery bypass and endovascular vessel sacrifice.…”

mentioning

confidence: 99%

Hybrid Treatment for a Giant Fusiform Partially Thrombosed Middle Cerebral Artery Aneurysm With Superficial Temporal Artery to Middle Cerebral Artery Bypass Followed by Endovascular Vessel Sacrifice: 2-Dimensional Operative Video

Robledo,

Frank,

O'Leary

et al. 2023

Operative Neurosurgery

View full text Add to dashboard Cite

We present the case of a 62-year-old patient who presented with symptoms of difficulty in word finding and vertigo. Computed tomography scan of the head was performed, which showed an oval-shaped area of hyperdensity at the left superior temporal lobe, measuring around 3.7 × 2.3 cm. MRI, axial T2 imaging revealed a giant, partially thrombosed, fusiform left middle cerebral artery (MCA) aneurysm. Further evaluation with digital subtraction angiography again revealed the filling portion of the fusiform aneurysm, involving the left temporal MCA division with visible stenosis of the parent vessel both before and after the fusiform segment, consistent with a dissecting aneurysm. The outflow branch of the aneurysm supplied the Wernicke area. Treatment options were discussed. Given the eloquence of the outflow vessel, a flow preservation option was necessary. The patient consented to the procedure. Direct superficial temporal artery to middle cerebral artery bypass was performed, and perfusion was maintained in eloquent regions. Under roadmap guidance, the aneurysm was occluded using platinum coils. Fusiform aneurysms of the middle cerebral artery MCA are uncommon and can cause compression or distal thrombus migration. In complex cases, surgical clipping or endovascular coiling may not work, requiring vessel sacrifice and direct arterial bypass for effective treatment. A literature review was performed including 17 studies on cranial aneurysms treated with endovascular embolization and arterial bypass; the overall success rate was 84%, with 16% of patients experiencing postoperative infarction. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] This video article and literature review provide valuable insights into the treatment of complex giant fusiform aneurysms with superficial temporal artery to middle cerebral artery bypass and endovascular vessel sacrifice.

show abstract

Combined Microsurgical and Endovascular Intracranial Aneurysm Treatment: Interdisciplinary Experience Using a True Hybrid Approach and a Systematic Review of the Literature

Ulmer,

Gruber,

Schubert

et al. 2024

Brain Sciences

View full text Add to dashboard Cite

(1) Background: Most intracranial aneurysms (IAs) can be treated either with microsurgical clipping or endovascular techniques. In a few cases, simultaneous treatment utilizing both modalities in a hybrid operation room may be favorable. This study analyzes the indication and benefits of a true hybrid approach (tHA) that combines simultaneous endovascular and microsurgical procedures for treatment of IAs in one session. (2) Methods: All patients receiving a true hybrid procedure between 2010 and 2022 in our institution were included. Demographic characteristics, neurological symptoms, pre-interventional treatments, angiographic findings, and postoperative clinical and radiological outcomes were analyzed. Results are discussed in the light of a systematic literature review on reported true hybrid procedures for IA treatment. (3) Results: In total, 10 tHAs were performed. Of these, coiling and concomitant decompressive craniectomy or hematoma evacuation was performed on six occasions. In two patients, multiple IAs were treated with different modalities during the same procedure. In two patients, intraoperative conditions did not allow for complete IA clipping, and the remnant was coiled in the same session. The review of the literature revealed nine papers comprising 58 IAs treated with a tHA. (4) Conclusions: The need for a tHA for IA treatment is rare and limited to highly selective cases. In our experience, tHAs have been most valuable in an emergency setting concerning ruptured IAs. Furthermore, tHAs may also be considered in patients with multiple aneurysms in different vascular territories.

show abstract

“Clip Anchor-Assisted Coil Embolization” for Endovascular Parent Artery Occlusion of Intracranial Traumatic Aneurysm

Cited by 3 publications

References 11 publications

Flow alteration therapy for impending rupture of intracranial giant aneurysm after flow diverter placement

Flow alteration therapy for impending rupture of intracranial giant aneurysm after flow diverter placement

Hybrid Treatment for a Giant Fusiform Partially Thrombosed Middle Cerebral Artery Aneurysm With Superficial Temporal Artery to Middle Cerebral Artery Bypass Followed by Endovascular Vessel Sacrifice: 2-Dimensional Operative Video

Combined Microsurgical and Endovascular Intracranial Aneurysm Treatment: Interdisciplinary Experience Using a True Hybrid Approach and a Systematic Review of the Literature

Contact Info

Product

Resources

About