De Novo Large Fusiform Posterior Circulation Intracranial Aneurysm Presenting With Subarachnoid Hemorrhage 7 Years After Therapeutic Internal Carotid Artery Occlusion

Arnaout, Omar; Rahme, Rudy J.; Aoun, Salah G.; Daou, Marc; Batjer, H. Hunt; Bendok, Bernard R.

doi:10.1227/neu.0b013e31825fd169

Cited by 27 publications

(21 citation statements)

References 54 publications

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“…the basilar terminus (BT). [12][13][14][15] However, anterior de novo aneurysms have been reported to follow bilateral ICA occlusion, 16 presumably as a result of hemodynamic forces due to flow rerouting into the external carotid arteries and their anastomotic intracranial branches including the ophthalmic artery (OA). Such aneurysm presentation has also mirrored anterior de novo IAs observed in Moyamoya disease, 17 which involves progressive bilateral carotid occlusion.…”

Section: Introductionmentioning

confidence: 99%

Aneurysmal Remodeling in the Circle of Willis after Carotid Occlusion in an Experimental Model

Tutino

Mandelbaum

Choi³

et al. 2013

J Cereb Blood Flow Metab

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Carotid occlusions are associated with de novo intracranial aneurysm formation in clinical case reports, but this phenomenon is not widely studied. We performed bilateral carotid ligation (n ¼ 9) in rabbits to simulate carotid occlusion, and sham surgery (n ¼ 3) for control. Upon euthanasia (n ¼ 3 at 5 days, n ¼ 6 at 6 months post ligation, and n ¼ 3 at 5 days after sham operation), vascular corrosion casts of the circle of Willis (CoW) were created. Using scanning electron microscopy, we quantified gross morphologic, macroscopic, and microscopic changes on the endocasts and compared findings with histologic data. At 5 days, CoW arteries of ligated animals increased caliber. The posterior communicating artery (PCom) increased length and tortuosity, and the ophthalmic artery (OA) origin presented preaneurysmal bulges. At 6 months, calibers were unchanged from 5 days, PComs further increased tortuosity while presenting segmental dilations, and the OA origin and basilar terminus presented preaneurysmal bulges. This exploratory study provides evidence that flow increase after carotid occlusion produces both compensatory arterial augmentation and pathologic remodeling such as tortuosity and saccular/fusiform aneurysm. Our findings may have considerable clinical implications, as these lesser-known consequences should be considered when managing patients with carotid artery disease or choosing carotid ligation as a therapeutic option.

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Section: Introductionmentioning

confidence: 99%

Aneurysmal Remodeling in the Circle of Willis after Carotid Occlusion in an Experimental Model

Tutino

Mandelbaum

Choi³

et al. 2013

J Cereb Blood Flow Metab

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“…Concerns have been raised about long-term hemodynamic effects of ICA sacrifice in young patients, with resultant de novo aneurysm formation in 4%-11% of patients thought to result from increased flow in the anterior and posterior communicating artery regions. [5][6][7][8] Finally, the need for either low-or high-flow bypass in patients who do not tolerate balloon test occlusion may add risk to the overall procedure.…”

mentioning

confidence: 99%

Treatment of Cavernous Sinus Aneurysms with Flow Diversion: Results in 44 Patients

Puffer¹,

Piano

Lanzino

et al. 2013

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Aneurysms of the cavernous segment of the ICA are difficult to treat with standard endovascular techniques, and ICA sacrifice achieves a high rate of occlusion but carries an elevated level of surgical complications and risk of de novo aneurysm formation. We report rates of occlusion and treatment-related data in 44 patients with cavernous sinus aneurysms treated with flow diversion.

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“…However, the formation of de novo cerebral aneurysms has been reported as a complication specific to internal carotid (IC) occlusion. This complication reportedly occurs in 4%-11% of the patients undergoing IC occlusion, [25][26][27][28] and this must be considered in the selection of treatment. Moreover, there have recently been a few reports on the results of treatment of extradural ICA aneurysms using flow diverters.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review

Aoyama

Shigeta

Sato

et al. 2017

JNET

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Objective:We reviewed the treatment results of internal carotid artery (ICA) aneurysms with a maximum diameter of 10 mm or greater for the future selection of patients with indications for Pipeline Flex (Medtronic, Irvine, CA, USA). Methods:The treatment methods, treatment effects, complication rate, and retreatment rate were studied in lesions that were treated by coil embolization but are presently considered indications for treatment using Pipeline Flex among the 516 cerebral aneurysms treated at our hospital between July 2009 and May 2016. We also reviewed the literature concerning coil embolization for large and giant aneurysms and examined the results of coil embolization for aneurysms with indications for Pipeline. Results:The subjects were 10 patients consisting of 5 with asymptomatic unruptured aneurysm, 2 with symptomatic unruptured aneurysm, and 3 patients with recurrence after treatment for ruptured aneurysm. The mean size of the aneurysms was 12.8 mm (10.5-17.8 mm), and the mean follow-up period was 49.1 ± 13.4 months. The treatments were balloon-assisted coil embolization in eight patients and stent-assisted coil embolization in two patients. None showed postoperative symptomatic ischemic lesions, and the permanent morbidity was 0%. Of the two patients with symptomatic aneurysms, the symptoms were alleviated after treatment in one patient, and retreatment was necessary in one patient.In the review of the literature, comparisons were made in 69 large or giant aneurysms treated by coil embolization between those with and without indications for Pipeline. The additional treatment rate was significantly lower in the lesions with indications for Pipeline (33.3% vs. 61.9%, P = 0.02). The retreatment rate was significantly lower at 15.4%, particularly in extradural aneurysms (Bouthillier C4, 5). Conclusion:The results of this study suggest that the retreatment rate after conventional coil embolization for extradural unruptured large cerebral aneurysms was not high and that coil embolization is worth considering for asymptomatic aneurysms at these sites 10-15 mm in diameter.

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De Novo Large Fusiform Posterior Circulation Intracranial Aneurysm Presenting With Subarachnoid Hemorrhage 7 Years After Therapeutic Internal Carotid Artery Occlusion

Cited by 27 publications

References 54 publications

Aneurysmal Remodeling in the Circle of Willis after Carotid Occlusion in an Experimental Model

Aneurysmal Remodeling in the Circle of Willis after Carotid Occlusion in an Experimental Model

Treatment of Cavernous Sinus Aneurysms with Flow Diversion: Results in 44 Patients

Endovascular Embolization of Large Internal Carotid Artery Aneurysms: Single-center Experience with 10 Cases and Literature Review

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