Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis

Turfe, Zaahir; Brinjikji, Waleed; Murad, M. Hassan; Lanzino, Giuseppe; Cloft, Harry J.; Kallmes, David F.

doi:10.1136/neurintsurg-2014-011102

Cited by 33 publications

(25 citation statements)

References 33 publications

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“…Carotid sacrifice achieves a 93% (95% confidence interval [CI], 86.0-97.0) complete aneurysm occlusion and 83.0% (95% CI, 52.0-96.0) resolution of mass effect, but is associated with a 4.0% (95% CI, 1.0-9.0) risk of procedurerelated neurological deficits. 1 However, because these aneurysms are often very large or giant with a wide neck, standard endovascular coiling achieved a complete aneurysm occlusion rate of only 67.0% (95% CI, 55.0-77.0) in a meta-analysis from 2014. 1 Furthermore, the coiling group demonstrated a retreatment rate of 18.0% (95% CI, 12.0-26.0) compared with 6.0% (95% CI, 2.0-12.0) for CVD without bypass (P=0.01).…”

Section: Angiography and Clinical Outcomementioning

confidence: 99%

“…1 However, because these aneurysms are often very large or giant with a wide neck, standard endovascular coiling achieved a complete aneurysm occlusion rate of only 67.0% (95% CI, 55.0-77.0) in a meta-analysis from 2014. 1 Furthermore, the coiling group demonstrated a retreatment rate of 18.0% (95% CI, 12.0-26.0) compared with 6.0% (95% CI, 2.0-12.0) for CVD without bypass (P=0.01). However, there were no differences in the improvement of mass effect between coiling, SAC, and CVD.…”

Section: Angiography and Clinical Outcomementioning

confidence: 99%

“…[1][2][3][4][5] These strategies include balloonassisted coiling, stent-assisted coiling (SAC), carotid vessel destruction (CVD), and flow diversion, each varying in degrees of success. Recent studies have demonstrated the effectiveness and safety in treating patients with large, wide-neck CCAs with flow diversion techniques.…”

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confidence: 99%

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Flow Diversion Versus Conventional Treatment for Carotid Cavernous Aneurysms

Zanaty

Chalouhi

Starke

et al. 2014

Stroke

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Background and Purpose-Several endovascular treatment options are available for cavernous carotid aneurysms. We compared pipeline embolization device (PED) versus conventional endovascular treatment in terms of evolution of mass effect, complications, recurrence, and retreatment rate. Methods-One hundred fifty-seven patients harboring 167 cavernous carotid aneurysms were treated using PED placement, coiling, stent-assisted coiling, and carotid vessel destruction. Procedural complications, angiographic results, and clinical outcomes were analyzed and compared. Results-There were no difference in age, sex, and mean aneurysm size between those treated with PED and those treated with conventional endovascular procedures. 006).The rate of major complications was 6.6% (11 of 167). Patients who were treated with PED or stent-assisted coiling had 3.84 lower odds to develop complications (OR, 0.26; P<0.05). Conclusions-The use of PED should be encouraged, especially in symptomatic patients. We found PED to be associated with less need for future treatment, higher improvement in symptoms rate, and lower rate of complications.

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Section: Angiography and Clinical Outcomementioning

confidence: 99%

Section: Angiography and Clinical Outcomementioning

confidence: 99%

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Flow Diversion Versus Conventional Treatment for Carotid Cavernous Aneurysms

Zanaty

Chalouhi

Starke

et al. 2014

Stroke

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“…25) Under existing circumstances, if the patient is judged to have ischemic tol erance by BTO, PAO should be considered first because of its rapid effects on compression symptoms and high radical ity as a treatment for aneurysms. 26) …”

Section: Discussionmentioning

confidence: 99%

Multimodal Assessment for Balloon Test Occlusion of the Internal Carotid Artery

Matsubara

Izumi

Okamoto

et al. 2016

JNET

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Objective: Permanent therapeutic occlusion of the carotid artery is one of the treatment options for patients with a large/ giant internal carotid artery aneurysm or tumor involving the neck or skull base. Balloon test occlusion (BTO) is performed to predict the tolerance of parent artery occlusion (PAO). The authors combined various modalities to improve the sensitivity of BTO. The purpose of this study is to present the efficacy of the multimodal BTO. Results: By multimodal assessment of BTO, 33 patients were considered tolerable, six were partially tolerable, and 11 were intolerable. Thirteen of 33 patients with predictive tolerance underwent PAO without bypass, and all but one showed no hemodynamic ischemia postoperatively. Three of six patients with predictive partial tolerance were treated by PAO with extracranial-intracranial bypass, and they experienced no hemodynamic ischemia. In contrast, one with predictive partial tolerance treated by PAO without bypass developed ischemic events as feared. Conclusion:The multimodal BTO is helpful to evaluate the tolerance of PAO and is a reliable predictor of postoperative ischemic events. It reduces risks and increases treatment safety for permanent therapeutic occlusion of the carotid artery.

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“…17) Due to the advent of flow diverters, PAO of the internal carotid artery is expected to be performed less frequently in the future. However, the sum of the mortality and complication rates has been reported to be 10%, 18,19) and, according…”

Section: Disclosure Statementmentioning

confidence: 99%

Long-term Results of Therapeutic Parent Artery Occlusion without Bypass Surgery for Internal Carotid Artery Aneurysms

Kuramoto

Imamura

Sakai

et al. 2017

JNET

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Objective: When internal carotid artery occlusion is performed for the treatment of an aneurysm, it is important to judge whether or not bypass surgery should be performed for the prevention of complications by the balloon occlusion test (BOT), but there are no clear criteria for the judgment. In this study, we evaluated the long-term results in patients who underwent internal carotid artery occlusion without bypass surgery. Methods:In all, 33 patients with 34 aneurysms who showed no symptoms, a venous phase delay of within 2 seconds, and a mean stump pressure of ≥40 mmHg on a 20-minute BOT between April 2001 and March 2015 and were treated by endovascular internal carotid artery occlusion under local anesthesia without bypass surgery were evaluated.Results: There were no periprocedural deaths, periprocedural ischemic complications were observed in four patients (12%), and they persisted in two patients (6%). On postprocedural diffusion-weighted magnetic resonance (MR) imaging, high intensity signal areas were observed in 25 patients (75%). In all, 30 patients could be followed up on an outpatient basis, and symptomatic cerebral infarction, which was cardiogenic, was noted in one patient (3.3%) during a mean follow-up period of 65.3 months. The final evaluation using DSA or MRA, which was performed after a mean of 63.7 months, revealed aneurysm recurrence in one patient and de novo aneurysm formation in one patient. Conclusion:With judgment of whether or not bypass surgery should be performed according to the results of the BOT, endovascular internal carotid artery occlusion is a safe treatment with a favorable long-term outcome.Keywords▶ internal carotid aneurysm, parent artery occlusion, balloon occlusion test, endovascular treatment

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Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis

Cited by 33 publications

References 33 publications

Flow Diversion Versus Conventional Treatment for Carotid Cavernous Aneurysms

Flow Diversion Versus Conventional Treatment for Carotid Cavernous Aneurysms

Multimodal Assessment for Balloon Test Occlusion of the Internal Carotid Artery

Long-term Results of Therapeutic Parent Artery Occlusion without Bypass Surgery for Internal Carotid Artery Aneurysms

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