Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation

Abstract

Hunterian proximal artery occlusion was used in the treatment of 160 of 335 patients harboring giant aneurysms of the anterior circulation. One hundred and thirty-three of these aneurysms arose from the internal carotid arteries, 20 from the middle cerebral arteries, and seven from the anterior cerebral arteries. Ninety percent of the patients had satisfactory outcomes. The safety of internal carotid artery occlusion has been greatly enhanced by preoperative flow studies and by test occlusion with an intracarotid balloon to identify those patients who require preliminary extracranial-to-intracranial bypass, which was used in all of the middle cerebral occlusions. The anterior cerebral artery had magnificent leptomeningeal collateral flow that prevented infarction even without cross flow. Obliteration of the aneurysm by thrombosis was complete, or nearly so, in all but four patients whose treatment was completed. Analysis of poor outcome in 16 patients revealed that hemodynamic ischemic infarction was known to occur after only two of the carotid occlusions.

Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients

“…Data from the era of surgical ICA clamp occlusion without previous tolerance testing indicate that approximately three-fourths of patients can tolerate ICA occlusion. [16][17][18] In our cohort, the angiographic test indicated tolerance to permanent ICA occlusion in two-thirds of patients, which indicates that the proportion of false-negatives is probably limited. After ICA occlusion, all aneurysms thrombosed completely except one, which makes the treatment very effective.…”

Cavernous Carotid Aneurysms in the Era of Flow Diversion: A Need to Revisit Treatment Paradigms

“…13,14,16,18 Studies using endovascular deconstructive carotid occlusion have reported a morbidity and mortality rate ranging from 3% to 8%. [19][20][21][22][23] Although endovascular parent artery occlusion is a relatively easy and inexpensive technique with low morbidity in a selected population, the long-term consequences of altered hemodynamics should be considered.…”

Endovascular treatment of fusiform cerebral aneurysms with the Pipeline Embolization Device

“…5 Indeed, hunterian ligation is still used successfully in the treatment of many giant fusiform aneurysms. 5,6 Advances in surgical technique saw modest improvements in outcomes; however, the relative rarity and the frequent necessity for complex surgical reconstruction continue to test even the most experienced neurovascular surgeons. The advent of endovascular therapy and the more recent development of flow-diverting stents offered a promising method of treatment.…”