Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature

Satoh, Akira; Sugiyama, Tatsuya; Hongo, Kazuhiro; Kakizawa, Yukinari; Ishihara, Shoichiro; Matsutani, Masao

doi:10.1007/978-3-211-76589-0_10

Cited by 39 publications

(28 citation statements)

References 14 publications

(20 reference statements)

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“…1,16,23,31,34,40 Although information on the pathogenesis of aneurysms is critical to determine the treatment strategy, evaluating the conditions of the aneurysm walls may be difficult because preoperative angiograms can show aneurysms to have various morphologies. 1,27,32,40 True saccular aneurysms with firm wall structures are usually amenable to both conventional clipping and coil embolization during the acute phase of SAH. 1,23,31 However, some saccular-shaped aneurysms may actually be BBAs with fragile walls, as shown in Case 2.…”

Section: Possible Usefulness In Determining the Surgical Strategymentioning

confidence: 99%

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

Indo

Oya

Tanaka

et al. 2014

JNS

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Object Surgery for aneurysms at the anterior wall of the internal carotid artery (ICA), which are also referred to as ICA anterior wall aneurysms, is often challenging. A treatment strategy needs to be determined according to the pathology of the aneurysm—namely, whether the aneurysm is a saccular aneurysm with firm neck walls that would tolerate clipping or coiling, a dissecting aneurysm, or a blood blister–like aneurysm. However, it is not always possible to properly evaluate the condition of the aneurysm before surgery solely based on angiographic findings. Methods The authors focused on the location of the ophthalmic artery (OA) in determining the pathology of ICA anterior wall aneurysms. Between January 2006 and December 2012, diagnostic cerebral angiography, for any reason, was performed on 1643 ICAs in 855 patients at Saitama Medical Center. The authors also investigated the relationship between the origin of the OA and the incidence of ICA anterior wall aneurysms. The pathogenesis was also evaluated for each aneurysm based on findings from both angiography and open surgery to identify any correlation between the location where the OA originated and the conditions of the aneurysm walls. Results Among 1643 ICAs, 31 arteries (1.89%) were accompanied by an anomalous origin of the OA, including 26 OAs originating from the C3 portion, 3 originating from the C4 portion, and 2 originating from the anterior cerebral artery. The incidence of an anomalous origin of the OA had no relationship to age, sex, or side. Internal carotid artery anterior wall aneurysms were observed in 16 (0.97%) of 1643 ICAs. Female patients had a significantly higher risk of having ICA anterior wall aneurysms (p = 0.026). The risk of ICA anterior wall aneurysm formation was approximately 50 times higher in patients with an anomalous origin of the OA (25.8% [8 of 31]) than in those with a normal OA (0.5% [8 of 1612], p < 0.0001). Based on angiographic classifications, saccular aneurysms were significantly more common in patients with an anomalous origin of the OA than in those with a normal OA (p = 0.041). Ten of 16 patients with ICA anterior wall aneurysms underwent craniotomies. Based on the intraoperative findings, all 6 aneurysms with normal OAs were dissecting or blood blister–like aneurysms, not saccular aneurysms. Conclusions There was a close relationship between the location of the OA origin and the predisposition to ICA anterior wall aneurysms. Developmental failure of the OA and subsequent weakness of the vessel wall might account for this phenomenon, as previously reported regarding other aneurysms related to the anomalous development of parent arteries. The data also appear to indicate that ICA anterior wall aneurysms in patients with an anomalous origin of the OA tend to be saccular aneurysms with normal neck walls. These findings provide critical information in determining therapeutic strategies for ICA anterior wall aneurysms.

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Section: Possible Usefulness In Determining the Surgical Strategymentioning

confidence: 99%

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

Indo

Oya

Tanaka

et al. 2014

JNS

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“…[1] had speculated that ulceration and hemorrhage are important in the development of focal wall defects in BBAs. A BBA tends to progress to a saccular feature [4,8], and this saccular lesion seems to result from a blood clot covering the focal wall defect [1]. The blood clot subsequently becomes organized and grows into a saccular lesion, which is not a true aneurysm in that there are no normal arterial structures in its wall.…”

Section: Discussionmentioning

confidence: 99%

Ruptured symptomatic internal carotid artery dorsal wall aneurysm with rapid configurational change. Clinical experience and management outcome: an original article

Lee

Hsieh

Wang

et al. 2010

Euro J of Neurology

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Among the four patients, ICA dorsal wall aneurysms underwent rapid growth with configurational change from a blister type to a saccular type despite different management. ICA trapping including the lesion segment can be considered as the first treatment option if the balloon occlusion test (BOT) is successful. If a BOT is not tolerated by the patient, extracranial-intracranial bypass revascularization surgery with endovascular ICA occlusion is another treatment option.

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“…73 However, the BBAs are small hemispheric-shaped lesions, bulging from unbranched site of the ICA and are suspected to originate from a dissection. [35][36][37]40,42,78,[148][149][150][151] Patients typically present with a severe SAH. 35 The critical points are (1) diagnostic problems due to their small size, (2) the extremely fragile wall of BBAs with a high probability of intraoperative rupture due to abrupt histologic transition from the sclerotic ICA wall to the fragile aneurysm neck, 35,42,152,153 (3) the presence of important branches (ophthalmic artery, AChoA and PComA), 66 and (4) a high probability of losing parent vessel patency, either intentionally or as a consequence of the treatment.…”

Section: Internal Carotid Arterymentioning

confidence: 99%

State-of-Art Surgical Treatment of Dissecting Anterior Circulation Intracranial Aneurysms

Balik

Yamada

Talari³

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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Intracranial dissecting aneurysms (IDAs) are an important cause of subarachnoid hemorrhage, stroke, or compression of intracranial structures. Since the availability of endovascular treatment and the advantage of intraprocedural anticoagulation, an endovascular strategy has become the mainstay of their therapy. But in some cases selective aneurysm obliteration by the endovascular approach is impossible or associated with an unacceptable risk of morbidity. This is particularly true when the IDA is a blood blister-like aneurysm or when dissection affects peripheral branches of the internal carotid artery. The literature dealing with surgical treatment of IDAs in the anterior circulation is heterogeneous, and formulation of general recommendations concerning the surgical strategy remains difficult. The aim of this study was to conduct a systematic review of the current knowledge on incidence, pathogenesis, clinical presentation, and diagnostic procedures with a special emphasis on the surgical treatment of intracranial dissections of anterior circulation.

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Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature

Cited by 39 publications

References 14 publications

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

Ruptured symptomatic internal carotid artery dorsal wall aneurysm with rapid configurational change. Clinical experience and management outcome: an original article

State-of-Art Surgical Treatment of Dissecting Anterior Circulation Intracranial Aneurysms

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