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

Bechan, R.S.; Majoie, Charles B. L. M.; Sprengers, Marieke E.S.; Peluso, Jo P.; Sluzewski, M.; Rooij, W.J. van

doi:10.3174/ajnr.a4487

Cited by 25 publications

(9 citation statements)

References 28 publications

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“…Furthermore, if the patient’s artery did not have sufficient collateral blood flow, bypass surgery (i.e., STA-MCA [superficial temporal artery-to-middle cerebral artery] anastomosis or a high flow) would be required. 18 – 20) On the other hand, FDs are ideal treatment devices because they promote endoluminal and neointimal growth leading to parent vessel reconstruction while preserving antegrade blood flow.…”

Section: Discussionmentioning

confidence: 99%

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Oishi

Teranishi

Yatomi

et al. 2018

Neurol. Med. Chir.(Tokyo)

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Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients’ mean age was 63.4 years (range, 19–88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments. Mean aneurysm size and neck width were 16.9 ± 6.8 mm and 8.3 ± 4.4 mm, respectively, in 40 symptomatic and 60 asymptomatic aneurysms. Follow-up catheter angiographies of 85 patients with 90 aneurysms showed no filling in 62 aneurysms (68.9%), entry remnant in 16 (17.8%), subtotal filling in 11 (12.2), and total filling in 1 (1.1%) with a mean follow-up of 10.2 ± 5.6 months. In-stent stenosis occurred in 1 patient and parent artery occlusion in 2 during follow-up. Hemorrhagic complications occurred in 4 (4.3%): delayed aneurysm rupture (2) and intraparenchymal hemorrhage (2). Ischemic complications with neurological symptoms occurred in 2 (2.1%): very delayed device occlusion (1) and intraprocedural distal embolism (1). Eighteen patients (45%) showed improvement in pre-existing cranial nerve dysfunction because of the aneurysm’s mass effect, 3 patients (7.5%) worsened. One patient died of systemic organ failure unassociated with the procedure. Morbidity and mortality rates were 4.3% and 1.1%, respectively. PED embolization for unruptured large and giant ICA aneurysms is safe and efficacious. Physicians should be observant of characteristic risks associated with FD therapy.

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Section: Discussionmentioning

confidence: 99%

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Oishi

Teranishi

Yatomi

et al. 2018

Neurol. Med. Chir.(Tokyo)

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“…Managing a cavernous ICA acute injury is a complex issue, as it involves rapid blood loss originating from a challenging to reach anatomical area. There are three options to treat such a condition: ICA sacrifice, ICA lesion embolization, and ICA endoluminal reconstruction [1][2][3][4][5][6]9].…”

Section: Discussionmentioning

confidence: 99%

Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience

Giorgianni¹,

Agosti

Terrana³

et al. 2020

Acta Neurochir

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Background and objective To describe our single-center experience in the treatment of cavernous internal carotid artery (ICA) acute bleeding with flow diverter stent (FDS), as a single endovascular procedure or combined with an endoscopic endonasal approach. Methods We analyze a case series of 5 patients with cavernous ICA acute bleeding, i.e., 3 iatrogenic, 1 post-traumatic, and 1 erosive neoplastic. After an immediate nasal packing to temporarily bleeding control, patients underwent digital subtraction angiography (DSA) to identify the site of the ICA injury. A concomitant balloon occlusion test (BOT) was performed, to exclude post-occlusive ischemic neurological damage. An FDS was placed with parallel intravenous infusion of abciximab in 3 cases and tirofiban in 2 cases. In two patients, an innovative "sandwich technique" combining the endovascular reconstruction with an extracranial intrasphenoidal cavernous ICA resurfacing with autologous flaps or grafts by endoscopic endonasal approach was performed. Results No patient had periprocedural ischemic-hemorrhagic complications. All patients had a regular clinical evolution, without general complications or new onset of focal neurological deficits. No further bleeding occurred in 3 patients, while 2 cases experienced a mild rebleeding in a period ranging from 5 to 15 days after the endovascular procedure. In these two cases, we proceeded with an endoscopic endonasal procedure to resurface the exposed ICA wall in the sphenoid sinus. Conclusions Although the treatment of choice for cavernous ICA acute bleeding remains the occlusion of the injured vessel, in cases of poor hemodynamic compensation at the BTO, the endovascular FDS emergency placement can be effective. A combined endoscopic endonasal technique to support the extracranial side of the vessel using autologous flaps or grafts can be performed to prevent the risk of rebleeding.

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“…Certainly, careful preoperative evaluation with a BTO is required prior to ICA sacrifice. In a large case series of 88 patients treated with ICA occlusion for aneurysms, Bechan et al 17 reported three subclinical infarcts and three patients with a transient hemiparesis, all of which were in the watershed territory between the anterior and middle cerebral artery. The only permanent complication in their series was a hypoperfusion infarction due to a retroperitoneal hematoma.…”

Section: Discussionmentioning

confidence: 99%

Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

Roy

Grossberg

Osbun

et al. 2016

J NeuroIntervent Surg

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CCF formation is a known risk of PED treatment of CCA. Although transvenous embolization can be used for treating CCFs, parent artery sacrifice remains a viable option on the basis of these data. Studies support the view that adjunctive coiling may have a protective effect against post-PED CCF formation. None of the coiled aneurysms in our database or in the literature have ruptured. Follow-up data will lead to a better understanding of the safety profile of the PED for CCA.

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

Cited by 25 publications

References 28 publications

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population

Emergency endovascular treatment of cavernous internal carotid artery acute bleeding with flow diverter stent: a single-center experience

Carotid cavernous fistula after Pipeline placement: a single-center experience and review of the literature

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