Toward an Endovascular Internal Carotid Artery Classification System

Abstract

SUMMARY: Does the world need another ICA classification scheme? We believe so. The purpose of proposed angiography-driven classification is to optimize description of the carotid artery from the endovascular perspective. A review of existing, predominantly surgically-driven classifications is performed, and a new scheme, based on the study of NYU aneurysm angiographic and cross-sectional databases is proposed. Seven segments -cervical, petrous, cavernous, paraophthlamic, posterior communicating, choroidal, and terminus -are named. This nomenclature recognizes intrinsic uncertainty in precise angiographic and cross-sectional localization of aneurysms adjacent to the dural rings, regarding all lesions distal to the cavernous segment as potentially intradural. Rather than subdividing various transitional, ophthalmic, and hypophyseal aneurysm subtypes, as necessitated by their varied surgical approaches and risks, the proposed classification emphasizes their common endovascular treatment features, while recognizing that many complex, trans-segmental, and fusiform aneurysms not readily classifiable into presently available, saccular aneurysm-driven schemes, are being increasingly addressed by endovascular means. We believe this classification may find utility in standardizing nomenclature for outcome tracking, treatment trials and physician communication.

Anterior Choroidal Artery Patency and Clinical Follow-Up after Coverage with the Pipeline Embolization Device

“…Inclusion criteria were the following: 1) presence of an intracranial internal carotid artery aneurysm treated by placement of Ն1 PED, and 2) coverage of the AchoA with at least 1 PED. We recorded the following baseline data: age, sex, neurologic examination before and after the procedure, location of the aneurysm (according to Shapiro et al 15 ), relationship of the AchoA to the aneurysm, and the number of PEDs implanted across the origin of the AchoA. At follow-up, the interval from the index procedure, aneurysm occlusion status, patency of the AchoA, and neurologic examination findings were recorded.…”

Stepwise stent deployment technique for tandem intracranial aneurysms: a review of 21 cases

“…For unruptured large aneurysms, we usually perform magnetic resonance imaging to determine details such as calcification in the aneurysm region, partial intraaneurysmal thrombosis, or mass effect. The aneurysms were located using the Shapiro classification [6]. More information regarding these patients and the aneurysms are shown in Table 1.…”

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

“…1 Unfortunately current imaging is usually unable to clearly distinguish these more dangerous CCAs. 9 There have also been rare case reports of fatal SAH in CCAs judged to be entirely intracavernous. 10 Several studies have followed the natural history of treated and untreated cohorts of patients with CCA.…”