Bilateral Internal Carotid Artery Aneurysms Research Articles

Recurrent reversible in-stent-stenosis after flow diverter treatment

Flow diverter stents (FDS) are well established in the treatment of intracranial aneurysms which are difficult to treat with conventional endovascular techniques. However, they carry a relatively high risk of specific complications compared to conventional stents. A minor but frequent finding is the occurrence of reversible in-stent-stenosis (ISS) that tend to resolve spontaneously over time. Here, we report the case of a patient in their 30s who was treated with FDS for bilateral paraophthalmic internal carotid artery (ICA) aneurysms. ISS were found at the respective early follow-up examinations on both sides and had resolved at the 1-year follow-up examinations. Surprisingly ISS reoccurred at both sides in later follow-up examinations and again resolved spontaneously. The recurrence of ISS after resolution is a finding that has not been described previously. Its incidence and further development should be investigated systematically. This might contribute to our understanding of the mechanisms underlying the effect of FDS.

Surgical treatment of a patient with fibromuscular dysplasia and bilateral internal carotid artery aneurysms

Surgical treatment of a patient with fibromuscular dysplasia and bilateral internal carotid artery aneurysms

Endovascular Reconstruction Utilizing Flow Diversion Stenting in a Patient With Bilateral Giant Cavernous Internal Carotid Artery Aneurysms

Bilateral giant cerebral aneurysms are exceedingly rare. Giant aneurysms of the internal carotid artery (ICA) carry a poor prognosis if untreated. Flow diversion is an endovascular technique whereby a device is placed in the parent blood vessel to divert blood flow away from the aneurysm and is an available treatment for giant aneurysms. A 69-year-old woman presented with progressive diplopia and was found to have bilateral ICA aneurysms. She had stenting of the left ICA aneurysm with improvement of her symptoms and no complications. Five years post procedure, she presented with recurrent diplopia and was found to have enlargement of the previously seen right-sided cavernous ICA aneurysm, which was treated with another flow diversion stent with no complications. Endoluminal reconstruction/flow diversion with Pipeline™ Embolization Device (PED) has emerged as an alternative to traditional endosaccular coiling and parent artery occlusion. We report a case of bilateral cavernous carotid giant aneurysms treated with flow diversion and demonstrate that flow diversion stenting using the PED is a safe and reliable treatment for bilateral giant ICA aneurysms. We encourage interventionists to consider this technique in patients with giant intracranial aneurysms. J Neurol Res. 2020;10(4):136-139 doi: https://doi.org/10.14740/jnr593

Mid-term follow-up of staged bilateral internal carotid artery aneurysm treatment with Pipeline embolization.

Endovascular treatment of large complex morphology aneurysms is challenging. High recanalization rates have been reported with techniques such as stent-assisted coiling and balloon-assisted coiling. Flow diverter devices have been introduced to improve efficacy outcomes and recanalization rates. Thromboembolic complications and in-device stenosis are certainly more worrisome when treatment of bilateral internal carotid arteries has been performed. This study aimed to report our experience with mid-term imaging follow-up of staged bilateral Pipeline embolization device placement for the treatment of bilateral internal carotid artery aneurysms. We reviewed the clinical, angiographic, and follow-up imaging data in all consecutive patients treated with bilateral internal carotid artery aneurysms who underwent elective Pipeline embolization. Six female patients were treated, harboring a total of 13 aneurysms. Of these, 60% were asymptomatic. Diplopia and headache were the most common symptoms. The most common location was the paraclinoid segment (6/13), including by cavernous segment (4/13) and ophthalmic segment (2/13). Successful delivery of the device was achieved in 12 cases. Difficult distal access precluded the deployment of the device in one case. The treatment was always staged with at least eight weeks' difference between the two procedures. All aneurysm necks were covered completely. There were no periprocedural complications. Angiographic follow-up ranged between 3 and 12 months, and computed tomography angiogram follow-up ranged between 2 and 24 months. Complete aneurysm occlusion was achieved in all cases. In our series, Pipeline deployment for the treatment of bilateral internal carotid artery aneurysms in a staged fashion is safe and feasible. Mid-term imaging follow-up showed permanent occlusion of all the treated aneurysms.

A case report of the unilateral approach to the ruptured right ICA aneurysm together with tuberculum sella meningioma and left ICA aneurysm

BackgroundTuberculum sellae meningioma associated with aneurysm is extremely rare with a limited number of individual cases previously reported. Because of the complicated anatomical structure of the skull base, comorbid disease in the sellae region is a challenging problem and is associated with high mortality in neurosurgery.Case presentationThis case report describes a rare case of comorbid bilateral internal carotid artery aneurysms and tuberculum sellae meningioma. This 58-year-old female presented with headache and nausea. She had lost her light perception in the right eye, and the right optic disc was degenerated. She also had a 5-year history of hypertension. This patient underwent a right pterional craniotomy, and we accomplished to clip the bilateral intracranial aneurysms and concurrently remove the tumor. After the surgery, we confirmed that both of the aneurysms were completely isolated, and the tumor was adequately resected. This patient had not suffered other neurological deficits. Unfortunately, her visual acuity had not recovered.ConclusionsAs we know, this is the first report of a unilateral surgical approach to clip the bilateral intracranial aneurysms and concurrently remove the tumor. It may provide a reference for clinical treatment of the similar disease.

Orthostatic hypotension and bradycardia in a 75‐year‐old man with bilateral internal carotid artery aneurysms

Orthostatic hypotension and bradycardia in a 75‐year‐old man with bilateral internal carotid artery aneurysms

Single-stage endovascular treatment of multiple intracranial aneurysms with combined endovascular techniques: is it safe to treat all at once?

Background and purposeMultiple aneurysms have a high reported incidence, but the optimal treatment strategy is not clear. The aim of this study was to evaluate the safety and effectiveness of...

Asymptomatic Bilateral Internal Carotid Artery Aneurysms with Distal High-grade Stenosis in a Patient with Type 1 Neurofibromatosis

Asymptomatic Bilateral Internal Carotid Artery Aneurysms with Distal High-grade Stenosis in a Patient with Type 1 Neurofibromatosis

Resolution of Diminished Olfactory Sensation After Treatment of Bilateral Ophthalmic Segment Aneurysms With Flow Diversion

Olfactory tract dysfunction due to an unruptured intracranial aneurysm is rare. We present a case in which a patient with impaired olfaction related to bilateral internal carotid artery aneurysms experienced subjective and quantitative objective improvement of olfactory sensation after treatment of ophthalmic segment aneurysms with flow diversion. A 44-year-old woman presented with hyposmia and bilateral ophthalmic segment internal carotid artery aneurysms. The symptom of hyposmia, worsening over a period of several months, was suspected to be due to mass effect from bilateral unruptured ophthalmic segment aneurysms pressing on the olfactory tracts. Each aneurysm was treated with a Pipeline embolization device (PED). Follow-up angiography at 5 months showed occlusion of both aneurysms. The patient experienced subjective improvement in olfaction and complete objective resolution of her hyposmia as measured by the validated University of Pennsylvania Smell Identification Test (UPSIT). Intracranial aneurysms causing dysfunction of olfactory sensation due to mass effect upon the olfactory tract can be successfully treated with flow diversion. Flow diversion should be considered as one of the treatment options for patients with cranial nerve dysfunction due to unruptured intracranial aneurysms.

Co-existence of bilateral fetal type posterior cerebral artery and the bilateral giant internal carotid artery aneurysms in an ataxic patient

We encountered a very unusual case of bilateral unruptured iant internal carotid artery aneurysms in a patient with hypoplasic vertebrobasilar system. Fifty-five year old man admitted to ur outpatient clinic with the complaints of dizziness and imbalnce. The neurological exam was unremarkable except mild truncal taxia. Computed tomography (CT) and CT angiography (CTA) evealed two giant aneurysms; the right-sided one was a saccular nternal carotid artery (ICA) aneurysm (45 mm × 35 mm × 33 mm n size) extending to the posterior communicating artery and he left-sided one was a fusiform supraclinoid ICA aneurysm 26 mm × 16 mm × 15 mm in size) (Fig. 1A–C). Additionally, both

Misdiagnosis of rupture sites of multiple intracranial aneurysms: Special report of two cases

Angiography and neurological examination are reliable tools for the identification of rupture in patients with multiple intracranial aneurysms. However, unusual presentation of rupture may cause the false localization of the ruptured aneurysm. We described two cases of bilateral internal carotid artery (ICA) aneurysms that were incorrectly positioned on CT scan. In the first case, CTA revealed bilateral IC-PC aneurysms. According to the localization of injured nerves and findings on radiograph rupture of left aneurysm was diagnosed. The patient suddenly became unconscious 24 h after operation. The cause of death was assumed to be the rupture of the right aneurysm. In the second case, CTA revealed IC-PC aneurysms. The diagnosis of a ruptured right IC-PC aneurysm was made based on neuroradiological findings. However, no rupture or bleeding was found during the operation. Thus the diagnosis of ruptured right IC-PC aneurysm was wrong. In the first case, disastrous re-bleeding occurred before the second operation for the ruptured one. In the second case, the patient died after we performed bilateral craniotomies at the same time. Misjudgment of rupture site by the CT scan resulted in clipping of the wrong aneurysm. Key words: Bilateral intracranial aneurysm, rupture.

A 10-year follow-up of extracranial–intracranial bypass for the treatment of bilateral giant internal carotid artery aneurysms in a patient with fibromuscular dysplasia: case report

Cervicocephalic fibromuscular dysplasia (FMD) is an idiopathic, non-inflammatory and non-atherosclerotic arteriopathy which usually affects small- and medium-sized cervical arteries distributed at the atlas and axis interspace. Few cervicocephalic FMD patients are associated with multiple intracranial aneurysms which may rupture or develop. So the authors describe a cervicocephalic FMD patient with a history of right oculomotor palsy in 2000. Angiography revealed bilateral internal carotid artery (ICA) aneurysms and a fusiform aneurysm in right vertebral artery. Typical "string-of-beads" phenomenon was observed in V2 segment of left vertebral artery. The right ICA giant aneurysm was treated by right ICA occlusion and superficial temporal artery (STA)-middle cerebral artery (MCA) bypass at that time. Five years later, the patient presented with paroxysmal weakness in right limbs. The subsequent angiography showed the enlargement of left ICA aneurysm. It was treated satisfactorily with left external carotid artery-saphenous vein-MCA bypass and left ICA ligation. During the long-term follow-up, the patient kept no neurological deficit and the angiography showed good patency of bilateral grafts and the lesions in bilateral vertebral arteries remained unchanged.

Case Report: Carotid-cavernous fistula due to aneurysmal rupture in a case of aortoaortitis with bilateral giant internal carotid artery aneurysms

Takayasu aortoarteritis (TA) rarely affects the nervous system, but when it does, it usually manifests as cerebral ischemia or stroke. These strokes have mainly been attributed to stenotic extracranial vessels. Stenoses of intracranial vessels, although rare in TA, can occur due to either embolization into the vessel or because of the vasculitic process itself. Intracranial aneurysms are very rare in patients with TA. Bilateral cavernous internal carotid artery (ICA) aneurysms are rarer. They have been reported following radiation therapy and in association with fibromuscular dysplasia and juvenile Paget disease. Bilateral mycotic intracavernous aneurysms also occur. Bilateral giant cavernous ICA aneurysms with carotid-cavernous fistula (CCF) consequent to rupture into the cavernous sinus in a case of TA are extremely unusual. We report a case that fulfilled both American College of Rheumatology and European League against Rheumatology criteria for TA. The patient had bilateral cavernous sinus giant aneurysms and CCF because the right-sided aneurysm had ruptured and was leaking into the cavernous sinus.

Open Surgical and Endovascular Treatment of Extracranial Internal Carotid Artery Aneurysms

Internal carotid artery (ICA) aneurysms are rare. The symptoms are related to cerebral embolization, local compression and rupture. Options for treatment include open surgery or endovascular treatment with a covered stent. We report a case of a 67 year old woman with bilateral idiopathic internal carotid artery aneurysms, found during the diagnostic evaluation for an episode of syncope. The right ICA aneurysm was treated with resection and end-to-end anastomosis of the ICA. There were no perioperative complications. Six months later the patient underwent endovascular repair of left carotid artery aneurysm with a covered stent. There were no complications in postoperative period. Treatment options for ICA aneurysms are surgical or endovascular, depending of size, location and anatomic relation to surrounding structures.

Polyarteritis nodosa presenting with bilateral cavernous internal carotid artery aneurysms

A 24-year-old man was admitted with a severe, abrupt-onset headache and diplopia. On neurologic examination, movement of the left eye was limited in all directions, while the right eye was limited on lateral gaze. Cerebral angiography demonstrated bilateral aneurysms on the cavernous portion of the internal ICA, measuring 2.4 cm on the left …

Hypopituitarism Caused by Bilateral Internal Carotid Artery Aneurysms with a Carotid-cavernous Fistula

Hypopituitarism Caused by Bilateral Internal Carotid Artery Aneurysms with a Carotid-cavernous Fistula

神経内視鏡による観察を併用した顕微鏡下脳動脈瘤手術

Introduction of microsurgery for cerebral aneurysms markedly improved the operative outcome. However, the microsurgically blind portion hidden behind unretractable structures such as a major artery, cranial nerves, aneurysm sack and tentorium, has remained a problem. An endoscope was applied for microsurgical operation of cerebral aneurysm to minimize the blind area under the microscope.We used a rigid form endoscope (CODMAN Gaab Neuroendoscope System with 30°, 70°and 120°angled telescope) to visualize the microsurgically blind portion in 10 patients with cerebral aneurysms. Application of endoscope was useful to reduce the risk of careless surgical injury by avoiding the extensive brain retraction in all patients. We report here on four patients. In 1 patient with high positioned basilar top aneurysm (Case 1), the aneurysm could not be visualized through pterional route, and after confirmation of the aneurysm by endoscope, neck clipping was performed through orbitozygomatic route. For bilateral internal carotid artery (IC) aneurysms (Case 2), after clipping of the left IC-posteior communicating artery (PcomA) aneurysm, the IC aneurysms on the right side could be inspected endoscopically through the prechiasmatic cistern. In another patient (Case 3), during endoscopic observation for left IC-PcomA aneurysm, IC-anterior choroidal artery aneurysm that had not been identified by angiography was detected. In the remaining patient (Case 4), an endoscope was used to confirm correct neck clipping for a vertebral artery-posterior inferior cerebellar artery aneurysm attached to the seventh and eighth cranial nerves.Though instruments of solid form endoscope entail some inconvenience for endoscopic surgery, the image is markedly clearer than that of the fiberoptic endoscope. Endoscopy seems to be useful for minimizing the surgical trauma in microsurgical operation for cerebral aneurysm.

False localization of rupture by computed tomography in bilateral internal carotid artery aneurysms

Focal clot on computed tomographic (CT) scan is one of the most reliable clues in determining the site of rupture in patients with multiple intracranial aneurysms. However, unusual presentation of clot may cause false localization of the ruptured aneurysm in bilateral aneurysms, particularly when they are located near the midline. We describe two cases of bilateral internal carotid artery (ICA) aneurysms presenting contralateral distribution of clot on CT scan. Misjudgment of rupture site by the CT scan resulted in clipping of the wrong aneurysm in one patient. Disastrous rebleeding occurred before the second operation for the ruptured one. In the other patient, the rupture site was assumed correctly despite contralateral situation of clot on CT, and both aneurysms were treated in one operative session. Adhesion and obliteration of the subarachnoid cisterns from previous hemorrhage will deviate the direction of hemorrhage and present contralateral clot on CT scan in bilateral aneurysms located near the midline as ICA aneurysms. Medial direction of rupture may obscure accurate localization of rupture side in such aneurysms.

Bilateral Mycotic Aneurysms of the Intracavernous Carotid Artery

A rare case of bilateral intracavernous internal carotid artery aneurysms is presented. The clinical and laboratory data strongly suggested the mycotic nature of the aneurysms. Internal carotid artery ligation was performed because of clinical evidence of progressive enlargement of the right-sided aneurysm. The left-sided aneurysm was managed medically. It remained asymptomatic and, 14 months later, a control angiogram showed no significant change in its size and configuration.

Direct surgical treatment of bilateral intracavernous internal carotid artery aneurysms

Bilateral intracavernous internal carotid artery aneurysms are described in a 3-year-old child. The etiology was uncertain, although the aneurysms may have been mycotic. As there was clinical and radiological evidence of progressive enlargement of both aneurysms, the more conventional forms of treatment were not applicable. A direct surgical approach was made to both aneurysms with exploration of the intracavernous portion of the internal carotid artery under deep hypothermia and cardiac arrest.