Carotid Bifurcation Aneurysms Research Articles

Microsurgical Management of Internal Carotid Artery Bifurcation Aneurysm After Failure of Endovascular Coiling and Flow Diversion: 2-Dimensional Operative Video.

We describe the case of a 51-year-old woman who underwent craniotomy and surgical clipping of a large internal carotid bifurcation aneurysm that was refractory to treatment with 2 rounds of endovascular coiling and internal carotid artery (ICA) to middle cerebral artery pipeline placement. The patient initially presented in 2004 with a 3-week history of sudden-onset headache with associated nausea. Computed tomography and lumbar puncture on presentation in 2004 were negative for subarachnoid hemorrhage. Digital subtraction angiography, however, demonstrated a large left ICA bifurcation aneurysm. The decision was made to proceed with endovascular coiling of the aneurysm. Six-month and 1-year follow-up imaging showed incomplete resolution of the aneurysm, and retreatment coiling was completed in 2005. After recoiling in 2005, the patient was lost to follow-up. During this period, she underwent pipeline placement from the ICA to the middle cerebral artery across the A1 segment at a different institution. Two years after flow diversion, the patient was referred back to our institution with further worsening of the aneurysm. Our surgical team opted for craniotomy and surgical clipping given the limited management options that this extremely complex case now presented. The patient consented to the procedure. Postoperative imaging demonstrated marked improvement in aneurysm severity. Although the current neurosurgical trend favors endovascular treatment over craniotomy, this case shows the vital importance of craniotomy and aneurysm clipping in the treatment of select patients. We also provide high-quality operative video of aneurysm clipping.1-7.

Usefulness and Reliability of the Bispectral Index during Balanced Anesthesia for Neurovascular Surgery in New Zealand White Rabbits.

Few data about the electroencephalogram and its calculated indices, such as the bispectral index (BIS), have been reported in rabbits. We aimed to evaluate whether a clinically stable anesthesia was mirrored by consistent and stable BIS values and to investigate the effects of modified cerebral blood supply, due to bilateral carotid clamping and re-opening, on BIS values. We also investigated the effects of fentanyl, as an antinociceptive drug, on the BIS. Sixty-eight rabbits undergoing general anesthesia for surgical creation of carotid bifurcation aneurysms were enrolled. The BIS values were recorded at nine selected time points (TPs) during each procedure and before and after fentanyl administration. The BIS values over time were compared with two-way repeated-measures analysis of variance followed by Tukey test, while the Wilcoxon signed rank test was performed to compare values at clamping and re-opening of the carotids as well as before and after fentanyl administration. The BIS values were significantly lower during anesthesia than at the end of anesthesia and at tracheal extubation; no significant differences were found among other TPs. Adequate depth of anesthesia was mirrored by consistent BIS values among rabbits, and alteration of cerebral blood supply did not modify BIS values, except once. Following fentanyl, BIS values did not change in a clinically relevant way.

Surgical Outcome After Microsurgical Clipping of Internal Carotid Bifurcation Aneurysm. Series of 30 cases

Welcome to BRAZILIAN JOURNAL OF NEUROSURGERY (JBNC), the official journal of the Brazilian Academy of Neurosurgery, is the oldest Neurosurgery journal in our country. It started in 1973 with the name of “Seara Médica Neurocirúrgica” and, since the beginning, it has been an extremely important information organ for Brazilian neurosurgeons. Brazil is the country with the third largest number of neurosurgeons in the world. Despite this large number of colleagues working in the specialty, we still do not have any journal indexed in PubMedTM, which is considered the most important database for medical journals in the world. Bem-vindo ao Jornal Brasileiro de Neurocirurgia - JBNC. Welcome to Brazilian Journal of Neurosurgery. O JORNAL BRASILEIRO DE NEUROCIRURGIA (JBNC), órgão oficial da Academia Brasileira de Neurocirurgia, é a revista de neurocirurgia mais antiga do nosso país. Iniciou no ano de 1973 com o nome de “Seara Médica Neurocirúrgica” e desde o início tem sido um órgão de informação de extrema importância para os neurocirurgiões brasileiros.

Carotid artery vein-pouch bifurcation aneurysm in rats: An experimental model for microneurosurgical training

BackgroundIn the era of endovascular treatment of intracranial aneurysms, surgical clipping is still a relevant treatment method in some cases. However, it has become harder to teach this skill, as the number of surgical cases has decreased over the past years. We therefore decided to use a previously described experimental aneurysm model for surgical training. Material and methodsWe operated on 8 rats and constructed a vein-pouch aneurysm at a surgically created carotid bifurcation. Survivors were kept alive for 1 month and operated on to clip the aneurysm. ResultsOnly 3 rats had survived at 1 month. All the carotid arteries were permeable. Only 2 aneurysms were circulating at 1 month, as 1 had thrombosed. They were successfully clipped at 1 month. ConclusionsThese preliminary results enabled our junior surgeon to clip two circulating aneurysms, under an operative microscope reproducing surgical conditions. Although the efficacy of the model could be improved, we believe it could be used as a first step in training neurosurgical residents in the basics of aneurysm clipping and microsurgical techniques in a realistic setting.

A Eulerian method to analyze wall shear stress fixed points and manifolds in cardiovascular flows.

Based upon dynamical systems theory, a fixed point of a vector field such as the wall shear stress (WSS) at the luminal surface of a vessel is a point where the vector field vanishes. Unstable/stable manifolds identify contraction/expansion regions linking fixed points. The significance of such WSS topological features lies in their strong link with "disturbed" flow features like flow stagnation, separation and reversal, deemed responsible for vascular dysfunction initiation and progression. Here, we present a Eulerian method to analyze WSS topological skeleton through the identification and classification of WSS fixed points and manifolds in complex vascular geometries. The method rests on the volume contraction theory and analyzes the WSS topological skeleton through the WSS vector field divergence and Poincar[Formula: see text] index. The method is here applied to computational hemodynamics models of carotid bifurcation and intracranial aneurysm. An in-depth analysis of the time dependence of the WSS topological skeleton along the cardiac cycle is provided, enriching the information obtained from cycle-average WSS. Among the main findings, it emerges that on the carotid bifurcation, instantaneous WSS fixed points co-localize with cycle-average WSS fixed points for a fraction of the cardiac cycle ranging from 0 to [Formula: see text]; a persistent instantaneous WSS fixed point confined on the aneurysm dome does not co-localize with the cycle-average low-WSS region. In conclusion, the here presented approach shows the potential to speed up studies on the physiological significance of WSS topological skeleton in cardiovascular flows, ultimately increasing the chance of finding mechanistic explanations to clinical observations.

Factors Affecting the Degree of Angular Remodeling in Stent-Assisted Coiling of Bifurcation Aneurysms

Background: Stent-assisted coiling (SAC) leads to significant changes in the vascular angle altering the bifurcation geometry and the hemodynamics at the bifurcation apex. It is believed that the stent alone exerts this effect, but other possible factors have not been studied. Purpose: To study the factors contributing to angular remodeling following SAC of bifurcation aneurysms including the anatomical, stent-related, and coil-related factors. Materials and Methods: We reviewed 43 basilar and carotid bifurcation aneurysms treated by SAC using Neuroform EZ (n = 28), Enterprise (n = 8), and Lvis Jr. (n = 7) stents. The bifurcation angle between the mother and stented daughter vessel was measured in 4 settings: pretreatment, poststenting, postcoiling, and at delayed follow-up (6–12 months). The degree of stent-induced angular remodeling was calculated by subtracting the poststenting bifurcation angle from the pretreatment one, while the coil-induced angular remodeling was calculated as the difference between the postcoiling and poststenting bifurcation angle. The immediate postprocedural degree of angular remodeling is the sum of the stent- and coil-induced angular remodeling. We studied the effect of several factors including the pretreatment bifurcation angle, aneurysm site, diameter of parent vessel, stent type, stent length in the daughter vessel, postoperative actual in situ coil size, and packing density. Results: The mean degree of stent-induced and coil-induced angular remodeling was 10.2 (0–47) and 4.53 (–7 to 30), respectively. The immediate postprocedural and delayed angular remodeling was 14.8 (–4 to 47) and 4.75 (–12 to 40), respectively. The degree of immediate remodeling was significantly affected by the actual in situ coil size (p = 0.017), and the pretreatment bifurcation angle (p = 0.024). Linear regression was carried out and the pretreatment bifurcation angle was defined as a predictor. The degree of delayed remodeling is significantly affected only by the pretreatment bifurcation angle (p = 0.011). Conclusion: Immediate angular remodeling following SAC of bifurcation aneurysms can happen after stenting or coiling or both. This is the first study reporting the role of the coils as an additional factor beside the stent in inducing immediate angular changes; this effect is correlated to the size of the coils. The pretreatment bifurcation angle is the most consistent factor affecting the degree of both immediate and delayed angular remodeling.

Comparison of carotid and basilar bifurcation aneurysms versus non-T-angled bifurcations: the geometry is associated with the outcome.

Patients with ruptured aneurysms of carotid bifurcation artery seem to suffer less often from cerebral vasospasm and early brain injury and have a better clinical outcome. Aim of our study was to identify differences in clinical course and outcome in aneurysms of terminus segments (carotid bifurcation artery and basilar tip) compared to aneurysms of other aneurysm locations except carotid bifurcation artery and basilar tip. Patients with SAH were entered into a prospectively collected database (1999 to June 2014). A total of 471 patients ('T-shaped' aneurysms n = 63, 'non-T-shaped' aneurysms n = 408) were selected. Outcome was assessed by modified Rankin Scale (mRS) 6months after SAH. Mean age was 53.75years. Statistically, analysis showed a significant better outcome in 'T-shaped' aneurysms (p = 0.0001) and a significant lower mortality rate (p = 0.02) despite higher rates of Fisher 3 bleeding pattern and CVS. In 'T-shaped' aneurysms, no prognostic factors for outcome could be detected. In 'non-T-shaped' aneurysms admission status (p < 0.0001), early hydrocephalus (p < 0.0001), shunt-dependence (p = 0.001), and the occurrence of severe CVS (p = 0.01) statistically were factors influencing patients' outcome. Multivariate analysis showed 'non-T-shaped' aneurysms itself as independent prognostic factor for patients' outcome. Despite same rate of poor admission status, early hydrocephalus and shunt dependence 'T-shaped' aneurysms have a highly significantly better. Pathophysiological mechanism actually is not understood. Further studies are necessary to identify, which factors lead to the decreased outcome in "non-T-shaped"- aneurysms.

4:21 PM Abstract No. 408 Treatment of carotid artery terminal bifurcation and sidewall aneurysms in canines with the Ballstent™ microcatheter

4:21 PM Abstract No. 408 Treatment of carotid artery terminal bifurcation and sidewall aneurysms in canines with the Ballstent™ microcatheter

Cerebral infarction caused by accidental incarceration of aneurysm-adjacent branches with temporary clips

Objective To explore the potential reasons of cerebral infarction caused by accidental incarceration of aneurysm-adjacent branches with temporary clips, and to give guidance to the appropriate application of temporary clips. Methods A retrospective analysis was conducted on the clinical data of 10 patients with accidental incarceration of branches of parent artery or aneurysm-adjacent perforator vessels who were admitted to Department of Neurosurgery of Fuzhou General Hospital from January 2004 to December 2016. Under microscopes, we observed the definite lesions of branches and perforator vessels during the procedures, features of temporary clips and the intraoperative procedure, and postoperative cerebral infarction with varying degrees in corresponding territories. Two cases of posterior communicating artery aneurysm and 2 cases of carotid bifurcation aneurysm were found on the extracranial superior mesenteric artery adventitia with varying degrees of atherosclerosis, misclipping occurred at the anterior pre-choroidal artery, recurrent artery of Heubner and lenticulostraiate artery. For 4 cases of anterior communicating artery aneurysms and 2 cases of middle cerebral artery aneurysm, mis-clipping was found at A1 or A2 and M1 segments adjacent to perforation. Results Among the 10 patients, CT review 2-4 days post surgery demonstrated cerebral infarction with varying degrees adjacent to the aneurysm branches, perforating branch of blood supply. Disturbance of consciousness occurred in 2 cases. Compared with preoperative state, short-term significant decrease in strength of limb muscles was observed in 5 cases, incomplete motor aphasia in 1 and asymptomatic cerebral infarction in 2. At follow-up ranging from 4 months to 3 years, 2 cases reported dementia and 2 cases had permanent hemiplegia, out of which 3 were disabling and needed long-term care. Conclusions Cerebral infarction caused by accidental incarceration of branches or perforator vessels with temporary clips could be related not only to the incarceration duration, age and vascular sclerosis, but also to the over-contraction of small blood vessels and the closing force of a temporary clip. Therefore, caution should be warranted regarding those factors in the use of temporary clips. Key words: Intracranial aneurysm; Vascular system injuries; Therapeutic occlusion; Brain infarction

Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries.

Cerebral aneurysms in the posterior circulation are known to have a higher rupture risk than those in the anterior circulation. We sought to test the hypothesis that differences in hemodynamics can explain the difference in rupture rates. A total of 117 aneurysms, 63 at the tip of the basilar artery (27 ruptured, 36 unruptured, rupture rate = 43%) and 54 at the bifurcation of the internal carotid artery (11 ruptured, 43 unruptured, rupture rate = 20%) were analyzed with image-based computational fluid dynamics. Several hemodynamic variables were compared among aneurysms at each location and between ruptured and unruptured aneurysms at each location. On average, aneurysms at the basilar tip had more concentrated inflow (P < .001), a larger inflow rate (P < .001), a larger maximum oscillatory shear index (P = .003), more complex flows (P = .033), and smaller areas under low wall shear stress (P < .001) than aneurysms at the bifurcation of the internal carotid artery. In general, ruptured aneurysms had larger inflow concentration (P = .02), larger shear concentration (P = .02), more complex flows (P < .001), and smaller minimum wall shear stress (P = .003) than unruptured aneurysms. High flow conditions, characterized by large and concentrated inflow jets, complex and oscillatory flow patterns, and wall shear stress distributions with focalized regions of high shear and large regions of low shear, are associated with aneurysm rupture, especially for basilar tip aneurysms. The higher flow conditions in basilar tip aneurysms could explain their increased rupture risk compared with internal carotid bifurcation aneurysms.

Application of LVIS stents in very small intracranial aneurysms

To investigate the safety and short-term efficacy of stent on 17 patients with very small intracranial aneurysms. A total of 17 patients with very small intracranial aneurysms were treated by LVIS stent from October 2014 to November 2015. The location, size of the aneurysms and the branch around aneurysms were evaluated by digital subtraction angiography (DSA). The metal coverage for aneurysms was enhanced by using deployment technology ("compression" mode). The safety and efficacy were assessed after operation. LVIS stents-assisted treatments for very small aneurysms were carried out in 17 cases, including 7 cases of paraclinoid aneurysms, 4 cases of posterior communicating artery aneurysms, 3 cases of anterior communicating artery aneurysms, 2 cases of carotid bifurcation aneurysms, 1 case of the superior cerebellar artery aneurysm. The stents for 17 patients with very small intracranial aneurysms were released completely (100%); Raymond grade I embolization was seen in 13 cases (76.5%); Raymond grade II embolization was seen in 4 cases (23.5%); during the follow up from a month to a year, 16 patients showed good curative effect (with the mRS score at 0-2), 1 showed poor effect (with the mRS score at 3-6), and the efficacy rate was 94.1%; no perioperative hemorrhagic and ischemic complications happened. LVIS stent-assisted therapy for very small intracranial aneurysms by using deployment technology was safe and feasible, which can significantly improve the embolization rate for very small aneurysms.

History of Carotid Stroke

> [The] two branches which they call carotides or soporales, the sleepy arteries, because they being obstructed, or any way stopt we presently fall asleep. > > —Ambroise Pare (ca. AD 1510–1590)1 Current understanding of carotid artery disease begins in Ancient Greece. The term carotid is derived from the Ancient Greek karos (κάρος), meaning to stupefy. This first description is ascribed to Hippocrates (ca. 460–370 BC) but defined in the later accounts of Rufus of Ephesus (fl. ca. AD 100), who stated that the term was used because superficial compression of the vessels was known to induce stupefaction. The importance of the carotid arteries was even evident in the timeless art of the era. The 31st metope (a rectangular architectural element) from the south side of the Parthenon in Athens (Figure 1) depicts a centaur gripping the neck and compressing the left carotid artery of a Lapith (member of a mythological Thessalian people) during the legendary Centauromachy battle. Galen (ca. AD 131–201) attributed the loss of consciousness to compression not of the carotid arteries but of “sensitive nerves” located proximal to the vessels.2 Today cardiologists recognize a similar syndrome of carotid sinus syncope, tested for through carotid baroreceptor hypersensitivity. Figure 1. The 31st metope from the south side of the Parthenon in Athens. On display in the British Museum, the southern aspect metopes depict the battle between the centaurs (left) and the Lapiths (right) at the wedding of Peirithus, the king of the Lapiths. The left carotid artery of the Lapith is here being intentionally compressed to induce unconsciousness. Photograph courtesy of Colin Howley. Used with permission. The most devastating consequence of carotid artery disease is stroke, which was referred to during classical antiquity as apoplexy. Hippocrates and Galen were both aware that the hemiplegia often accompanying apoplexy resulted from a lesion in …

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal artery Aneurysms with Unilateral Frontopterionel Skin Incision Technique

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal artery Aneurysms with Unilateral Frontopterionel Skin Incision Technique

Surgical and Endovascular Treatment of Extracranial Carotid Artery Aneurysms: Early and Long-Term Results of a Single Center

To evaluate early and long-term results of surgical and endovascular therapy of extracranial carotid artery aneurysms. A retrospective study was conducted of 26 aneurysms in 25 patients (19 men and 6 women) who underwent surgery between 1993 and 2010: 18 were atherosclerotic, 3 were from arteritis, 1 was a relapsing mycotic aneurysm from previous carotid surgery, and 4 were posttraumatic. A neurologic event was the presenting symptom in 10 cases (7 transient ischemic attacks, 3 strokes); 13 patients were asymptomatic and a cranial nerve dysfunction (hoarseness) was present in 2; fever was present in 1. A total of 15 aneurysms, located on the carotid bifurcation (CB), were resected and an end-to-end carotid anastomosis was performed. In 6 patients with CB aneurysms, a vein graft was applied in 5, and a polytetrafluoroethylene graft in the other. Aneurysmorrhaphy and a vein patch was the procedure in 2 patients with an aneurysm of the CB. One of these 2 patients had a relapsing mycotic pseudoaneurysm and was treated initially with a vein patch, subsequently with a vein graft, and lastly with a carotid artery ligation. Three common carotid artery aneurysms from arteritis were treated under local anesthesia through implantation of a Viabahn endoprosthesis. A perioperative minor stroke occurred in 1 patient (3.8%) because of intentional ligation of the internal carotid artery from a relapsing mycotic aneurysm, already treated with a vein patch and subsequently with a vein bypass. No permanent cranial nerve injuries were recorded; transient cranial nerve injuries were observed in 2 patients. Surgical treatment is feasible, with an acceptable rate of stroke and cranial nerve injuries, especially when the aneurysm is located on the common carotid artery and carotid bulb. Endovascular therapy is a fascinating option, with satisfactory early and long-term results, and should always be considered when treating aneurysms located in the distal internal carotid artery and when the patient is not a good candidate for open surgery.

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal Artery Aneurysms with Unilatera

Surgical Treatment of Internal Carotid Bifurcation and Pericallosal Artery Aneurysms with Unilatera

In Vitro and In Vivo Imaging Characteristics Assessment of Polymeric Coils Compared with Standard Platinum Coils for the Treatment of Intracranial Aneurysms

Conventional platinum coils cause imaging artifacts that reduce imaging quality and therefore impair imaging interpretation on intraprocedural or noninvasive follow-up imaging. The purpose of this study was to evaluate imaging characteristics and artifact production of polymeric coils compared with standard platinum coils in vitro and in vivo. Polymeric coils and standard platinum coils were evaluated in vitro with the use of 2 identical silicon aneurysm models coiled with a packing attenuation of 20% each. DSA, flat panel CT, CT, and MR imaging were performed. In vivo evaluation of imaging characteristics of polymeric coils was performed in experimentally created rabbit carotid bifurcation aneurysms. DSA, CT/CTA, and MR imaging were performed after endovascular treatment of the aneurysms. Images were evaluated regarding visibility of individual coils, coil mass, artifact production, and visibility of residual flow within the aneurysm. Overall, in vitro and in vivo imaging showed relevantly reduced artifact production of polymeric coils in all imaging modalities compared with standard platinum coils. Image quality of CT and MR imaging was improved with the use of polymeric coils, which permitted enhanced depiction of individual coil loops and residual aneurysm lumen as well as the peri-aneurysmal area. Remarkably, CT images demonstrated considerably improved image quality with only minor artifacts compared with standard coils. On DSA, polymeric coils showed transparency and allowed visualization of superimposed vessel structures. This initial experimental study showed improved imaging quality with the use of polymeric coils compared with standard platinum coils in all imaging modalities. This might be advantageous for improved intraprocedural imaging for the detection of complications and posttreatment noninvasive follow-up imaging.

Tasuki Clipping Combined With High Flow Bypass for Ruptured, Previously Coiled, Partially Thrombosed Giant Aneurysm at the Carotid Bifurcation

A 33-year-old woman presented with a ruptured, partially thrombosed carotid bifurcation aneurysm after partial coiling, which was successfully treated by "tasuki" (a cloth sash crossing from one shoulder to the opposite hip, worn by relay marathon runners) clipping combined with radial artery and external carotid artery-to-middle cerebral artery bypass. "Tasuki" clipping can overcome the dilemma between achieving early complete thrombosis in the blind sac and maintaining anterograde flow of the parent artery to prevent inadvertent occlusion of the perforators and anterior choroidal artery.

Hyperperfusion Syndrome after Stent/Coiling of a Ruptured Carotid Bifurcation Aneurysm

The authors report a syndrome of regional, symptomatic cerebral hyperperfusion, and edema mimicking infarction in a 54-year-old woman following coiling of a ruptured right carotid bifurcation aneurysm and stenting of the right middle cerebral artery. The patient presented with a Hunt and Hess grade III subarachnoid hemorrhage 7 days after developing thunderclap headache. She underwent successful coiling under general anesthesia of the 1.6 × 1.5 × 1.6 cm aneurysm, but immediately after the coil was placed occlusion of the proximal M1 segment was developed. This occlusion was stented after ~5-min delay, and flow restored without angiographic evidence of distal emboli. Following the procedure, she was extubated and noted to have left hemiparesis, neglect, and mutism without a CT correlate. Cerebral infarction was suspected, but urgent repeat angiography demonstrated patent cerebral vasculature. On the following day, symptoms persisted, and non-contrast head CT now showed cerebral edema localized to the right middle cerebral artery territory mimicking subacute infarction. CT perfusion imaging and angiography showed a widely patent MCA circulation, and suggested a regional hyperperfusion syndrome. The blood pressure was incrementally lowered, with rapid and sustained neurological improvement. Hyperperfusion events following aneurysm repair and related circumstances are reviewed.

Caution: Carotid Artery Aneurysm May Disguise as Neck Tumor

Objective: 1) To present a case where a right common carotid aneurysm was clinically undistinguishable from tumor. 2) Stress the importance of contrast-enhanced imaging in the workup of a neck mass. 3) Review of literature. Method: A 64-year-old male smoker with hypertension presented with hoarseness, dysphagia, and an enlarging right neck mass. Physical examination revealed 6-cm neck mass, nonfluctuant, nonpulsatile. F/L: Right parapharyngeal mass impinging right hemilarynx, causing partial airway obstruction. Noncontrast computed tomography (CT) scan was suggestive of neoplasia versus abscess formation. Contrast-enhanced CT revealed an aneurysm of the right carotid bifurcation. PubMed literature was reviewed. Results: Extracranial carotid aneurysms are rare (1-4%), with atherosclerosis being the most common etiology. They arise in the internal carotid (67%), bifurcation (32%), and the external carotid artery (1%). Airway obstruction and dysphagia has been reported in very few cases. In our patient this led to the clinical diagnosis of tumor. Contrast-enhanced imaging is essential in the workup of a neck mass. Management options include interposition bypass grafting, resection with patch angioplasty, or carotid ligation, as well as endovascular interventions with stenting or occlusion. Conclusion: Large carotid artery aneurysms may resemble a tumor and they must be considered in the differential diagnosis of a neck mass. The importance of contrast-enhanced imaging before attempting invasive procedures cannot be overemphasized.

Stent placement for the treatment of complex internal carotid bifurcation aneurysms: a review of 16 cases

Stent placements for the treatment of complex internal carotid bifurcation aneurysms are not well documented yet. In this article, we reported a series of 16 such cases to evaluate the feasibility, safety and effectiveness of stent placement for these particular lesions. Between June 2001 and August 2011, 16 patients with 16 ICA bifurcation aneurysms were treated by stent assisted coiling at our institution. Their clinical data, treatment results and follow-up were retrospectively collected and analyzed. Sixteen stents, including 10 Enterprise, 4 Neuroform, 1 Solitaire and 1 one balloon-mounted coronary stent (BX), were successfully deployed in this series. Immediate angiogram showed complete occlusion in 5, neck remnant in 2 and residual sac in 9. No procedure-related complication occurred. Angiographic follow-up results (mean, 12.1 months) were available in 15 patients, 9 of the aneurysms were cured, 1 was improved, 3 were stable, 2 were recanalized, and 1 was retreated. Clinical follow-up (mean, 28.6 months) of all 16 patients demonstrated no neurologic deterioration or rebleeding. Our result suggests that stent placement for the treatment of complex ICA bifurcation aneurysms is feasible and safe. However, its efficacy should be further evaluated by larger case series and more adequate follow-up.