Reconstruction Of Internal Carotid Artery Research Articles

A Treatment Approach for Carotid Blowout Syndrome and Soft Tissue Reconstruction after Radiotherapy in Patients with Oral Cancer: A Report of 2 Cases.

This retrospective case series study aims to demonstrate a salvage technique for the treatment of carotid blow-out syndrome (CBS) in irradiated head and neck cancer patients with a vessel-depleted neck. Between October 2017 and October 2021, two patients (N = 2) with CBS were treated at our institution in a multidisciplinary approach together with the Department of Vascular Surgery. Patients were characterized based on diagnoses, treatment procedures, and the subsequent postoperative course. Surgical emergency intervention was performed in both cases. The transition zone from the common carotid artery (CCA) to the internal carotid artery (ICA) was resected and reconstructed with a xenogic (case 1) or autogenic (case 2) interposition (end-to-end anastomosis). To allow reconstruction of the vascular defect, an additional autologous vein graft was anastomosed to the interposition graft in an end-to-side technique, allowing arterial anastomosis for a free microvascular flap without re-clamping of the ICA. Because of the intraoperative ICA reconstruction, none of the patients suffered a neurological deficit. The techniques presented in the form of two case reports allow for acute bleeding control, cerebral perfusion, and the creation of a vascular anastomosis option in the vessel-depleted neck.

Surgical treatment of severe deformity of the internal carotid arteries

Objective. To evaluate the outcomes of internal carotid artery (ICA) redressment with transposition into the «new orifice» with a severe pathological elongation of the internal carotid artery. Materials and methods. In 2021, 42 operations were performed in 38 patients having severe deformations of the ICA required the transposition of ICA orifice by 2 or more diameters from the old orifice are presented. Four patients underwent reconstructions on both sides. All patients were symptomatic, with chronic cerebrovascular insufficiency grade 2–4 (according to the classification of A. V. Pokrovsky, 1978). 29 women (76.3 %), 9 men (23.7 %) were enrolled in the study. The average age was 69.1±7.7 years. 18 patients (47.4 %) were found to have a combination of hemodynamically significant pathological deformities with atherosclerotic lesions of the carotid arteries. All patients underwent ultrasound duplex scanning and computed tomography with contrasting brachiocephalic arteries in the preoperative period. Results. Most deformations are represented by S- and Z-shaped (73,8 %) оr ICA loops (21,4 %). The maximum level of transposition was required for loop deformations (25.6 mm±6.17) and was comparable for S- and Z-shaped deformations (17.8 mm±6.3; 17.5 mm±8.0). In the postoperative period, there were no signs of cerebral circulation disorders in this group of patients. In 84 % of cases, 32 patients showed clinical improvement with partial or complete regression of cerebral neurological symptoms. In 1 case (2.4 %), there was a hematoma of a postoperative wound that did not require specific surgical or medical treatment. During postoperative duplex control in the postoperative period, turbulent flows, stenosis and deformity in the area of the new orifice were not observed. Conclusion. The results confirm the data reported by other authors about the safety of the surgical method. ICA reconstruction with orifice transposition may be an alternative method of surgical treatment with minimal risk of complications. To achieve the best result, during the creation of a new orifice of the ICA, it is necessary to preserve as much as possible the original anatomy of the bulb of the ICA and the bifurcation of the common carotid artery. For a more detailed assessment of the results, further study is planned on a large clinical material.

Paraclinoid unruptured giant aneurysm with therapeutic success

The global prevalence of intracranial aneurysms (IA) ranges from 5–10%, with a demographic variation. Large and giant aneurysms typically involve cavernous and paraclinoid segments of the internal carotid artery (ICA), and represent 5% of IA. Typically, these lesions involve segments of the ICA, especially the cavernous and paraclinoid segments. The remaining cases affect the vertebrobasilar region, middle cerebral artery (MCA), and anterior cerebral artery (ACA). From the morphological point of view, they are divided into saccular and fusiform. In cases of rupture, the subarachnoid hemorrhage (SAH) is the most common presentation followed by intracerebral hemorrhage (ICH), or both. Other manifestations can occur as occlusion of perforating vessels, embolic events, seizures, and mass effects. The management of unruptured intracranial aneurysms (UIA) is controversial, and the aim of treatment is to exclude the lesions and preserve neurological function. Endovascular techniques for the treatment of paraclinoid aneurysms, in particular, ICA reconstruction using flow-diverting stents, have become a valid option. However, surgery or endovascular treatment has a number of limitations and the choice of treatment is individual in each case. This type of lesion has an extremely poor natural history, and treatment is a challenge regardless of the technique used. The report described a clinical case of a 55-year-old female, with a personal history of hypertension, hyperthyroidism, and depressive syndrome. The patient started complaints of moderate-intensity right frontal headache, progressively worsening with two months of evolution. She also reported blurred vision and diplopia. Brain computed tomography (CT) documented a partially calcified sellar and parasellar lesion. Subsequently, magnetic resonance imaging (MRI)/MRI angiographies were performed and showed a saccular aneurysm of the right ICA, cavernous segment. The patient underwent a diagnostic and therapeutic angiography with stent placement. Clinical and imaging improvements were documented by angiography and MRI angiography with progressive reduction of the aneurysm during the period of follow-up.

Application of the Willis Covered Stent in the Treatment of Blood Blister-Like Aneurysms: A Single-Center Experience.

ObjectiveTo evaluate the effectiveness of the Willis covered stent (WCS) in the treatment of ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA).MethodThe clinical data of 16 patients consecutively treated with WCSs from December 2015 to January 2019 were retrospectively analyzed. Clinical data and angiographic findings were analyzed by two experienced neuroradiologists and neurosurgeons, including age, sex, Hunt and Hess (H&H) grade at admission, modified Rankin scale (mRS) score, aneurysm size, and location, the diameter of the patent artery in proximal and distal ends, stent size, rate of aneurysm occlusion, procedure-related complications, and follow-up.ResultsAll the 16 patients (five males, 11 females) with ICA BBAs underwent WCS deployment successfully. The median age was 49 years (range, 29–72). All patients had complete aneurysm occlusion on immediate postoperative angiography. Anterior choroidal artery (AChA) was occluded in one patient accidentally while no obvious neurological dysfunction was observed. However, this patient underwent subarachnoid hemorrhage 1 day after the treatment; endoleak and aneurysm recurred, and the patient died 10 days later. Therefore, the effective rate of WCS treatment was 93.8% (15/16), and procedure-related complications rate was 6.3% (1/16). Moreover, one patient was urgently treated because of accidental aneurysm rupture after anesthesia, and external ventricular drainage was then performed postoperatively. Another patient developed coma and hemiplegia 3 days after treatment, with emergency angiography showing in-stent thrombosis and ICA occlusion which was recanalized with arterial rt-PA thrombolysis; the patient recovered completely. The clinical follow-up period was 3–30 months in 14 patients. The mRS scores were 0 in 12 patients (85.7%) and 4 in 1 case (7.1%), while 1 patient (7.1%) died 6 months postoperatively for unknown reasons. Angiographic follow-up was performed in 13 patients, and no recurrence was observed. However, ICA occlusion without neurological deficit was observed in one patient.ConclusionBased on careful preoperative evaluation, appropriate WCS size selection, and precise surgical operation, WCSs may provide an alternative and effective solution for blood BBAs via aneurysm isolation and ICA reconstruction immediately; However, further follow-up studies with larger samples are required.

Flow Diverter Reconstruction of Internal Carotid Artery (Loop) Dissections with or without Associated Pseudoaneurysms

Endovascular treatment of cervical internal carotid artery (ICA) loop dissections in acute stroke interventions can be challenging. Flow diverters can effectively reconstruct vessel loops and treat the injured vessel and provide a safe conduit for intracranial catheterization. We retrospectively reviewed our neurointerventional database and identified all patients with ICA loop dissections treated with flow diverters in the acute setting between August 2016 and September 2020. Patient demographics, procedural data, imaging follow-up results, and clinical outcome information were collected. Seven patients with a mean age of 62 years (range: 43-85 years) who underwent reconstruction of an ICA (loop) dissection with flow diverters were included. Four ICA dissections were treated with the Surpass Streamline flow diverter and 3 with the Pipeline embolization device. All cases were technically successful. All stroke cases achieved intracranial flow ≥thrombolysis in cerebral infarction 2B. Observed intracranial hemorrhages were all asymptomatic. All cases showed patent flow diverter(s) with or without (carotid) stent(s) on follow-up imaging. Semielectively treated patients did not show a change from baseline modified Rankin scale related to the procedure. Patients with acute stroke had a modified Rankin scale ≤2 in 4 of 5 cases (80%) at 3 months. Two patients died due to medical issues unrelated to the procedures. No patient showed new or recurrent symptoms. Use of flow diverters, in some cases in conjunction with (carotid) stents, is an effective treatment option for cervical carotid artery (loop) dissections.

Long-Term Surgical Outcomes of Carotid Body Tumors With Pathological Fibrosis: A Cohort Study.

ObjectiveTo compare the surgical outcomes of carotid body tumor (CBT) with or without pathological fibrosis, and evaluate the associated factors of fibrous CBT (FCBT).Materials and MethodsParaffin-embedded tissues of 236 patients with unilateral CBTs at our center were retrospectively reviewed from January 2008 to May 2020. Based on the pathologic features, CBTs were divided into FCBT and conventional CBT (CCBT) groups. The clinical data and surgical outcomes of the two groups were compared.ResultsOf 236 patients, 53 had FCBT and 183 had CCBT. FCBTs showed higher vascular invasion (24.53%), marked pleomorphism (22.64%), internal carotid artery reconstruction (37.74%), estimated blood loss (559.62 cm3), and postoperative nerve injury (49.06%), with lower 10-year recurrence- (89.2%) and major adverse event-free survival (87.3%) compared to CCBTs. Nerve injury was correlated with the Shamblin grade; major adverse events and nerve injury were both correlated with pathological fibrosis.ConclusionCompared with CCBT, FCBT is prone to increased recurrence, metastasis, major adverse events, and nerve injury risk. Early surgical resection, routine excision of surrounding abnormal lymph nodes, and closer clinical surveillance in FCBT patients are recommended.

Clinical application of combined infratemporal fossa approaches for internal carotid artery in petrous bone reconstruction for large lateral skull base tumors

Objective: By summarizing the technical points and therapeutic outcomes of combing infratemporal fossa approach (IFA) and internal carotid artery (ICA) reconstruction for the colossal skull base tumor invading ICA in petrous bone, the clinical application value was discussed. Methods: Five patients (2 males, 3 females,aging from 27 to 55 years old) who received surgeries between July 2015 and May 2017 for lateral skull base pathology involved petrous ICA using technique combined IFA and pre-reconstruction, were reviewed. Results: Among the five patients, three were paraganglioma of head and neck, one was carotid aneurysms, and one was recurrent adenoid cystic carcinoma (ACC). The median tumor size in the largest cross-section was 60 mm × 51 mm (range, 28 mm × 22 mm-72 mm × 58 mm). Complete excision was achieved with IFA and ICA reconstruction. The median blood loss volume was 1 000 ml (range, 600-2 500 ml). Four cases showed no new long-term neurologic sequelae, while one showed hemiplegia due to graft vessel occlusion. Except for the one with ACC having facial nerve cut, others achieved good facial nerve function of HB grade Ⅰ to Ⅱ during 3 to 12 months, follow-up. No tumor recurrence was observed over the median duration of follow-up for above 36 months (range, 36-58 months). Conclusion: For lesions involved superior part of ICA, which is unable to separate from ICA, IFA and ICA reconstruction can achieve complete excision.

Management of Multiple Head and Neck Paragangliomas With Assistance of a 3-D Model.

Extirpation of multiple head and neck paragangliomas carries challenge due to close anatomic relationships with critical neurovascular bundles. This study aims to assess whether the application of 3-D models can assist with surgical planning and treatment of these paragangliomas, decrease surgically related morbidity and mortality. Fourteen patients undergoing surgical resection of multiple head and neck paragangliomas were enrolled in this study. A preoperative 3-D model was created based on radiologic data, and relevant critical anatomic relationships were preoperatively assessed and intraoperatively validated. All 14 patients presented with multiple head and neck paragangliomas, including bilateral carotid body tumors (CBT, n = 9), concurrent CBT with glomus jugulare tumors (GJT, n = 4), and multiple vagal paragangliomas (n = 1). Ten patients underwent genomic analysis and all harbored succinate dehydrogenase complex subunit D (SDHD) mutations. Under guidance of the 3-D model, the internal carotid artery (ICA) was circumferentially encased by tumor on 5 of the operated sides, in 4 (80%) of which the tumor was successfully dissected out from the ICA, whereas ICA reconstruction was required on one side (20%). Following removal of CBT, anterior rerouting of the facial nerve was avoided in 3 (75%) of 4 patients during the extirpation of GJT with assistance of a 3-D model. Two patients developed permanent postoperative vocal cord paralysis. There was no vessel rupture or mortality in this study cohort. The 3-D model is beneficial for establishment of a preoperative strategy, as well as planning and guiding the intraoperative procedure for resection of multiple head and neck paragangliomas.

Combined Endovascular and Surgical Treatment of Chronic Carotid Artery Occlusion: Hybrid Operation.

Objectives The optimal treatment choice of chronic carotid artery occlusion (CAO) remains inconclusive. This study was aimed at exploring the safety and effectiveness of hybrid surgery in the treatment of CAO and at determining predictors for successful recanalization. Methods In this study, we enrolled 37 patients with CAO who underwent hybrid surgical treatment during the period 2016–2018. We extracted and analyzed patients' demographic data, disease characteristics, surgical success rates, perioperative complications, and prognosis. Results A total of 37 patients with symptomatic CAO underwent hybrid surgical treatment. Thirty cases (81.1%) were successfully recanalized, while seven were not. Blood reflux after carotid endarterectomy occurred in 18 patients (60%) of the success group and 1 (14.3%) of the failure group (OR, 9.0; 95% CI, 0.95-54.5; P = 0.042). The rate of distal ICA reconstruction below the clinoid segment was 20 (66.7%) in the success group and 1 (14.3%) in the failure group (OR, 12.0; 95% CI, 1.3-113.7; P = 0.029). In patients with successful recanalization, no ischemic events occurred after surgery and during follow-up, but restenosis of >50% was found in one case. In the failure group, two patients experienced recurrent ischemic events during follow-up. Perfusion imaging in successful recanalization cases is significantly improved, preoperative I/C ratio was 1.44 (IQR 1.27-1.55), and postoperative 1.12 (IQR 1.05-1.23). National Institutes of Health Stroke Scale (NIHSS) score of successful recanalization cases was 5.35 (2.26) before surgery and 2.03 (1.40) at 6 months (P < 0.01). Conclusion Hybrid surgery might be a safe and effective way to treat CAO. Distal internal carotid artery reconstruction to below the clinoid segment and blood reflux after carotid endarterectomy are predictors of successful recanalization.

Results of Endovascular Treatment for High-Flow Direct Carotid-Cavernous Fistulas

Objective : to study the results of treatment in patients with direct high-flow carotid-cavernous fistulas with their transarterial occlusion using detachable balloons and microcoils. Material and methods. Thirty-five patients underwent surgery using detachable balloons and microcoils. The clinical picture in all patients was represented by pulsating exophthalmos, ptosis on the side of the lesion, ophthalmoplegia, and conjunctival chemosis. Results. In all patients closure of carotid-cavernous fistulas and reversal of symptoms were achieved after primary surgery. Internal carotid artery reconstruction with microcoils could be achieved significantly more often than that with balloons. An anastomotic recurrence was significantly more common in patients undergoing surgery with balloons. Conclusion. The use of microcoils allows to perform reconstructive surgery significantly more frequently, while the recurrence rate is significantly lower than after using the balloons.

Successful Endovascular Treatment for Recanalized Post-Traumatic Carotid-Cavernous Fistula

Carotid-cavernous fistulas (CCFs) are spontaneous or acquired communications between the internal carotid artery (ICA) and the cavernous sinus, which can be classified as direct or indirect. Direct fistulas between the ICA and the cavernous sinus can arise from injury, rupture of intracavernous carotid aneurysm, collagen deficiency syndrome, artery dissection, fibromuscular dysplasia, and direct surgical trauma. The symptoms caused by CCF are related to their size, duration, location, the direction of venous outflow, and the presence of arterial and venous collaterals. The goal of treatment for direct CCFs is to close the defect between the ICA and the cavernous sinus while maintaining the patency of the ICA. This goal can be achieved either by transarterial fistula occlusion using a removable balloon, transarterial or transvenous occlusion of the ipsilateral cavernous sinus with coils or other embolic material, or by implanting a covered stent in the fistula area. The choice of a method for CCF treatment remains relevant. The paper describes a clinical case of successful endovascular treatment for post-traumatic recanalized CCF in a patient with obvious ophthalmic manifestations as pulsating exophthalmos, conjunctival chemosis, and ischemic optic neuropathy of the right eye. Previously, the patient had undergone endovascular CCF embolization with coils and ICA reconstruction with flow diverting stents. Fistula embolization was performed with coils via transvenous access. In the opinion of the authors, the use of venous access in this case allowed them to perform total occlusion of the recanalized fistula and to achieve good angiographic and clinical results in the long-term period.

Open surgical reconstruction of the extracranial internal carotid artery aneurysm at the base of the skull: An experience of five cases in a tertiary vascular surgery center

Aim: Aneurysms of the internal carotid artery (ICA) at the base of the skull are uncommon dangerous lesions whose management remains unclear. The aim of this retrospective study is to report the short term results of open surgical repair done in our center to formulate a standardized surgical technique of ICA reconstruction with best results. Subjects and Methods: From 2017 to 2019, totally five ICA reconstructions were performed for extracranial internal carotid artery (EICA): two male patients and three female patients (mean age, 34 years). The cause was atherosclerosis (n = 3 patients), trauma (n = 1 patient), and syndromic (associated with a complex congenital cardiac condition, n = 1 patient). The symptoms were mainly swelling and pain, in one case. Results: All patients underwent open extracranial surgical reconstruction at the skull base; interposition grafting using reverse saphenous vein graft was used in three cases, after resection of the aneurysm, and direct end to end anastomosis was employed in two cases of saccular aneurysms. The ICA was patent on the postoperative angiogram in all cases. All patients are doing well on follow-up. Conclusion: Venous graft bypass and direct ICA to ICA anastomosis for EICA can be performed safely with an open surgical approach and produces durable satisfactory results.

Internal Carotid Artery Reconstruction with a "Mega Flow Diverter": First Experience with the 6×50 mm DERIVO Embolization Device.

Endoluminal reconstruction with a flow diverter device has emerged as a viable and often preferable alternative to traditional techniques for the treatment of intracranial aneurysms. Precise measurement and device selection are mandatory steps when considering flow diverters usage in order to avoid potential complications. In this sense, incomplete wall-apposition has been described as a predictive factor for immediate in-stent and delayed thrombosis after stent use. One significant usage limitation of flow diverter devices is the parent artery diameter, since the maximum opening of the sizes available are recommended for vessel diameters between 5.2–5.75 mm. Here we present the first clinical use of the largest flow diverter available, the 6×50 mm DERIVO embolization device (Acandis GmbH & Co. KG, Pforzheim, Germany), into the arterial circulation for a cervical internal carotid artery endovascular reconstruction. This is a new device for large or fusiform aneurysms requiring flow diversion, especially located in the vertebrobasilar system or extracranial segments.

Flow-diverter Stents for Internal Carotid Artery Reconstruction Following Spontaneous Dissection: ATechnical Report.

Extracranial internal carotid artery (ICA) dissection is an important cause of ischemic stroke in younger adults. The optimal medical and surgical strategies for managing these lesions have not been well established. We report acase series of extracranial ICA reconstruction using overlapping flow-diverter stents as arescue therapy for the treatment of symptomatic ICA dissection in patients presenting with recurrent ischemic stroke and/or severe hemispheric hypoperfusion who failed medical management. Consecutive patients undergoing endovascular reconstruction of either occluded or severely narrowed ICA due to dissection and presenting with symptoms of recurrent cerebral ischemia or cerebral hypoperfusion were included. Data were collected on demographic characteristics, antiplatelet management, clinical presentation, imaging findings, treatment characteristics, complications and stroke recurrence rates. A total of 7patients were included. The mean age was 47years, 4 patients were male and 3 were female. All patients were symptomatic presenting with ipsilateral recurrent ischemia with or without cerebral hemodynamic compromise and necessitated reconstructive treatment. Patients were placed on dual antiplatelet therapy with aspirin and either ticagrelor or clopidogrel prior to the procedure. In cases where patients were not preloaded with dual antiplatelets intravenous abciximab was used as a bridging therapy. Post-stenting angioplasty was performed if deemed necessary. There were no symptomatic ischemic or hemorrhagic complications. No patients had recurrent ischemic events. Reconstruction of the ICA as arescue strategy for extracranial carotid dissection using flow-diverter stents is feasible and was performed without adverse events in this small series.

Staged curative treatment of a complex direct carotid-cavernous fistula with a large arterial defect and an 'oversized' internal carotid artery

This is a case of a high-flow, post-traumatic direct carotid-cavernous fistula with a widened arterial defect and a large-diameter internal carotid artery (ICA). The unique aspect of this case is...

SURGICAL TREATMENT OF PATIENT WITH FIBROMUSCULAR DYSPLASIA OF THE THIRD TYPE AND GIANT ANEURYSM OF EXTRACRANIAL SEGMENT OF INTERNAL CAROTID ARTERY

We present the results of a successful surgical treatment of an extremely rare disease – giant aneurysm of internal carotid artery (ICA) in patient with fibromuscular dysplasia (FMD) of type III. This case is the first experience of the surgical treatment of the patient with this pathology during 8 years of existence of the neurosurgical department of Kemerovo Cardiology Dispensary. Taking into account the anatomic features (large size of the aneurysm, expressed kinking) resection of the aneurysm with end-to-end anastomosis was chosen as a method of surgical treatment. It is concluded that surgical reconstruction of ICA with the application of end-to-end anastomosis technic without prosthetics in FMD and ICA aneurysm is the optimal therapeutic and preventive method.

Reconstruction of the Internal Carotid Artery After Treatment of Complex Traumatic Direct Carotid-Cavernous Fistulas With the Willis Covered Stent: A Retrospective Study With Long-Term Follow-up.

Endovascular treatment of complex traumatic direct carotid-cavernous fistulas (TDCCFs) is a challenge. To evaluate the long-term efficacy of the Willis covered stent in endovascular treatment of complex TDCCFs, focusing on reconstruction and preservation of the internal carotid artery. During the past 8 years, 25 patients with 27 TDCCFs who previously had unsuccessful treatment of fistulas with detachable balloons received endovascular treatment with Willis covered stents. The efficacy, complications, in-stent stenosis, angiographic, and clinical follow-up results were evaluated retrospectively between 6 and 88 months (mean, 43.8 months) after the stent placement. The technical success rate of stenting placement was 100%. Forty-four Willis covered stents were implanted into the target artery of 27 TDCCFs. Complete exclusion was achieved in 16 patients with 17 TDCCFs immediately after the stent placement, with transient endoleaks in 10 TDCCFs. Redilation was performed in 6 TDCCFs, and additional stents were implanted in the other 4 TDCCFs for endoleak exclusion. The initial angiographic results showed complete exclusion of fistulas with preservation of the internal carotid artery in 24 patients with 26 TDCCFs. One patient in whom complete occlusion initially was achieved subsequently experienced a delayed endoleak, which required placement of an additional stent. The angiographic follow-up results (mean, 30.3 months) demonstrated complete exclusion in all 27 TDCCFs, with patency of internal carotid artery in 23 patients. The clinical follow-up demonstrated a full recovery in 23 patients and improvement in 2 patients. The use of Willis covered stents was confirmed to be effective, safe, and a curative approach for endovascular treatment of complex TDCCFs and internal carotid artery reconstruction. DB, detachable balloonEVT, endovascular treatmentICA, internal carotid arteryn-BCA, N-butyl cyanoacrylateTDCCF, traumatic direct carotid-cavernous fistula.

The modern role of microsurgery in treatment of large and giant aneurysms of the internal carotid artery

Large (1.5-2.5 cm) and giant (>2.5 cm in diameter) aneurysms of the internal carotid artery (ICA) remain one of the complex neurosurgical pathologies in terms of microsurgery. In recent years, endovascular techniques for treatment of paraclinoid aneurysms, in particular ICA reconstruction using flow-diverting stents, have become a priority. However, surgery of flow stents has a number of limitations, therefore the choice of treatment in each case is individual. To analyze the results of direct surgery in patients with large and giant aneurysms of the ICA and to determine the role and place of modern microsurgical techniques in the treatment of this vascular disease. The study included 260 patients with large and giant ICA aneurysms who were operated on at the Institute using microsurgical techniques in the period between 2001 and 2015. The mean age of patients was 45.1 years. The male/female ratio was 1:2.5. One hundred sixty four (63.1%) patients were operated on after hemorrhages, of whom 15 (5.7%) patients were operated on in the acute period; 69 (26.5%) patients had a pseudotumoral course of the disease; 9 (3.5%) patients had a mixed course of the disease; aneurysms were incidentally found in 18 (6.9%) patients. The aneurysm localization was as follows: paraclinoid aneurisms in 158 (60.7%) patients, supraclinoid aneurisms in 77 (29.6%) patients, and ICA bifurcation aneurisms in 25 (9.6%) patients. Microsurgical clipping was performed in 228 (87.7%) patients, including 158 (60.7%) patients in whom an intravascular blood aspiration technique was used. Aneurysm trapping using a flowmetry probe was performed in 16 patients, with creating vascular anastomoses in 4 (1.5%) cases. In 16 (6.2%) patients, interventions were completed by gauze strengthening. We performed a comparative analysis of the results of endovascular treatment of paraclinoid aneurysms reported in recent publications and obtained in the present series. Treatment outcomes (Glasgow Outcome Scale) were favorable (Grade 4-5) in 224 (86.2%) patients and satisfactory in 29 (11.1%) patients. Two patients (0.7%) developed diencephalic (electrolyte) disturbances that were successfully corrected using replacement therapy. The mortality was 2.7% (7 patients); the treatment completeness was 94.3%. Comparison with the literature data demonstrated comparable results for both treatment techniques. Microsurgical techniques in treatment of large and giant ICA aneurysms are the methods of choice in complex non-standard cases where endovascular treatment is ineffective or contraindicated. Planning of microsurgical treatment should include the possibility of revascularization surgery. Treatment of these patients should be carried out at large dedicated centers having appropriate expertise and facilities.

The first carotid endarterectomy

The first carotid endarterectomy

Cerebral Hyperperfusion Syndrome after Endovascular Reconstruction of Carotid Artery in High-Flow Carotid-Jugular Fistula

We describe the occurrence of cerebral hyperperfusion syndrome (CHS) in a case of long-standing carotid-jugular fistula (CJF) treated by endovascular reconstruction of the carotid artery. A 43-year-old male with a high-flow CJF between the internal carotid artery (ICA) and internal jugular vein underwent endovascular reconstruction of the carotid artery using a stent graft. After treatment, the patient developed CHS. The patient succumbed to a large intracranial bleed in the left external capsule and parietal lobe on the fifth postoperative day. CHS following endovascular reconstruction of carotid artery is rare. We present the first reported case of CHS following endovascular reconstruction of ICA. A review of literature for patients treated by endovascular rerouting of blood flow to the cerebral parenchyma associated with hyperperfusion syndrome has been performed.