Large Internal Carotid Artery Aneurysms Research Articles

Post-surgical Swallowing Rehabilitation Combined with Electric Stimulation to Treat Persistent Dysphagia Arising from a Large Internal Carotid Artery Aneurysm

In this report, we describe the case of a 99-year-old woman who presented with a large extracranial internal carotid artery aneurysm (ICAA) in the left submandibular area, which manifested as progressive dysphagia. The patient underwent aneurysmectomy and reconstruction of the left internal carotid artery and left common carotid artery to the internal/external carotid artery via bypass grafting. However, persistent dysphagia remained after surgery. A therapeutic strategy was employed, combining swallowing training with transcutaneous neuromuscular electric stimulation of the swallowing muscles. The patient’s dysphagia was gradually alleviated, and she was eventually able to eat normally and continue with previous daily activities. This case study demonstrates the efficacy of this therapeutic strategy in combating persistent dysphagia arising from a giant ICAA-a finding relevant to the clinical management of patients with this disease presentation.

P-004 Radiation Dose Analysis of Large and Giant Internal Carotid Artery Aneurysm Treatment with the Pipeline Embolization Device versus Traditional Coiling Techniques

BackgroundFlow diversion is an effective and increasingly accepted method for endovascular treatment of cerebral aneurysms. Additionally, the public has heightened concerns regarding radiation exposure from medical procedures. This study analyzes...

Combination of coils and Onyx 18 for treatment of large sidewall aneurysms of internal carotid artery

Objective To investigate the safety of combination of coils and Onyx 18 for the treatment of large sidewall aneurysms of internal carotid artery.Methods Ten patients with ten large sidewall aneurysms of intemal carotid artery were treated with combination of coils and Onyx 18,and the clinical data were recorded.The immediate occlusion of aneurysms,complications and outcomes were reviewed.Results Seven aneurysms were completely occluded.Two aneurysms with neck remnants and one with dome remnant were shown at the immediate angiography.Two patients had transient neurological deficits.All of the patients were followed-up with 16 months of median duration.Good outcomes were achieved in all the patients without neurological deficits.Eight patients received DSA examination during the follow-up period.One aneurysm was recanalization,and one remained stable.There was no recanalization in five aneurysms,but one patient had the occluded parent artery.Conclusions Combination of coils and Onyx 18 could be used for the treatment of large sidewall aneurysms of internal carotid artery. Key words: Large internal carotid artery aneurysm; Sidewall aneurysm; Combined embolization ; Onyx18

A novel flow-diverting device (Tubridge) for the treatment of 28 large or giant intracranial aneurysms: a single-center experience.

The Tubridge flow diverter is a novel device developed in China and aimed at reconstructing the parent artery and occluding the aneurysm. We conducted this study to evaluate its feasibility, safety, and efficacy for the treatment of large or giant internal carotid artery aneurysms, which are still challenging with conventional therapy. The clinical and angiographic data of 28 patients with 28 large or giant internal carotid artery aneurysms treated with Tubridge flow diverters were prospectively collected and analyzed. Thirty-three Tubridge flow diverters were successfully implanted except for 1 poor midstent opening; the result was a technical success rate of 97.0% (32/33). Follow-up angiographies were available for 25 aneurysms; the mean follow-up was 9.9 months (5-24 months). Of the 25 aneurysms, 18 (72.0%) were completely occluded, 6 (24.0%) were improved, and 1 (4.0%) was unchanged. All of the visible covered branches and parent arteries were patent, with no stenosis or obliteration. During a follow-up of 6-30 months (mean, 19 months), symptoms were resolved in 13 patients, improved in 6 patients, and unchanged in 4 patients. Five patients experienced transient clinical deterioration due to a postoperative increased mass effect. Procedure-related morbidity and mortality were both zero. Our preliminary experience shows that the Tubridge flow diverter is a safe and effective tool for treating large and giant internal carotid artery aneurysms. However, multicenter randomized trials and studies involving a long-term follow-up are necessary.

Radiation dose analysis of large and giant internal carotid artery aneurysm treatment with the pipeline embolization device versus traditional coiling techniques

BackgroundFlow diversion is an effective and increasingly accepted method for endovascular treatment of cerebral aneurysms. Additionally, the public has heightened concerns regarding radiation exposure from medical procedures. This study analyzes...

海綿静脈洞部大型・巨大内頚動脈瘤に対する頭蓋外内バイパス術とそのピットフォール

Our treatment modalities and techniques for intracavernous large or giant internal carotid artery (ICA) aneurysms have been changed based on past clinical experience. We report clinical results and pitfalls of bypass surgery for intracavernous ICA aneurysms. This study included unruptured symptomatic 37 intracavernous ICA aneurysms in 36 patients. Treatment methods were selected based on the anatomical features of the aneurysm and neurological/hemodynamic conditions during balloon test occlusion (BTO). Eleven aneurysms were treated without bypass surgery. Low flow bypass (STA-MCA anastomosis) was performed for 18 aneurysms, and eight aneurysms were treated with high flow bypass. A saphenous vein graft was originally used for high flow bypass, but it was changed with a radial artery because of the problem of long-term patency. ICA occlusion was accomplished by ligation of the cervical ICA alone in the early cases until we encountered a case with brain infarction due to emboli from the aneurysm after ICA ligation. Accordingly, ICA occlusion was performed by endovascular internal trapping two days after bypass surgery. There was, however, a case of graft thrombosis before ICA occlusion. We now occlude ICA by surgical trapping between the neck and the intracranial ICA immediately after revascularization. No patients had permanent ischemic neurological deficits due to cerebral hypoperfusion after ICA occlusion. Our treatment algorithm based on BTO was reliable. When the patients undergo bypass surgery, we perform ICA occlusion by surgical trapping between the neck and the intracranial portion.

Large and tortuous – internal carotid artery aneurysm: endovascular repair

Extracranial internal carotid artery (ICA) aneurysms are a rare entity. There are very few cases reported in the world literature and most of these have been managed by open surgical techniques, which is the gold standard. Endovascular repair of these aneurysms is now an emerging reality in the modern world. We describe our experience of endovascular repair of a large extracranial internal carotid artery aneurysm which was associated with a highly tortuous and kinked artery and was reaching upto the base of skull. We faced several intraoperative challenges which we would like to share and eventually succeeded. We are happy to report an excellent patient outcome with no morbidity and strongly recommend such techniques for the repair of these aneurysms. But more cases need to be done and more data needs to be acquired as regards long term follow up before we can conclusively state that endovascular option for such aneurysms is the preferred modality.

Repair of Large Internal Carotid Artery Aneurysm in a Patient with Neurofibromatosis Type 1

Repair of Large Internal Carotid Artery Aneurysm in a Patient with Neurofibromatosis Type 1

Pipeline for Uncoilable or Failed Aneurysms: Results from a Multicenter Clinical Trial

To evaluate the safety and effectiveness of the Pipeline Embolization Device (PED; ev3/Covidien, Irvine, Calif) in the treatment of complex intracranial aneurysms. The Pipeline for Uncoilable or Failed Aneurysms is a multicenter, prospective, interventional, single-arm trial of PED for the treatment of uncoilable or failed aneurysms of the internal carotid artery. Institutional review board approval of the HIPAA-compliant study protocol was obtained from each center. After providing informed consent, 108 patients with recently unruptured large and giant wide-necked aneurysms were enrolled in the study. The primary effectiveness endpoint was angiographic evaluation that demonstrated complete aneurysm occlusion and absence of major stenosis at 180 days. The primary safety endpoint was occurrence of major ipsilateral stroke or neurologic death at 180 days. PED placement was technically successful in 107 of 108 patients (99.1%). Mean aneurysm size was 18.2 mm; 22 aneurysms (20.4%) were giant (>25 mm). Of the 106 aneurysms, 78 met the study's primary effectiveness endpoint (73.6%; 95% posterior probability interval: 64.4%-81.0%). Six of the 107 patients in the safety cohort experienced a major ipsilateral stroke or neurologic death (5.6%; 95% posterior probability interval: 2.6%-11.7%). PED offers a reasonably safe and effective treatment of large or giant intracranial internal carotid artery aneurysms, demonstrated by high rates of complete aneurysm occlusion and low rates of adverse neurologic events; even in aneurysms failing previous alternative treatments.

The Treatment of Large and Giant Paraclinoid Internal Carotid Artery Aneurysms

Paraclinoid internal carotid artery aneurysms originate from the internal carotid artery between the distal dural ring and the posterior communicating artery. Surgical treatment of these aneurysms is technically challenging because of the surrounding neurovascular structures. There are several ways to treat these lesions: direct clipping with retrograde suction decompression, endovascular coiling, coiling with stent, and flow diverter stent. Here, I briefly review the surgical and endovascular options.

Recanalization of a large supraclinoid carotid aneurysm via elicited vertebral artery-internal carotid artery anastomosis: case report

Proximal ligation of the internal carotid artery (ICA) with high-flow bypass is one of the surgical strategies for treating large, unclippable ICA aneurysms. We encountered a rare case of recanalization of a large ICA aneurysm that disappeared after high-flow bypass surgery, and subsequently reappeared via an elicited vertebral artery (VA)-ICA anastomosis (anastomosis between the anterior meningeal artery branching from the right VA, and the ascending pharyngeal artery branching (APA) from the right ICA). To the best of our knowledge, this is the first case report describing angiographical recurrence of a large ICA aneurysm after the surgery. Periodic long-term follow-up by neuroimaging may be necessary after this surgery, particularly in cases of ICA proximal ligation with the ICA aneurysm, when the APA has not been clearly identified as a branch from the ipsilateral external carotid artery on the preoperative angiogram.

Delayed Migration of a Pipeline Embolization Device

Giant and complex aneurysms are increasingly treated with the Pipeline Embolization Device (PED). However, clinical experience with the device remains preliminary. To report the first case of a delayed migration of an intracranial PED. A 61-year-old woman with a known large right cavernous internal carotid artery aneurysm had a 3-month history of increasing retro-orbital pain. She underwent uneventful treatment of her aneurysm with the PED. Five months after the procedure, the patient's pain recurred. On the routine 6-month follow-up angiography, there was proximal PED migration, with the distal end of the device projecting directly into the aneurysm and creating a jet of contrast against the aneurysm sac. The migration distance was more than 1 cm, and there was significant foreshortening of the device. A second, overlapping PED was successfully deployed within the first PED to bridge the neck of the aneurysm and redirect the flow jet away from the aneurysm sac. Complete resolution of the patient's symptoms was noted 4 weeks later. Delayed proximal migration may occur after placement of a PED. Accurate stent sizing and adequate apposition to the vessel wall may minimize the occurrence of this undesirable phenomenon. If there is any concern regarding the position of the PED, early imaging follow-up may be indicated.

Large doughnut-shaped internal carotid artery aneurysm

Large doughnut-shaped internal carotid artery aneurysm

Large doughnut-shaped internal carotid artery aneurysm

Large doughnut-shaped internal carotid artery aneurysm

Contrast stasis in large and giant internal carotid artery aneurysms as a good prognostic factor for endovascular coil embolization: retrospective study

Objective:Before treatment for large and giant aneurysms, we need some of the predictors to prognose a good result. In this retrospective study, we attempted to determine criteria such as angiographic signs to identify good candidates for effective endovascular surgery.Methods:This study involved 45 patients with large or giant aneurysms treated by endovascular embolization. For angiographic study, we delivered a bolus injection of contrast medium. All aneurysms were confirmed angiographically and the morphology was defined in detail before endovascular embolization. We divided the patients into two groups based on angiographic findings. Group A (n = 16) manifested stasis of the contrast medium in the aneurysm on venous phase. Group B (n = 29) exhibited other findings. We retrospectively evaluated the relationship between stasis of the contrast medium in the aneurysm and results of endovascular embolization.Results and Discussion:There was no significant difference between the two groups with respect to the size of the aneurysm. However, the neck/dome ratio (P = 0·04) and size of the neck (P = 0·003) were significantly different between groups A and B. The morphological outcome was better in group A than group B (P = 0·03). We demonstrate that contrast stasis is a good predictor of outcome in patients with large or giant aneurysms to consider the endovascular embolization. Hemodynamic studies on large patient populations may reveal other factors predictive of a good treatment outcome.

Clipping of large and giant internal carotid artery aneurysms assisted by retrograde suction decompression

Objective To present our experience with retrograde suction decompression in clipping of large and giant internal carotid artery aneurysms and analyze its advantages and pitfalls.Methods A retrospective analysis of 26 large and giant intracranial aneurysms treated by suction decompression assisted clipping between November 2005 and February 2010 was present.The surgical techniques and the outcome of patients were reviewed.Results All aneurysms were successfully clipped, and postoperative 3D - CTA or DSA revealed no major branch occlusion or residual aneurysm.There was no surgical mortality in both giant and large aneurysm groups.Conclusions Retrograde suction decompression is a successful adjunct to clipping of large and giant internal carotid artery aneurysms. Key words: Aneurysm; Internal carotid artery; Retrograde suction decompression

Spontaneous rupture of an intra-cavernous internal carotid artery aneurysm presenting with massive epistaxis

We report a rare case of epistaxis resulting from a ruptured internal carotid artery aneurysm, and present a successful treatment method. A 72-year-old woman was admitted following recurrent massive epistaxis. There was no history of trauma or surgery. Radiographic imaging demonstrated a large internal carotid artery aneurysm. An attempt was made to occlude the aneurysm with endovascular coils. Despite this, the patient went on to have further epistaxis. Endovascular ablation of the feeding internal carotid artery led to complete resolution. This case demonstrates that spontaneous epistaxis from intra-cavernous carotid artery aneurysms can be managed using endovascular techniques. To our knowledge, we report the first use of interventional radiological techniques to assess the collateral circulation to the brain and subsequently undertake endovascular ablation of the internal carotid artery.

Unusual Delayed Hydrocephalus After Bare Platinum Coil Embolization of an Unruptured Aneurysm -Case Report-

A 69-year-old woman developed hydrocephalus after the embolization of an incidentally detected unruptured large internal carotid artery aneurysm with bare platinum coils. Endovascular embolization resulted in near-total aneurysm occlusion. She complained of mild headache 18 hours after the procedure and magnetic resonance (MR) imaging performed on the 6(th) post-treatment day revealed wall enhancement and perianeurysmal brain edema. Follow-up MR imaging showed recanalization of the aneurysm and gradual ventricular enlargement. She presented with typical symptoms of hydrocephalus including disorientation, gait disturbance, and urine incontinence at 7 months post-embolization. We removed 30 ml of cerebrospinal fluid by lumbar tap, which improved her condition without symptom recurrence for 2 months. She did not require shunt placement. Post-interventional hydrocephalus is known in patients with unruptured aneurysms embolized with bioactive second-generation coils. This case shows that hydrocephalus can occur after aneurysm embolization with bare platinum coils without intracranial hemorrhage.

Cushing's Disease Associated With Unruptured Large Internal Carotid Artery Aneurysm -Case Report-

A 40-year-old woman with Cushing's disease presented with hypertensive cerebral hemorrhage. Neuroimaging detected an unruptured large intracavernous aneurysm, which projected beyond the midline, and thin crescent-shaped adenoma along the aneurysm wall. The aneurysm was treated with endovascular tight packing with coils. Transsphenoidal adenomectomy was then safely performed. The signs of Cushing's disease were resolved, and she was discharged without deficits. The first line therapy for Cushing's disease is transsphenoidal adenomectomy. However, the therapeutic strategy and optimal timing of treatment are unclear for Cushing's disease with large intracavernous aneurysm. The present case shows that transsphenoidal surgery was safely possible with minimal invasiveness after embolization of the intracavernous aneurysm.

Intra-mural propagation of a large cavernous internal cerebral artery aneurysm after parent artery sacrifice

The mechanism of aneurysm growth after isolation from the circulation is not well known. We report a case of a woman who presented with mass effects of a large cavernous internal carotid artery (ICA) aneurysm. The parent vessel harboring the aneurysm was sacrificed but the aneurysm continued to enlarge with propagation of the disease along the vessel wall progressively extending to the middle cerebral artery (MCA) leading to ischemic stroke. This case provides imaging evidence of the role of mural inflammation in the development of certain aneurysms.