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Dacic N, Stosic S, Nikolic O, Jelicic ZD, Ilic AD, Radovic MN, Ostojic J. Bilateral Cerebral Hypoperfusion in Asymptomatic Unilateral Carotid Artery Stenosis: An Arterial Spin Labeling MRI Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:771. [PMID: 40428729 DOI: 10.3390/medicina61050771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2025] [Revised: 04/14/2025] [Accepted: 04/20/2025] [Indexed: 05/29/2025]
Abstract
Background and Objectives: Carotid artery stenosis is a significant risk factor for ischemic stroke due to impaired cerebral blood flow (CBF). Even asymptomatic unilateral stenosis can induce subclinical cerebrovascular changes, potentially affecting both hemispheres through collateral circulation. This study aimed to systematically assess cerebral perfusion in asymptomatic individuals with unilateral carotid artery stenosis by comparing ipsilateral and contralateral hemispheres with healthy controls, challenging the assumption that the contralateral hemisphere remains unaffected. Materials and Methods: This cross-sectional study included 114 participants, comprising 54 asymptomatic individuals (mean age 65.5) with significant unilateral carotid stenosis and 60 age-matched controls (mean age 64.8). Cerebral perfusion was assessed using 1.5T Magnetic Resonance Imaging (MRI) with pseudo-continuous arterial spin labeling (pCASL). CBF was measured bilaterally in four predefined middle cerebral artery (MCA) regions: precentral gyrus, lentiform nucleus, insular cortex, and temporal cortex. Statistical analyses included multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), paired t-tests, and discriminant analysis (DA). Results: Significant bilateral reductions in CBF were observed in individuals with carotid stenosis compared to controls (MANOVA and ANOVA, p < 0.001). The greatest perfusion deficit was in the ipsilateral insular cortex (49.88 ± 10.83 mL/100 g/min), followed by intermediate contralateral perfusion (51.49 ± 8.86 mL/100 g/min) and higher control values (58.78 ± 10.44 mL/100 g/min). DA indicated the insular cortex as the region with the highest discriminative contribution (64.7%). Conclusions: Unilateral carotid artery stenosis in asymptomatic individuals is associated with significant bilateral cerebral hypoperfusion, suggesting widespread hemodynamic effects. Pronounced perfusion deficits in the insular cortex underline its vulnerability. The observed contralateral perfusion reductions challenge the traditional use of the contralateral hemisphere as a reference standard, underscoring the need for comprehensive perfusion assessment in carotid artery disease.
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Affiliation(s)
- Nikola Dacic
- Center for Radiology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Srdjan Stosic
- Center for Radiology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Olivera Nikolic
- Center for Radiology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Zoran D Jelicic
- Department of Computing and Control, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Aleksandra Dj Ilic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Neurology Clinic, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Mirna N Radovic
- Department of Computing and Control, Faculty of Technical Sciences, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Jelena Ostojic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
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Peeters SM, Colby GP, Kim WJ, Bae WI, Sparks H, Reitz K, Tateshima S, Jahan R, Szeder V, Nour M, Duckwiler GR, Vinuela F, Martin NA, Wang AC. Proximal Internal Carotid Artery Occlusion and Extracranial-Intracranial Bypass for Treatment of Fusiform and Giant Internal Carotid Artery Aneurysms. World Neurosurg 2023; 180:e494-e505. [PMID: 37774787 DOI: 10.1016/j.wneu.2023.09.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To discuss the treatment of intracranial fusiform and giant internal carotid artery (ICA) aneurysms via revascularization based on our institutional experience. METHODS An institutional review board-approved retrospective analysis was performed of patients with unruptured fusiform and giant intracranial ICA aneurysms treated from November 1991 to May 2020. All patients were evaluated for extracranial-intracranial (EC-IC) bypass and ICA occlusion. RESULTS Thirty-eight patients were identified. Initially, patients failing preoperative balloon test occlusion were treated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and concurrent proximal ICA ligation. We then treated them with STA-MCA bypass, followed by staged balloon test occlusion, and, if they passed, endovascular ICA coil occlusion. We treat all surgical medically uncomplicated patients with double-barrel STA-MCA bypass and concurrent proximal ICA ligation. The mean length of follow-up was 99 months. Symptom stability or improvement was noted in 85% of patients. Bypass graft patency was 92.1%, and all surviving patients had patent bypasses at their last angiogram. Aneurysm occlusion was complete in 90.9% of patients completing proximal ICA ligation. Three patients experienced ischemic complications and 4 patients experienced hemorrhagic complications. CONCLUSIONS Not all fusiform intracranial ICA aneurysms require intervention, except when life-threatening rupture risk is high or symptomatic management is necessary to preserve function and quality of life. EC-IC bypass can augment the safety of proximal ICA occlusion. The rate of complete aneurysm occlusion with this treatment is 90.9%, and long-term bypass graft-related complications are rare. Perioperative stroke is a major risk, and continued evolution of treatment is required.
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Affiliation(s)
- Sophie M Peeters
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Wi Jin Kim
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Whi Inh Bae
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Hiro Sparks
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kara Reitz
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Satoshi Tateshima
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Reza Jahan
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Viktor Szeder
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - May Nour
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Gary R Duckwiler
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Fernando Vinuela
- Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Neil A Martin
- Pacific Neuroscience Institute, Santa Monica, California, USA
| | - Anthony C Wang
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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3
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Ding M, Wang X, Zhao H, Shi M, Shang Y, Wang H, Wang X, Tong X. Internal carotid artery constriction with or without superficial temporal artery-middle cerebral artery bypass for patients with giant internal carotid aneurysms. World Neurosurg 2022; 164:e662-e670. [DOI: 10.1016/j.wneu.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022]
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Tsukada T, Izumi T, Isoda H, Nishihori M, Kropp AE, Mizuno T, Wakabayashi T. Comparison of hemodynamic stress in healthy vessels after parent artery occlusion and flow diverter stent treatment for internal carotid artery aneurysm. J Neurosurg 2021; 136:619-626. [PMID: 34416714 DOI: 10.3171/2021.2.jns204185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE De novo aneurysms generally develop in healthy vessels after parent artery occlusion for large internal carotid artery (ICA) aneurysm, possibly owing to increased hemodynamic stress in the remaining vessels. In recent years, there has been a shift toward flow diverter stent treatment. However, there is a lack of direct evidence and data that prove this change in hemodynamic stress in healthy vessels after parent artery occlusion and flow diverter stent treatment. The authors compared hemodynamic stress in healthy-side vessels before and after parent artery occlusion and flow diverter treatments. METHODS The authors included patients who underwent 3D cine phase-contrast MRI before and after large ICA aneurysm treatment. Spatially and temporally averaged volume flow rates and spatially averaged systolic wall shear stress (WSS) in healthy-side ICA distal to the posterior communicating artery (C1 segment according to Fisher's classification) were measured before and after parent artery occlusion and flow diverter treatments. RESULTS Seventeen patients were included (5 patients in the parent artery occlusion group and 12 in the flow diverter group). At 1-2 months after treatment, median volume flow rate in healthy-side ICA increased from 5.36 ml/sec to 6.28 ml/sec (total increase 117%, p = 0.04) in the parent artery occlusion group and from 4.65 ml/sec to 4.93 ml/sec (total increase 106%, p = 0.02) in the flow diverter group. In the parent artery occlusion group, median WSS in the C1 segment of the healthy-side ICA increased from 3.91 Pa to 5.61 Pa (total increase 143%, p = 0.08); however, no significant increase was observed in the flow diverter group (4.29 Pa to 4.57 Pa [total increase 107%, p = 0.21]). CONCLUSIONS Postoperatively, volume flow rate and WSS in the C1 segment of the healthy-side ICA significantly increased in the parent artery occlusion group. Therefore, the parent artery occlusion group was more prone to de novo aneurysm than the flow diverter group.
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Affiliation(s)
- Tetsuya Tsukada
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Izumi
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruo Isoda
- 2Brain & Mind Research Center, Nagoya University, Nagoya, Aichi, Japan
| | - Masahiro Nishihori
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - A Elisabeth Kropp
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Mizuno
- 3Department of Medical Technology, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Lukyanchikov VA, Orlov EA, Oganesyan MV, Gordeeva AA, Pavliv MP. [Anatomical bases of brain revascularization: choosing an extra-intracranial bypass option]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:120-126. [PMID: 34951769 DOI: 10.17116/neiro202185061120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Surgical brain revascularization is an important treatment for acute or chronic ischemia, intracranial aneurysms and skull base tumors. Individual anatomy of brain vessels should be clearly understood for this procedure. Variants of collateral cerebral blood flow in patients with cerebrovascular diseases depend on individual characteristics of circle of Willis and reserve mechanisms of collateral circulation. These anatomical variations require careful preoperative planning to choose the optimal revascularization option.
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Affiliation(s)
- V A Lukyanchikov
- University's Hospital of the Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
- Russian People's Friendship University, Moscow, Russia
| | - E A Orlov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M V Oganesyan
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Gordeeva
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M P Pavliv
- Sechenov First Moscow State Medical University, Moscow, Russia
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Kubo Y, Koji T, Murakami T, Yoshida K, Matsumoto Y, Ogasawara K. Long-Term Outcomes of Cerebral Blood Flow and Neurotransmitter Receptor Function on Iodine-123-Iomazenil Single-Photon Emission Computed Tomography and Cognitive Assessments After Parent Artery Occlusion Combined with Cerebral Revascularization for Internal Carotid Artery Aneurysms. World Neurosurg 2020; 143:e199-e205. [PMID: 32810631 DOI: 10.1016/j.wneu.2020.07.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many studies of external-internal carotid artery (EC-IC) bypass as cerebral revascularization for unclippable internal carotid artery (ICA) aneurysms have reported surgical outcomes, including bypass patency and aneurysm resolution. However, no previous studies have assessed the long-term outcomes of cerebral blood flow (CBF), brain neural density, and cognition. The purpose of the present study was to evaluate the long-term outcomes of CBF and neurotransmitter receptor function using early and late images of iodine-123 (123I)-iomazenil (IMZ) single-photon emission computed tomography (SPECT) and the cognitive function of patients who had undergone EC-IC bypass for symptomatic aneurysms in the cavernous portion of the ICA. METHODS We performed a prospective observational study of 11 patients who had undergone superficial temporal artery-middle cerebral artery bypass or bypass using a saphenous vein graft for symptomatic aneurysms in the cavernous portion of the ICA. One patient experienced extensive infarction and, therefore, did not undergo postoperative testing. 123I-IMZ SPECT was performed with scanning at 23 minutes (early) and 180 minutes (late) after tracer administration before and after surgery. The preoperative and follow-up neuropsychological test scores from 6 patients were also analyzed. RESULTS None of 10 patients who had undergone EC-IC bypass showed reductions in CBF and brain neural density. In addition, the neuropsychological test scores had not changed significantly from preoperatively to postoperatively. CONCLUSION Using early and late 123I-IMZ SPECT, the present study has demonstrated that patients undergoing uncomplicated cerebral revascularization for unclippable ICA aneurysms will not experience reductions in CBF or neurotransmitter receptor function, and their cognitive function was not impaired.
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Affiliation(s)
- Yoshitaka Kubo
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
| | - Takahiro Koji
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kenji Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
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Tani S, Imamura H, Asai K, Shimizu K, Adachi H, Tokunaga S, Funatsu T, Suzuki K, Adachi H, Kawabata S, Matsui Y, Sasaki N, Akiyama R, Horiuchi K, Sakai C, Sakai N. Comparison of practical methods in clinical sites for estimating cerebral blood flow during balloon test occlusion. J Neurosurg 2019; 131:1430-1436. [PMID: 30497173 DOI: 10.3171/2018.5.jns18858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/16/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to compare methods of measurement for venous phase delay (VPD) or mean stump pressure (MSTP) to rank their potential to predict ischemic tolerance during balloon test occlusion in the internal carotid artery, exploring a more correlative and convenient way to measure cerebral blood flow (CBF) that could be utilized even in the acute phase or in institutions not adequately equipped to measure CBF during the test. METHODS X-ray angiography perfusion analysis using diagnostic digital subtraction angiography (DSA) equipment enables 1-step examination (without any room-to-room transfer of patients) to measure CBF, VPD, and MSTP completely simultaneously, which has not been accomplished by any previous perfusion studies. RESULTS This analysis was applied to 17 patients and resulted in successful estimation of all 3 parameters in each case. The average VPD of several cortical veins had a strong correlation with relative CBF (rCBF) between bilateral hemispheres with a correlation coefficient of 0.89443, a correlation as strong as that (0.90357) of the "approximate VPD," which is interpreted based on the trend line of the scatterplot of the time to peak contrast opacification in cortical veins and their spatial positioning from the median sagittal plane. MSTP and classic visual determination of VPD have weaker correlation coefficients with rCBF (0.56119 and 0.70048, respectively). Overall, subjective visual determination in combination with the calculation of the trend line to estimate VPD provided a considerably strong correlation with rCBF (R = 0.86660) without any dedicated software or hardware. CONCLUSIONS VPD has a stronger correlation with rCBF than MSTP. rCBF could be successfully predicted on common DSA equipment, even by visual determination without expensive software, if the trend line is adopted for processing to estimate VPD.
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Affiliation(s)
- Shoichi Tani
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Hirotoshi Imamura
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Katsunori Asai
- 2Department of Neurosurgery, Osaka International Cancer Institute, Osaka
| | - Kampei Shimizu
- 3Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and
| | - Hidemitsu Adachi
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - So Tokunaga
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Takayuki Funatsu
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Keita Suzuki
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Hiromasa Adachi
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Shuhei Kawabata
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Yuichi Matsui
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Natsuhi Sasaki
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Ryo Akiyama
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Kazufumi Horiuchi
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
| | - Chiaki Sakai
- 4Department of Neurosurgery, Hyogo College of Medicine College Hospital, Hyogo, Japan
| | - Nobuyuki Sakai
- 1Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe
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Kovilapu UB, Rastogi V, Sinha V, Thalaru S. Definitive management of ruptured cavernous internal carotid artery aneurysm. Med J Armed Forces India 2017; 73:203-206. [DOI: 10.1016/j.mjafi.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 08/17/2016] [Indexed: 10/20/2022] Open
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Ibrahim TF, Jahromi BR, Miettinen J, Raj R, Andrade-Barazarte H, Goehre F, Kivisaari R, Lehto H, Hernesniemi J. Long-Term Causes of Death and Excess Mortality After Carotid Artery Ligation. World Neurosurg 2016; 90:116-122. [DOI: 10.1016/j.wneu.2016.01.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 01/22/2023]
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Václavů L, van der Land V, Heijtel DFR, van Osch MJP, Cnossen MH, Majoie CBLM, Bush A, Wood JC, Fijnvandraat KJ, Mutsaerts HJMM, Nederveen AJ. In Vivo T1 of Blood Measurements in Children with Sickle Cell Disease Improve Cerebral Blood Flow Quantification from Arterial Spin-Labeling MRI. AJNR Am J Neuroradiol 2016; 37:1727-32. [PMID: 27231223 DOI: 10.3174/ajnr.a4793] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Children with sickle cell disease have low hematocrit and elevated CBF, the latter of which can be assessed with arterial spin-labeling MR imaging. Quantitative CBF values are obtained by using an estimation of the longitudinal relaxation time of blood (T1blood). Because T1blood depends on hematocrit in healthy individuals, we investigated the importance of measuring T1blood in vivo with MR imaging versus calculating it from hematocrit or assuming an adult fixed value recommended by the literature, hypothesizing that measured T1blood would be the most suited for CBF quantification in children with sickle cell disease. MATERIALS AND METHODS Four approaches for T1blood estimation were investigated in 39 patients with sickle cell disease and subsequently used in the CBF quantification from arterial spin-labeling MR imaging. First, we used 1650 ms as recommended by the literature (T1blood-fixed); second, T1blood calculated from hematocrit measured in patients (T1blood-hematocrit); third, T1blood measured in vivo with a Look-Locker MR imaging sequence (T1blood-measured); and finally, a mean value from T1blood measured in this study in children with sickle cell disease (T1blood-sickle cell disease). Quantitative flow measurements acquired with phase-contrast MR imaging served as reference values for CBF. RESULTS T1blood-measured (1818 ± 107 ms) was higher than the literature recommended value of 1650 ms, was significantly lower than T1blood-hematocrit (2058 ± 123 ms, P < .001), and, most interesting, did not correlate with hematocrit measurements. Use of either T1blood-measured or T1blood-sickle cell disease provided the best agreement on CBF between arterial-spin labeling and phase-contrast MR imaging reference values. CONCLUSIONS This work advocates the use of patient-specific measured T1blood or a standardized value (1818 ms) in the quantification of CBF from arterial spin-labeling in children with SCD.
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Affiliation(s)
- L Václavů
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
| | - V van der Land
- Department of Pediatric Hematology (V.v.d.L., K.J.F.), Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - D F R Heijtel
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
| | - M J P van Osch
- C.J. Gorter Center for High Field MRI (M.J.P.v.O.), Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M H Cnossen
- Department of Pediatric Hematology (M.H.C.), Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - C B L M Majoie
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
| | - A Bush
- Department of Biomedical Engineering (A.B.), Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - J C Wood
- Department of Pediatrics (J.C.W.), Children's Hospital Los Angeles, Los Angeles, California
| | - K J Fijnvandraat
- Department of Pediatric Hematology (V.v.d.L., K.J.F.), Emma Children's Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | - H J M M Mutsaerts
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands Sunnybrook Research Institute (H.J.M.M.M.), Toronto, Ontario, Canada
| | - A J Nederveen
- From the Department of Radiology (L.V., D.F.R.H., C.B.L.M.M., H.J.M.M.M., A.J.N.), Academic Medical Center, Amsterdam, the Netherlands
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Bechan RS, Majoie CB, Sprengers ME, Peluso JP, Sluzewski M, van Rooij WJ. Therapeutic Internal Carotid Artery Occlusion for Large and Giant Aneurysms: A Single Center Cohort of 146 Patients. AJNR Am J Neuroradiol 2016; 37:125-9. [PMID: 26294643 DOI: 10.3174/ajnr.a4487] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/08/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE At our institution, patients with large or giant ICA aneurysms are preferably treated with endovascular ICA balloon occlusion. Alternative treatment or conservative treatment is offered only for patients who cannot tolerate permanent ICA occlusion. In this observational study, we report the clinical and imaging results of ICA occlusion for aneurysms in a large single-center patient cohort. MATERIALS AND METHODS Between January 1995 and January 2015, occlusion of the ICA was considered in 146 patients with large or giant ICA aneurysms. Ninety-six patients (66%) passed the angiographic test occlusion, and, in 88 of these 96 patients (92%), the ICA was permanently occluded. In 11 of 88 patients with angiographic tolerance, ICA occlusion was performed with the patient under general anesthesia without clinical testing. RESULTS There was 1 hypoperfusion infarction after hypovolemic shock from a large retroperitoneal hematoma (complication rate 1.1% [95% CI, 1%-6.8%]). The mean imaging and clinical follow-up was 35 months (median 18 months; range, 3-180 months). On the latest MR imaging, 87 of 88 aneurysms (99%) were completely occluded and 61 of 80 aneurysms (76%) were decreased in size or completely obliterated. Of 62 patients who presented with cranial nerve dysfunction by mass effect of the aneurysm, 30 (48%) were cured, 25 (40%) improved, 6 (10%) were unchanged, and 1 patient (2%) was hemiplegic after a complication. CONCLUSIONS ICA occlusion for large and giant aneurysms after angiographic test occlusion was safe and effective. Two-thirds of eligible patients passed the angiographic test. Most aneurysms shrunk, and most cranial nerve dysfunctions were cured or improved.
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Affiliation(s)
- R S Bechan
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - C B Majoie
- Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands
| | - M E Sprengers
- Academisch Medisch Centrum (C.B.M., M.E.S.), Amsterdam, the Netherlands
| | - J P Peluso
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - M Sluzewski
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
| | - W J van Rooij
- From Sint Elisabeth Ziekenhuis (R.S.B., J.P.P., M.S., W.J.v.R.), Tilburg, the Netherlands
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Asai K, Imamura H, Mineharu Y, Tani S, Adachi H, Narumi O, Sato S, Sakai C, Sakai N. X-ray Angiography Perfusion Analysis for the Balloon Occlusion Test of the Internal Carotid Artery. J Stroke Cerebrovasc Dis 2015; 24:1506-12. [PMID: 25873471 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/13/2015] [Accepted: 03/12/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A perfusion study should be performed during the balloon occlusion test (BOT) to prevent ischemic events after therapeutic carotid occlusion. We evaluated the efficacy of X-ray angiography perfusion analysis during the BOT. METHODS Twenty-one consecutive patients who underwent the BOT of the internal carotid artery were included. Patients who had a venous phase delay of less than .5 seconds and a mean stump pressure of more than 50 mm Hg without any neurologic symptoms were considered tolerant, and other patients were considered intolerant. A time-density curve was constructed for each hemisphere using X-ray angiography perfusion software (2D-Perfusion). The mean transit time and area under the curve, which correspond to cerebral blood volume, were calculated from the curve. Differences in these parameters between the occluded and nonoccluded hemispheres and the perfusion index were compared between the tolerant and intolerant groups. RESULTS In the intolerant group, the mean transit time was significantly longer (1.31 ± .72 seconds versus .44 ± .21 seconds, P = .001) and the perfusion index was significantly lower (.72 ± .16 versus .94 ± .08, P = .001) compared with those in the tolerant group. The area under the curve was not different between the groups. CONCLUSIONS Parameters obtained by X-ray angiography perfusion analysis were significantly different between the tolerant and intolerant groups. The X-ray angiography perfusion analysis could be a safe and effective method for assessing ischemic tolerance before therapeutic carotid occlusion.
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Affiliation(s)
- Katsunori Asai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan.
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yohei Mineharu
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Shoichi Tani
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidemitsu Adachi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Osamu Narumi
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shinsuke Sato
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chiaki Sakai
- Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan; Division of Neuroendovascular Therapy, Institute of Biomedical Research and Innovation, Kobe, Japan
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Tansavatdi K, Dublin AB, Donald PJ, Dahlin B. Combined Balloon Test Occlusion and SPECT Analysis for Carotid Sacrifice: Angiographic Predictors for Success or Failure? J Neurol Surg B Skull Base 2015. [PMID: 26225310 DOI: 10.1055/s-0035-1547363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objectives To evaluate angiographic patterns that may predict the success or failure of carotid artery balloon test occlusion (BTO) and single-photon emission computed tomography (SPECT) analysis for carotid sacrifice. Study Design This is a retrospective nonrandomized study. Study Setting Conducted at the University of California Davis Medical Center, Sacramento, California. Patients A total of 31 patients, ranging from 24 to 83 years of age, with a mean age of 61 years (22 men, 9 women) with head and neck cancer (26 patients), malignant glomus tumor (1 patient) or giant carotid aneurysms (4 patients) as possible candidates for surgical carotid artery sacrifice were evaluated from September 2005 to September 2012. Methods All patients underwent unilateral internal carotid artery balloon test occlusion with SPECT analysis (20 mCi technetium 99m-hexamethyl propyleneamine oxime [HMPAO]) imaging before and during carotid occlusion. Carotid angiography with carotid cross-compression (manual compression of the cervical artery contralateral to the side of contrast injection) was used to analyze filling through the anterior communicating artery to the contralateral hemisphere. Intervention The balloon occlusion was terminated in two patients because of deterioration of the neurologic exam. Main Outcome Measures All patients who passed the neurologic examination during BTO and also passed the SPECT occlusive study underwent successful carotid sacrifice without neurologic sequelae. Patients failing the occlusive neurologic examination and/or the SPECT study elected chemoradiation, with the exception of one patient who underwent a successful carotid bypass graft and carotid resection. Results The success of carotid sacrifice in patients passing both the occlusive test and the SPECT analysis for carotid sacrifice was 100%. Three patients failed both the BTO and the SPECT, with two demonstrating no anterior circulation cross-fill, but one showed some cross-fill. Six additional patients passed the BTO but failed the SPECT, with poor cross-fill in five patients. In addition, three patients who had excellent cross-fill through the anterior communicating artery to the contralateral hemisphere failed the SPECT examination in two cases and failed both tests in another case.
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Affiliation(s)
| | - Arthur B Dublin
- Section of Neuroradiology, Department of Radiology, University of California Davis Medical Center, Sacramento, California, United States
| | - Paul J Donald
- Department of Otolaryngology, University of California Davis Medical Center, Sacramento, California, United States
| | - Brian Dahlin
- Section of Neuroradiology, Department of Radiology, University of California Davis Medical Center, Sacramento, California, United States
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Nakajima N, Nagahiro S, Satomi J, Tada Y, Nakajima K, Sogabe S, Hanaoka M, Matsubara S, Uno M, Satoh K. Prevention of Retrograde Blood Flow Into Large or Giant Internal Carotid Artery Aneurysms by Endovascular Coil Embolization with High-Flow Bypass: Surgical Technique and Long-Term Results. World Neurosurg 2015; 83:1127-34. [PMID: 25681599 DOI: 10.1016/j.wneu.2015.01.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 12/10/2014] [Accepted: 01/19/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recanalization has been reported in large or giant aneurysms of the internal carotid artery (ICA) addressed by high-flow bypass and endovascular treatment. Aneurysmal recanalization may be attributable to retrograde blood flow into the aneurysm through the ICA branches, such as the ophthalmic artery or the meningohypophyseal trunk, or through the surgically created bypass. We modified the endovascular treatment of aneurysms to prevent retrograde flow and evaluated the long-term efficacy of our method. METHODS We used a hybrid operative/endovascular technique to treat 5 patients with large or giant aneurysms arising from the C2-C4 segment of the ICA who presented with visual symptoms due to the mass effect of the aneurysm. To prevent retrograde flow into the aneurysm our modified endovascular treatment involves coil embolization of the aneurysmal orifice and the ICA, including the origin of the ophthalmic artery and meningohypophyseal trunk, and placement of a high-flow bypass using a radial artery graft. RESULTS During the 5- to 12-year follow-up period, 4 aneurysms disappeared, and the other decreased in size. There were no subarachnoid hemorrhages. All bypass grafts remained patent. Visual preservation was achieved in 2 patients; 1 patient manifested visual improvement. Although 2 patients experienced transient neurological deficits we encountered no permanent complications in this series. The final modified Rankin scale of the 5 patients was 0 or 1. CONCLUSIONS Prevention of retrograde flow into the aneurysm by coil embolization with high-flow bypass is a safe and effective method. It prevents the recanalization of large or giant ICA aneurysms.
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Affiliation(s)
- Norio Nakajima
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
| | - Junichiro Satomi
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Kohei Nakajima
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Mami Hanaoka
- Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan
| | - Shunji Matsubara
- Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
| | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan
| | - Koichi Satoh
- Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima, Japan
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15
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Labeyrie MA, Lenck S, Bresson D, Desilles JP, Bisdorff A, Saint-Maurice JP, Houdart E. Parent artery occlusion in large, giant, or fusiform aneurysms of the carotid siphon: clinical and imaging results. AJNR Am J Neuroradiol 2015; 36:140-5. [PMID: 25082818 DOI: 10.3174/ajnr.a4064] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Parent artery occlusion has long been considered the reference treatment for large/giant or fusiform aneurysms of the carotid siphon. However, meager recent data exist on this technique, which tends to be replaced by stent-assisted reconstructive techniques. In our department since 2004, we have assessed the safety, efficacy, and complication risk factors of parent artery occlusion by using coils for trapping these aneurysms. MATERIALS AND METHODS We determined retrospectively the complication rate, factors associated with the occurrence of an ischemic event, changes in symptoms of mass effect, evolution of the aneurysmal size, and the growth of an additional aneurysm after treatment. RESULTS Fifty-six consecutive patients were included, with a median age of 54 years (range, 25-85 years; 92% women), 48% with giant aneurysms and 75% with infraclinoid aneurysms. There was a permanent morbidity rate of 5% exclusively due to ischemia, a zero mortality rate, an aneurysmal retraction rate of 91%, and an improvement rate for pain of 98% and for cranial nerve palsy of 72%, with a median follow-up of >3 years. Para-/supraclinoid topography of the aneurysm (P = .043) and the presence of cardiovascular risk factors (P = .024) were associated with an excessive risk of an ischemic event, whereas the presence of a mural thrombus had a protective role (P = .033). CONCLUSIONS In this study, parent artery occlusion by using coils to treat large/giant or fusiform aneurysms of the carotid siphon was safe and effective, especially for giant infraclinoid aneurysms. According to recent meta-analyses, these results suggest that the validation of stent-assisted reconstructive treatments for these aneurysms requires controlled studies with parent occlusion artery.
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Affiliation(s)
- M-A Labeyrie
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - S Lenck
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - D Bresson
- Neurosurgery (D.B.), Université Paris Diderot, Pôle Neurosensoriel, Lariboisière Hospital, Paris, France
| | - J-P Desilles
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - A Bisdorff
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - J-P Saint-Maurice
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
| | - E Houdart
- From the Departments of Interventional Neuroradiology (M.-A.L., S.L., J.-P.D., A.B., J.-P.S.-M., E.H.)
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Alaraj A, Wallace A, Dashti R, Patel P, Aletich V. Balloons in endovascular neurosurgery: history and current applications. Neurosurgery 2014; 74 Suppl 1:S163-90. [PMID: 24402485 DOI: 10.1227/neu.0000000000000220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand. In this article, we review the history of balloons, the initial applications, the types of balloons available, and the current applications available for endovascular neurosurgeons.
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Affiliation(s)
- Ali Alaraj
- Department of Neurosurgery, College of Medicine, University of Illinois at Chicago. Chicago, Illinois
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Sorteberg A. Balloon occlusion tests and therapeutic vessel occlusions revisited: when, when not, and how. AJNR Am J Neuroradiol 2014; 35:862-5. [PMID: 24457824 DOI: 10.3174/ajnr.a3852] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A Sorteberg
- Department of Neurosurgery Oslo University Hospital The National Hospital-Rikshospitalet Oslo, Norway
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Ambekar S, Madhugiri V, Sharma M, Cuellar H, Nanda A. Evolution of management strategies for cavernous carotid aneurysms: a review. World Neurosurg 2014; 82:1077-85. [PMID: 24690538 DOI: 10.1016/j.wneu.2014.03.042] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cavernous carotid aneurysms are considered benign lesions with indolent natural history. Apart from idiopathic aneurysms, traumatic, iatrogenic, and mycotic aneurysms are common in the cavernous segment of the carotid artery. With rapid advances in endovascular therapy, management of cavernous carotid aneurysms has evolved. Our aim was to review the management options available for cavernous carotid aneurysms. METHODS The English literature was searched for various studies describing the management of cavernous carotid aneurysms and the evolution of various treatments was studied. RESULTS Numerous treatment options are available such as conservative management, Hunterian ligation, surgical clipping, and endovascular therapy. The introduction of flow-diverting stents has revolutionized the management of these lesions. The evolution of various treatment strategies are described. CONCLUSIONS A thorough knowledge of all the options is paramount to individualize therapy. We discuss the indications of treatment, various management options for cavernous carotid aneurysms and their outcomes.
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Affiliation(s)
- Sudheer Ambekar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Venkatesh Madhugiri
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puduchery, India
| | - Mayur Sharma
- Center of Neuromodulation, Wexner Medical center, The Ohio State University, Columbus, Ohio, USA
| | - Hugo Cuellar
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
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Rashad S, Hassan T, Aziz W, Marei A. Carotid artery occlusion for the treatment of symptomatic giant carotid aneurysms: a proposal of classification and surgical protocol. Neurosurg Rev 2014. [PMID: 24578099 DOI: 10.1007/s10143-014-0533-y.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Giant intracranial aneurysms are rare disorders that represent only 5% of all intracranial aneurysms; they have a wide variety of presentations including rupture, embolic effects, and mass effect symptoms that can mislead the diagnosis to tumors rather than aneurysms. Their treatment is difficult and carries higher morbidity and mortality than usual aneurysms due to their complex nature. This study involved retrospective analysis of data of 28 patients, managed between 2006 and 2012, suffering from giant internal carotid artery (ICA) aneurysms with various presenting symptoms, none of which was hemorrhage. They were all evaluated by BOT prior to any intervention; they were subjected to various treatment strategies including selective coiling, parent artery occlusion with or without bypass, aneurysm trapping with or without bypass, and patients were followed for a period ranging from 6 months to 5 years. Out of 26 patients with giant aneurysms with mass effects, 16 patients showed full recovery (61.5 %), 5 showed partial improvement (19.2 %), and 5 showed no change in mass effect symptoms (19.2 %). One patient died (3.5 %). Symptoms such as TIA or epistaxis showed complete recovery. This study shows that a well-designed protocol aiming at parent artery sacrifice will yield good to excellent results in managing ICA giant aneurysms, and it also shows that parent artery sacrifice is superior to other forms of treatment of these lesions regarding recurrence rates, morbidity, and mortality.
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Affiliation(s)
- Sherif Rashad
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
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Rashad S, Hassan T, Aziz W, Marei A. Carotid artery occlusion for the treatment of symptomatic giant carotid aneurysms: a proposal of classification and surgical protocol. Neurosurg Rev 2014; 37:501-11; discussion 511. [PMID: 24578099 DOI: 10.1007/s10143-014-0533-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 12/06/2013] [Accepted: 01/19/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Sherif Rashad
- Department of Neurosurgery, Alexandria University School of Medicine, Alexandria, Egypt
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Kim BC, Kwon OK, Oh CW, Bang JS, Hwang G, Jin SC, Park H. Endovascular internal carotid artery trapping for ruptured blood blister-like aneurysms: long-term results from a single centre. Neuroradiology 2014; 56:211-7. [PMID: 24430115 DOI: 10.1007/s00234-014-1317-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/02/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Endovascular internal carotid artery (ICA) trapping was performed to treat ruptured blood blister-like aneurysms (BBAs). The aim of this study was to evaluate the procedural risks and long-term follow-up results. METHODS The records of 11 consecutive patients with BBAs who underwent endovascular ICA trapping between 2005 and 2010 were reviewed. Clinical outcomes were assessed with modified Rankin Scale (mRS) scores. RESULTS Endovascular ICA trapping was performed in 11 patients as either the primary treatment (7 patients) or the secondary treatment (4 patients) after the patient underwent other treatments. Three patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass when balloon test occlusion (BTO) revealed inadequate collateral circulation. In the primary ICA trapping group (seven patients), six patients had good outcomes (mRS 0 in five, mRS 1 in one), and one patient had a poor outcome (mRS 6: dead). In the secondary ICA trapping group (four patients), two patients had good outcomes (mRS 0), and two patients had poor outcomes (mRS 4, 5). All ten of the surviving patients were clinically stable during the follow-up period (mean 39 months). A radiological follow-up of nine patients (mean 22 months) demonstrated stable occlusion, with the exception of one reopening of the ICA because of coil migration. Perfusion studies of nine patients (mean: 23 months) demonstrated no perfusion decrease. CONCLUSION Endovascular ICA trapping is an effective and durable treatment for BBAs.
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Affiliation(s)
- Byong-Cheol Kim
- Department of Neurosurgery, Dongguk University Ilsan Hospital, Goyang, South Korea
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Universal extracranial-intracranial graft bypass for large or giant internal carotid aneurysms: techniques and results in 38 consecutive patients. World Neurosurg 2013; 82:130-9. [PMID: 23454690 DOI: 10.1016/j.wneu.2013.02.063] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 02/06/2013] [Accepted: 02/13/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To present indications, surgical techniques, and outcomes of extracranial-intracranial (EC-IC) graft bypass. METHODS Between January 1996 and June 2011, 38 patients with large or giant internal carotid artery (ICA) aneurysms were treated using graft bypass, employing the radial artery (RA) or the saphenous vein (SV) as a graft. Preoperative balloon test occlusions were not performed in any of the cases. In 17 patients, the external carotid artery (ECA)-RA-M2 segment of the middle cerebral artery bypass was used for treatment, and ECA-SV-M2 bypass was used in 21 patients. RESULTS All aneurysms were completely trapped, and there were no subarachnoid hemorrhages or recanalizations of aneurysms during the follow-up period (8-170 months). Of the 38 bypasses, 36 (94.7%) remained patent, and there were no permanent neurologic deficits. Hyperperfusion syndrome was not experienced in this series. There were 2 temporary neurologic deficits. In 1 case using the RA, graft vasospasm occurred, and kinking occurred in 1 case using the SV. Another patient with a SV graft had to undergo an emergent revision of the graft 8 hours after the initial operation. One patient with a SV graft underwent a second operation to control an epidural abscess. CONCLUSIONS Universal EC-IC graft bypass is a safe and effective method for treating large or giant ICA aneurysms.
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van Rooij WJ, Sluzewski M, van der Laak C. Flow diverters for unruptured internal carotid artery aneurysms: dangerous and not yet an alternative for conventional endovascular techniques. AJNR Am J Neuroradiol 2012; 34:3-4. [PMID: 22918425 DOI: 10.3174/ajnr.a3317] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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van Ooij P, Zwanenburg JJM, Visser F, Majoie CB, vanBavel E, Hendrikse J, Nederveen AJ. Quantification and visualization of flow in the Circle of Willis: Time-resolved three-dimensional phase contrast MRI at 7 T compared with 3 T. Magn Reson Med 2012; 69:868-76. [DOI: 10.1002/mrm.24317] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/01/2012] [Accepted: 04/09/2012] [Indexed: 11/09/2022]
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