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Enriquez Marulanda A, Young M, Shutran M, Taussky P, Kicielinski K, Ogilvy CS. Acute Coiling With Delayed Flow Diversion for Posterior Communicating Segment Internal Carotid Artery Aneurysms: A Multicenter Case Series. Neurosurgery 2024; 94:729-735. [PMID: 37931125 DOI: 10.1227/neu.0000000000002720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/22/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In ruptured posterior communicating artery (PcomA) aneurysms, the protection of the aneurysm dome alone with initial subtotal coiling decreases the risk of rerupture in the acute setting but does not provide durable/definitive long-term protection against delayed rupture. Delayed flow diverter (FD) placement can be a potential alternative to definitively secure these aneurysms without increasing the risk of complications and PComA occlusion. We analyzed PComA aneurysms treated with a planned delayed FD after primary coiling and assess radiographic and clinical outcomes. METHODS We performed a retrospective study of prospectively collected data for intracranial aneurysms treated with planned FD at 2 institutions from 2013 to 2022. PComA aneurysms that underwent primary coiling and delayed FD placement were included for analysis. RESULTS There were 29 PComA aneurysms identified that were included in the analysis. Patients were mostly female (79.3%), with a median age of 60 years. The mean aneurysm maximum diameter was 7.2 mm ± (5.3). Immediate Raymond-Roy occlusion grade after primary coiling was I in 48.3%, II in 41.4%, and III in 10.3% of aneurysms. The median time from initial coiling to planned delayed FD placement was 6.3 months (3.2-18.6). A total of 21 (72.4%) aneurysms underwent follow-up radiological imaging. Complete and near-complete occlusion status was achieved in 76.2% of the evaluated aneurysms. There were no retreatments and no evidence of delayed aneurysm rupture. One case (3.5%) presented thromboembolic complications and 1 (3.5%) intracranial hemorrhagic complication after FD placement, which was associated with mortality. Most patients (90.5%) had a modified Rankin scale of ≤2 on the last follow-up. CONCLUSION Primary coiling with planned staged FD placement is effective for treating ruptured PComA aneurysms with high occlusion rates and low complications.
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Affiliation(s)
- Alejandro Enriquez Marulanda
- Neurosurgical Division, Beth Israel Deaconess Medical Center Brain Aneurysm Institute. Harvard Medical School, Boston , Massachusetts , USA
| | - Michael Young
- Neurosurgical Division, Beth Israel Deaconess Medical Center Brain Aneurysm Institute. Harvard Medical School, Boston , Massachusetts , USA
| | - Max Shutran
- Neurosurgical Division, Beth Israel Deaconess Medical Center Brain Aneurysm Institute. Harvard Medical School, Boston , Massachusetts , USA
| | - Philipp Taussky
- Neurosurgical Division, Beth Israel Deaconess Medical Center Brain Aneurysm Institute. Harvard Medical School, Boston , Massachusetts , USA
| | - Kimberly Kicielinski
- Neurosurgery Department, Medical University of South Carolina, Charleston , South Carolina , USA
| | - Christopher S Ogilvy
- Neurosurgical Division, Beth Israel Deaconess Medical Center Brain Aneurysm Institute. Harvard Medical School, Boston , Massachusetts , USA
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Yi T, Sui Y, Zheng D, Ren X, Lin X, Wu Y, Lin D, Pan Z, Zheng X, Hong G, Wu M, Zeng L, Chen W. Diagnostic Performance of Carotid Ring Sign on CT-Angiography in Internal Carotid True Occlusion. Stroke 2024; 55:1025-1031. [PMID: 38527154 DOI: 10.1161/strokeaha.123.045156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/24/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND To differentiate between pseudo occlusion (PO) and true occlusion (TO) of internal carotid artery (ICA) is important in thrombectomy treatment planning for patients with acute ischemic stroke. Although delayed contrast filling has been differentiated carotid PO from TO, its application has been limited by the implementations of multiphasic computed tomography angiography. In this study, we hypothesized that carotid ring sign, which is readily acquired from single-phasic CTA, can sufficiently differentiate carotid TO from PO. METHODS One thousand four hundred and twenty patients with anterior circulation stroke receiving endovascular therapy were consecutively recruited through a hospital- and web-based registry. Two hundred patients with nonvisualization of the proximal ICA were included in the analysis after a retrospective screening. Diagnosis of PO or TO of the cervical segment of ICA was made based on digital subtraction angiography. Diagnostic performances of carotid ring sign on arterial-phasic CTA and delayed contrast filling on multiphasic computed tomography angiography were evaluated and compared. RESULTS One-hundred twelve patients had ICA PO and 88 had TO. Carotid ring sign was more common in patients with TO (70.5% versus 6.3%; P<0.001), whereas delayed contrast filling was more common in PO (94.9% versus 7.7%; P<0.001). The sensitivity and specificity of carotid ring sign in diagnosing carotid TO were 0.70 and 0.94, respectively, whereas sensitivity and specificity of delayed contrast filling was 0.95 and 0.92 in judging carotid PO. CONCLUSIONS Carotid ring sign is a potent imaging marker in diagnosing ICA TO. Carotid ring sign could be complementary to delayed contrast filling sign in differentiating TO from PO, in particular in centers with only single-phasic CTA.
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Affiliation(s)
- Tingyu Yi
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
- Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (T.Y.)
| | - Yi Sui
- Department of Neurology, Shenyang First People's Hospital, Shenyang Medical College, China (Y.S.)
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China (Y.S.)
| | - Dinghuan Zheng
- Department of Neurology, Huian County Hospital, Quanzhou, Fujian, China (D.Z.)
| | - Xinwen Ren
- George Institute for Global Health China (X.R.)
| | - Xiaohui Lin
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Yanmin Wu
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Dinglai Lin
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Zhinan Pan
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Xiufen Zheng
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Ganji Hong
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Meihua Wu
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Lisan Zeng
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
| | - Wenhuo Chen
- Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.)
- Department of Neurology, Fujian Medical University Union Hospital, China (W.C.)
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Sun T, He Y, Han M, Li Y, Zhao P, Wu W, Li X, Wang C, Wang D. Feasibility and efficiency of a new classification based on high-resolution MRI for carotid artery pseudo-occlusion and occlusion: Hybrid revascularization pilot study. Clin Neurol Neurosurg 2024; 239:108226. [PMID: 38484603 DOI: 10.1016/j.clineuro.2024.108226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/07/2023] [Accepted: 03/02/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE Studies on changes in the distal internal carotid artery based on high resolution magnetic resonance imaging (HRMRI) are scarce. Herein, we propose a histological classification system for patients with carotid artery pseudo-occlusion or occlusion based on preoperative HRMRI, for which we evaluated the feasibility and clinical implications. MATERIALS AND METHODS From January 2017 to June 2021, 40 patients with Doppler ultrasound, CTA or MRA suggesting carotid artery occlusion were enrolled in this study. A new classification system based on HRMRI was established and subsequently verified by postoperative specimens. We recorded and analyzed patient characteristics, HRMRI data, recanalization rate, requirements of additional endovascular procedures, complications, and outcomes. RESULTS Four histological classifications (type Ⅰ-Ⅳ) were identified. According to our classification system, 20 patients (50.00%) were type I, nine (22.50%) were type II, 7 (17.50%) were type III, and four (10.00%) were type Ⅳ. The success rate of recanalization was 88.89% (32/36) in type I-III patients. Four (44.44%) type Ⅱ patients and five (71.43%) type Ⅲ patients suffered from intraoperative dissection. CONCLUSION Patients identified as types I (pseudo-occlusion) and II (thrombotic-occlusion) were able to be treated via hybrid revascularization with relatively low risk, while patients identified as type III (fibrous-occlusion) required more careful treatment. Recanalization is not suitable for patients identified as type Ⅳ. Our proposed classification system based on HRMRI data can be used as an adjunctive guide to predict the technical feasibility and success of revascularization via a hybrid technique.
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Affiliation(s)
- Tao Sun
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Yiming He
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Mengtao Han
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Yabin Li
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Peng Zhao
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Wei Wu
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250000, China
| | - Xingang Li
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China
| | - Chao Wang
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China; Department of Neurosurgery, Qilu Hospital of Shandong University Dezhou Hospital (Dezhou, China),Cheeloo Hospital of Shandong University, Jinan, Shandong 250000, China; Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, Shandong 250000, China.
| | - Donghai Wang
- Department of Neurosurgery and Shandong Key Laboratory of Brain Function Remodeling, Qilu Hospital of Shandong University, Jinan, Shandong 250000, China; Department of Neurosurgery, Qilu Hospital of Shandong University Dezhou Hospital (Dezhou, China),Cheeloo Hospital of Shandong University, Jinan, Shandong 250000, China.
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Payman AA, Pecoraro NC, Tsiang JT, Souter J, Hand R, Bechara CF, Serrone JC. Stenting for Traumatic Pseudoaneurysms of the Cervical Internal Carotid Artery: Case Report and Systematic Review. World Neurosurg 2024; 184:e603-e612. [PMID: 38336211 DOI: 10.1016/j.wneu.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The optimal stenting approach for traumatic pseudoaneurysms (PSA) of the extracranial internal carotid artery (ICA) remains underinvestigated. We present a case of a traumatic pseudoaneurysm of the extracranial ICA managed with stenting and review of prior published similar cases. METHODS The systematic review followed PRISMA-S guidelines and included studies that investigated traumatic pseudoaneurysms of the extracranial ICA managed by stent placement. Statistical analysis assessed the association between the type of injury and stent type, dual antiplatelet therapy (DAPT) duration, and clinical presentation, and the association between stent type and DAPT duration. RESULTS Our search yielded 82 publications with 135 patients with extracranial ICA PSA treated with stenting. The odds of neck hematoma presentation was 12.2 times greater for patients with penetrating rather than blunt injuries (P = 0.000002). Covered stents had 2.02 times higher odds of use for penetrating rather than blunt injuries compared to bare metal stents. (P = 0.0029). Shorter duration DAPT was seen with bare metal stents having 1.25 higher odds of DAPT duration less than one month compared to covered (P = 0.001). CONCLUSIONS In traumatic extracranial ICA pseudoaneurysms, covered stents are used more commonly for penetrating injuries compared to blunt injuries. Penetrating injuries are more strongly associated with the presentation of a hematoma compared to blunt injuries. Stent type may influence the recommended DAPT duration. Surgeons should consider these findings when selecting stent type and DAPT duration with patients presenting with traumatic extracranial ICA pseudoaneurysm.
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Affiliation(s)
- Andre A Payman
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
| | - Nathan C Pecoraro
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John T Tsiang
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Robert Hand
- Loyola University Medical Center, Maywood, Illinois, USA
| | - Carlos F Bechara
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Department of Neurological Surgery, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois, USA
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Yan R, Fang X. Anatomical localization of horizontal segment of the petrous internal carotid artery in transnasal endoscopic skull base surgery. Br J Neurosurg 2024; 38:493-497. [PMID: 33754921 DOI: 10.1080/02688697.2021.1903393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To discuss the localization of horizontal segment of petrous internal carotid artery in transnasal endoscopic skull base surgery, and to provide anatomical data for clinical surgery. METHODS The horizontal segment of the petrous internal carotid artery of 5 adult cadaveric heads were exposed by endoscopic transnasal and microscopic open approaches respectively, and the relevant data and images were measured and collected. RESULTS The medial wall of the foramen spinosum is the lateral wall of the isthmus of the eustachian tube, and the thickness of the bone is 0.5 ± 0.2 mm. The medial wall of the isthmus of the eustachian tube is the lateral wall of the posterior genu of the carotid canal and the thickness of the bone is 0.2 ± 0.1 mm. The vidian nerve originates from the anterior genu of the petrous internal carotid artery. The distance from the base of vidian nerve to the isthmus of eustachian tube is 19.2 ± 2.8 mm. CONCLUSION The foramen spinosum is the landmark of isthmus of the Eustachian tube. The isthmus of the Eustachian tube is the landmark of the posterior genu of the internal carotid artery. The line between the base of the vidian nerve and the isthmus of the Eustachian tube ioks the landmark of horizontal segment of the petrous internal carotid artery.
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Affiliation(s)
- Renchun Yan
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, WuHu, China
| | - Xinyun Fang
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, WuHu, China
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Ding Y, Meng Q. [Advances in clinical anatomy of the transnasal approaches to the parapharyngeal segment of the internal carotid artery]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:354-358. [PMID: 38563183 DOI: 10.13201/j.issn.2096-7993.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Indexed: 04/04/2024]
Abstract
The intracranial segment of the internal carotid artery located inside the skeleton structure of skull base or inside the skull has clear anatomical landmarks and fixed anatomical structure. However, the parapharyngeal segment of the internal carotid artery located outside the cranial is surrounded by soft tissues, lacks clear and recognizable anatomical landmarks and sometimes has anatomical variation, which is closely related to transnasal endoscopic surgery. Intraoperative accidental injury can lead to serious complications or even death. Currently, clinical anatomical studies related to the parapharyngeal segment of the internal carotid artery under transnasal endoscopic surgery mainly focus on its anatomical variation and anatomical landmarks. This article reviews on these two aspects in order to provide anatomical reference for surgeons to reduce surgical risks during transnasal endoscopic surgery.
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Affiliation(s)
- Yue Ding
- Health Science Center,Shenzhen University,Shenzhen,518000,China
| | - Qingguo Meng
- Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Shenzhen University,Shenzhen Second People's Hospital
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Graziani L, Bolchini M, Zavarise P, Dalla Volta G. Simultaneous bilateral intracranial-tract internal carotid artery stenting (CAS), a case report. Acta Neurol Belg 2024; 124:743-746. [PMID: 37644251 DOI: 10.1007/s13760-023-02374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Lanfroi Graziani
- Interventional Cardiology and Hemodynamics Unit, Istituto Clinico Città di Brescia, Brescia, Italy
| | - Marco Bolchini
- Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa, 11, 25121, Brescia, Italy.
- Neurology Unit, Istituto Clinico Città di Brescia, Via Bartolomeo, Gualla 15, 25128, Brescia, Italy.
| | - Paola Zavarise
- Neurology Unit, Istituto Clinico Città di Brescia, Via Bartolomeo, Gualla 15, 25128, Brescia, Italy
| | - Giorgio Dalla Volta
- Neurology Unit, Istituto Clinico Città di Brescia, Via Bartolomeo, Gualla 15, 25128, Brescia, Italy
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Dai Q, Shu L, Zhu P, Tan H, Wu T. Splice implantation of multiple drug-eluting stents for tandem severe stenosis of the internal carotid artery: A case report. Medicine (Baltimore) 2024; 103:e37561. [PMID: 38518011 DOI: 10.1097/md.0000000000037561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Abstract
RATIONALE Severe stenosis of the internal carotid artery tandem affects the blood supply to the brain and threatens human life, which can be solved by interventional procedures. PATIENT CONCERNS A 64-year-old male patient presented with a sudden onset of dizziness, palpitation, numbness, and weakness of the limbs. Imaging studies suggested multiple tandem severe stenoses from the left internal carotid artery contrast C2 to C4. DIAGNOSIS Severe stenosis of the left internal carotid tandem. INTERVENTIONS Multiple drug-eluting stent splicing and implantation were performed. OUTCOMES The left internal carotid artery stenosis was released, intracranial vascular filling was significantly improved, and the patient recovered well. LESSONS Interventional implantation of multiple drug-eluting stents relieves tandem severe stenosis of the internal carotid artery, with a wide range of applicability, high safety profile, and rapid postoperative recovery compared with endothelial debridement procedures.
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Affiliation(s)
- Qinghai Dai
- Department of Interventional Medicine, Brain Disease Hospital, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Lingfeng Shu
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Pengcheng Zhu
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hongtu Tan
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
| | - Tao Wu
- Department of Interventional Medicine, Brain Disease Hospital, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- The First Clinical Medical College, Henan University of Chinese Medicine, Zhengzhou, China
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Ledbetter D, Gumin J, Phillips L, Ene C, Shimizu Y, Lang FF. Facilitating Repeat Intracarotid Injections in Mouse Models by a Novel Injection Site Repair Technique. J Vis Exp 2024. [PMID: 38557500 DOI: 10.3791/66303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Given recent advances in the delivery of novel antitumor therapeutics using endovascular selective intraarterial delivery methods in neuro-oncology, there is an urgent need to develop methods for intracarotid injections in mouse models, including methods to repair the carotid artery in mice after injection to allow for subsequent injections. We developed a method of intracarotid injection in a mouse model to deliver therapeutics into the internal carotid artery (ICA) with two alternative procedures. During injection, the needle is inserted into the common carotid artery (CCA) after tying a suture around the external carotid artery (ECA) and injected therapeutics are delivered into the ICA. Following injection, the common carotid artery (CCA) can be ligated, which limits the number of intracarotid injections to one. The alternative procedure described in this article includes a modification where intracarotid artery injection is followed by injection site repair of the CCA, which restores blood flow within the CCA and avoids the complication of cerebral ischemia seen in some mouse models. We also compared the delivery of bone marrow-derived human mesenchymal stem cells (BM-hMSCs) to intracranial tumors when delivered through intracarotid injection with and without injection site repair following the injection. Delivery of BM-hMSCs does not differ significantly between the methods. Our results demonstrate that injection site repair of the CCA allows for repeat injections through the same artery and does not impair the delivery and distribution of injected material, thus providing a model with greater flexibility that more closely emulates intracarotid injection in humans.
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Affiliation(s)
- Daniel Ledbetter
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Joy Gumin
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Lynette Phillips
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center
| | - Yuzaburo Shimizu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center; Department of Neurosurgery, Juntendo University
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center;
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Maeda-Anezaki M, Omura K, Mori R, Ishida K. Case of giant juvenile angiofibroma resected by external incision with temporary double balloon occlusion of the internal carotid artery by intraoperative endovascular treatment. BMJ Case Rep 2024; 17:e256731. [PMID: 38479825 PMCID: PMC10941159 DOI: 10.1136/bcr-2023-256731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
We report the first case of a juvenile nasal angiofibroma (JNA) fed by multiple arteries from the internal carotid artery (ICA), removed without complications by temporarily blocking the ICA with two balloons. An early adolescent with JNA underwent preoperative embolisation of feeding arteries arising from the external carotid artery (ECA) (University of Pittsburgh Medical Centre classification IV). Endoscopic resection was attempted once but discontinued due to massive bleeding (7000 mL). 17 months later, the JNA had grown to fill both nasal cavities. Repeated preoperative embolisation of the feeders from the ECA was performed, followed by surgery combined with endoscopic and external incision. Intraoperatively, two balloons were inserted into the right ICA, which were inflated at the proximal and distal sites of the feeder vessels to cut-off blood flow to the tumour. The tumour was almost completely resected with 6270 mL of blood loss and no postoperative neurological deterioration.
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Affiliation(s)
- Mayuka Maeda-Anezaki
- Otorhinolaryngology, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
- Otorhinolaryngology, Self Defence Forces Central Hospital, Setagaya-ku, Tokyo, Japan
| | - Kazuhiro Omura
- Otorhinolaryngology, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Ryosuke Mori
- Neurosurgery, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
| | - Katsuhiro Ishida
- Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Minatoku, Tokyo, Japan
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Perrin G, Molinier E, Gory B, Kyheng M, Labreuche J, Pasi M, Janot K, Bourcier R, Sibon I, Consoli A, Desilles JP, Olivot JM, Papagiannaki C, Soize S, Gentric JC, Dargazanli C, Caroff J, Pop R, Naggara O, Moulin S, Eker O, Alias Q, Clarençon F, Lapergue B, Marnat G. Impact of Day 1 carotid patency on outcome in dissection-related tandem occlusions treated with mechanical thrombectomy. J Neuroradiol 2024; 51:196-203. [PMID: 38309578 DOI: 10.1016/j.neurad.2024.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The clinical benefit of mechanical thrombectomy(MT) for stroke patients with tandem occlusion is similar to that of isolated intracranial occlusions. However, the management of cervical internal carotid artery(ICA) occlusion during the MT, particularly in the setting of carotid dissection, remains controversial. We aimed to investigate the clinical impact of cervical ICA patency at day 1 on 3-month functional outcome. METHODS We collected data from the Endovascular Treatment in Ischemic Stroke, a prospective national registry in 30 French centers performing MT between January 2015 and January 2022. Inclusion criteria were consecutive tandem occlusions related to cervical ICA dissection treated with MT. Tandem occlusions of other etiology, isolated cervical ICA occlusions without intracranial thrombus and patients without day-1 ICA imaging were excluded. Primary endpoint was the 3-month functional outcome. Secondary endpoints included intracranial hemorrhage(ICH), excellent outcome, mortality and early neurological improvement. A sensitivity analysis was performed in patients with intracranial favorable recanalization after MT. RESULTS During the study period, 137 patients were included of which 89(65%) presented ICA patency at day 1. The odds of favorable outcome did not significantly differ between patients with patent and occluded ICA at day 1(68.7 vs 59.1%;aOR=1.30;95%CI 0.56-3.00,p=0.54). Excellent outcome, early neurological improvement, mortality and ICH were also comparable between groups. Sensitivity analysis showed similar results. CONCLUSION ICA patency at day 1 in patients with tandem occlusions related to dissection did not seem to influence functional outcome. Endovascular recanalization of the cervical ICA including stenting might not be systematically required in this setting.
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Affiliation(s)
| | | | - Benjamin Gory
- Neuroradiology Department, Nancy University Hospital, INSERM 1254, IADI, Université de Loraine, Nancy, France
| | - Maeva Kyheng
- Biostatistic Department - Lille University Hospital, Lille, France
| | - Julien Labreuche
- Biostatistic Department - Lille University Hospital, Lille, France
| | - Marco Pasi
- Neurology department, Tours University Hospital, Tours, France
| | - Kevin Janot
- Neuroradiology department, Tours University Hospital, Tours, France
| | - Romain Bourcier
- Neuroradiology Department, Nantes University Hospital, Nantes, France
| | - Igor Sibon
- Neurology Department, Bordeaux University Hospital, Bordeaux, France
| | - Arturo Consoli
- Neuroradiology Department, Foch Hospital, Suresnes, France
| | | | - Jean-Marc Olivot
- Neurology Department, Toulouse University Hospital, Toulouse, France
| | | | - Sebastien Soize
- Neuroradiology Department, Reims University Hospital, Reims, France
| | | | - Cyril Dargazanli
- Neuroradiology Department, Montpellier University Hospital, Montpellier, France
| | - Jildaz Caroff
- Neuroradiology Department, Kremlin-Bicêtre University Hospital, Kremlin-Bicêtre, France
| | - Raoul Pop
- Neuroradiology Department, Strabsourg University Hospital, Strasbourg, France
| | - Olivier Naggara
- Neuroradiology Department, Sainte-Anne University Hospital, Paris, France
| | - Solene Moulin
- Neurology Department, Reims University Hospital, Reims, France
| | - Omer Eker
- Neuroradiology Department, Lyon University Hospital, Lyon, France
| | - Quentin Alias
- Neuroradiology Department, Rennes University Hospital, Rennes, France
| | - Frederic Clarençon
- Neuroradiology Department, Pitié-Salpêtriere University Hospital, Paris, France
| | | | - Gaultier Marnat
- Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France.
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12
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Ishizuka T, Endo H, Yamaguchi S, Hiratsuka Y, Noro S, Ishikawa K, Fuchizaki T, Tatsuta Y, Sakurai S, Shindo K, Yamaguchi Y, Ogino T, Kamiyama K, Osato T, Nakamura H. Endovascular treatment of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery. Clin Neurol Neurosurg 2024; 238:108179. [PMID: 38387238 DOI: 10.1016/j.clineuro.2024.108179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
Persistent primitive hypoglossal artery is a relatively rare anatomical variation and a type of persistent carotid-basilar anastomosis. Acute internal carotid artery occlusion associated with persistent primitive hypoglossal artery is rare, and atherothrombotic occlusion is extremely rare. We present a case of acute atherothrombotic internal carotid artery occlusion associated with persistent primitive hypoglossal artery that was successfully treated by endovascular treatment. A 70-year-old male with a history of left internal carotid artery stenosis was transferred to our hospital by ambulance because of abnormal behaviors and aphasia. He was diagnosed with cerebral infarction and left internal carotid artery occlusion. Left carotid angiography revealed the persistent primitive hypoglossal artery arising from the cervical internal carotid artery and complete internal carotid artery occlusion distal to the origin of the persistent primitive hypoglossal artery. Therefore, we performed endovascular treatment. Mechanical thrombectomy was performed under minimal flow arrest with consideration of brain ischemia causing coma. After additional balloon angioplasty, recanalization was achieved, and the patient's symptoms improved. During the 1.5-year follow-up period, no recurrence or restenosis was observed. This report provides evidence that atherosclerotic internal carotid artery stenosis associated with persistent primitive hypoglossal artery can occur even distal to the origin of the persistent primitive hypoglossal artery and that the lesion may become acutely occluded, leading to acute stroke. Endovascular treatment considering brain ischemia was effective in this case.
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Affiliation(s)
- Tomoaki Ishizuka
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Soichiro Yamaguchi
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Yuma Hiratsuka
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Kohei Ishikawa
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Tomoki Fuchizaki
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Yasuyuki Tatsuta
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Suguru Sakurai
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Koichiro Shindo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Yohei Yamaguchi
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Tatsuya Ogino
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-ku, Sapporo, Hokkaido 060-8570, Japan.
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13
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Petrovic J, Sevkovic M, Pesic S, Vucurevic B, Mihajlovic V, Ilijevski N. Surgical treatment of segmental occlusion of the internal carotid artery. J Vasc Surg 2024; 79:694. [PMID: 37777944 DOI: 10.1016/j.jvs.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Jovan Petrovic
- Vascular Surgery Clinic, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia.
| | - Milorad Sevkovic
- Vascular Surgery Clinic, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia
| | - Slobodan Pesic
- Vascular Surgery Clinic, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia
| | - Bojan Vucurevic
- Vascular Surgery Clinic, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia
| | - Vladimir Mihajlovic
- Department of Invasive Radiological Diagnostics and Treatment, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia
| | - Nenad Ilijevski
- Vascular Surgery Clinic, Institute for Cardiovascular Diseases "Dedinje", Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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14
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Kashtiara A, Beldé S, Schollaert J, Menovsky T. Anatomical Variations and Anomalies of the Middle Cerebral Artery. World Neurosurg 2024; 183:e187-e200. [PMID: 38101539 DOI: 10.1016/j.wneu.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Intracranial arteries have a high rate of variation, but a clear schematic overview is lacking. In this pictorial review we classify and depict all the variations and anomalies within the middle cerebral artery (MCA). METHODS PubMed was searched with the MeSH-term "Middle Cerebral Artery." Articles were selected based on their description of variants within the MCA. Cross-referencing was used to broaden the range of articles. The anatomical variants were then schematically drawn using the anteroposterior and lateral view during angiography of the internal carotid artery. RESULTS A total of 29 unique medical illustrations were made, depicting variation in number of vessels; variation in vessel origin; and variation in morphology. CONCLUSIONS The MCA provides vital blood supply to the frontal, parietal, temporal, and central brain structures. An overview of these variations is important to diagnose and treat patients with MCA-related pathology correctly and safely. They can aid in distinguishing pathology from normal anatomical variance; aid neurosurgeons during aneurysmal clipping or arteriovenous malformation resections; and aid interventional radiologists during thrombectomy or coiling. This article provides a summary regarding current knowledge of anatomical variations within the MCA, their prevalence and clinical relevance. A total of 29 unique illustrations were made, depicting currently known variants. We encourage all who diagnose, treat, and study the MCA to use this overview for a uniform and better understanding of its anatomy.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium.
| | - Sarah Beldé
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Joris Schollaert
- Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium
| | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health sciences, University of Antwerp, Antwerp, Belgium; Department of Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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15
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Gupta S, Hauser BM, Catapano JS, Farhadi D, Ng PR, Bernstock JD, See AP, Lawton MT, Smith ER, Du R. Rupture risk and outcomes of giant aneurysms in pediatric patients: a multi-institutional case series and systematic review. J Neurosurg Pediatr 2024; 33:276-284. [PMID: 38157537 DOI: 10.3171/2023.10.peds23296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/31/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Giant aneurysms in pediatric patients are vascular lesions that can cause significant neurological morbidity and mortality. Their rarity has precluded large cohort studies to inform their management. The objective of this study was to understand the clinical course and outcomes of giant aneurysms in pediatric patients. METHODS The authors performed a multi-institutional cohort study of cases from Boston Children's Hospital and Barrow Neurological Institute, as well as a systematic review and pooled cohort analysis of previously reported cases using descriptive statistics and multivariate regression modeling. RESULTS Fifteen patients were included in the multi-institutional cohort, and an additional 88 patients were included from 14 series, yielding 103 patients within the pooled cohort. Among the pooled cohort, the most common aneurysm locations were in the middle cerebral artery (36%), internal carotid artery (27%), vertebral artery (11%), and vertebrobasilar junction (8%). Within 69 cases containing radiographic data in the analysis, 38% of aneurysms were saccular. Twenty-eight cases presented with aneurysm rupture (28%), including 0% of cavernous carotid aneurysms, 26% of other anterior circulation aneurysms, and 44% of posterior circulation aneurysms (p = 0.003). In multivariate analysis, posterior circulation location (OR 2.66, 95% CI 1.03-6.86) and younger age (OR 0.90 per year, 95% CI 0.81-1.00) were associated with aneurysm rupture presentation. Most cases were treated (97%) rather than observed (3%). The mortality rate was 3% for unruptured aneurysms and 18% for ruptured aneurysms. A favorable neurological outcome occurred in 80% of unruptured aneurysm cases and 54% of ruptured cases. In multivariate analysis, unruptured aneurysm presentation (OR 3.74, 95% CI 1.24-11.29) and endovascular treatment modality (OR 5.05, 95% CI 1.56-16.29) were associated with a favorable outcome. CONCLUSIONS Giant aneurysms are rare entities in pediatric patients that are unlikely to be discovered incidentally and usually merit treatment. Most patients survive with good neurological outcome, even in ruptured aneurysm cases. These data reveal that posterior circulation location and younger age are risk factors that correlate with an increased risk of aneurysm rupture.
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Affiliation(s)
- Saksham Gupta
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Departments of2Neurosurgery and
| | - Blake M Hauser
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua S Catapano
- 3Department of Neurosurgery, Barrow Neurologic Institute, St. Joseph's Medical Center, Phoenix; and
| | - Dara Farhadi
- 3Department of Neurosurgery, Barrow Neurologic Institute, St. Joseph's Medical Center, Phoenix; and
- 5Department of Neurosurgery, Banner University Medical Center/The University of Arizona, Tucson, Arizona
| | - Patrick R Ng
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua D Bernstock
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Departments of2Neurosurgery and
| | - Alfred Pokmeng See
- Departments of2Neurosurgery and
- 4Interventional Neuroradiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael T Lawton
- 3Department of Neurosurgery, Barrow Neurologic Institute, St. Joseph's Medical Center, Phoenix; and
| | | | - Rose Du
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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16
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Corrivetti F, Guizzardi G, Bove I, Enseñat J, Prats-Galino A, Solari D, Cavallo LM, Iaconetta G, Di Somma A, de Notaris M. Transorbital Exposure of the Internal Carotid Artery: A Detailed Anatomic and Quantitative Roadmap for Safe Successful Surgery. Oper Neurosurg (Hagerstown) 2024; 26:314-322. [PMID: 37815220 DOI: 10.1227/ons.0000000000000943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/15/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The superior eyelid endoscopic transorbital approach has rapidly gained popularity among neurosurgeons for its advantages in the treatment, in a minimally invasive fashion, of a large variety of skull base pathologies. In this study, an anatomic description of the internal carotid artery (ICA) is provided to identify risky zones related to lesions that may be approached using this technique. In this framework, a practical roadmap can help the surgeon to avoid potentially life-threatening iatrogenic vascular injuries. METHODS Eight embalmed adult cadaveric specimens (16 sides) injected with a mixture of red latex and iodinate contrast underwent superior eyelid transorbital endoscopic approach, followed by interdural dissection of the cavernous sinus, extradural anterior clinoidectomy, and anterior petrosectomy, to expose the entire "transorbital" pathway of the ICA. Furthermore, the distance of each segment of the ICA explored by means of the superior eyelid endoscopic transorbital approach was quantitatively analyzed using a neuronavigation system. RESULTS We exposed 4 distinct ICA segments and named the anatomic window in which they are displayed in accordance with the cavernous sinus triangles distribution of the middle cranial fossa: (1) clinoidal (Dolenc), (2) infratrochlear (Parkinson), (3) anteromedial (Mullan), and (4) petrous (Kawase). Critical anatomy and key surgical landmarks were defined to further identify the main danger zones during the different steps of the approach. CONCLUSION A detailed knowledge of the reliable surgical landmarks of the course of the ICA as seen through an endoscopic transorbital route and its relationship with the cranial nerves are essential to perform a safe and successful surgery.
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Affiliation(s)
- Francesco Corrivetti
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno , Italy
| | - Giulia Guizzardi
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Ilaria Bove
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Joaquim Enseñat
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
| | - Giorgio Iaconetta
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno , Italy
| | - Alberto Di Somma
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
| | - Matteo de Notaris
- Laboratory of Neuroanatomy, EBRIS Foundation, European Biomedical Research Institute of Salerno, Salerno , Italy
- Department of Neurosurgery, Hospital Clinic de Barcelona, Barcelona , Spain
- Laboratory of Surgical Neuroanatomy, Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
- Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples , Italy
- Unit of Neurosurgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno , Italy
- Department of Neuroscience, Neurosurgery Operative Unit, "San Pio" Hospital, Benevento , Italy
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17
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Levy BR, Monteiro A, Raygor KP, Donnelly BM, Davies JM, Snyder KV, Siddiqui AH, Levy EI, Sigounas D. Visual Morbidity in Patients With Ophthalmic Segment Aneurysms Treated With Flow Diverters: A Dual-Center Experience. Neurosurgery 2024; 94:538-544. [PMID: 37721433 DOI: 10.1227/neu.0000000000002694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/27/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Flow diverter (FD) treatment for aneurysms of the ophthalmic segment of the internal carotid artery (ICA) may raise concerns about visual morbidity related to coverage of the ophthalmic artery by the device. Our objective was to evaluate clinical and angiographic outcomes associated with FD treatment of these aneurysms, with particular emphasis on visual morbidity. METHODS We performed a retrospective analysis of the endovascular databases at 2 US centers to identify consecutive patients with aneurysms along the ophthalmic segment of the ICA that were treated with FDs between January 2010 and December 2022. Baseline demographics, aneurysm characteristics, and periprocedural and postprocedural data, including the occurrence of visual complications, were collected. RESULTS One hundred and thirteen patients with 113 aneurysms were identified for inclusion in this study. The mean age of the patients was 59.5 ± 12.4 years, and 103 (91.2%) were women. The ophthalmic artery origin was involved in 40 (35.4%) aneurysms, consisting of a neck origin in 33 (29.2%) and a dome origin in 7 (6.2%). New transient visual morbidity during the hospital stay included impaired visual acuity or blurriness in 1 (0.9%) patient, diplopia in 1 (0.9%), and floaters in 1 (0.9%). New transient visual morbidity during follow-up included impaired visual acuity or blurriness in 5 patients (4.4%), diplopia in 3 (2.7%), ipsilateral visual field defect in 1 (0.9%), and floaters in 6 (5.3%). Permanent visual morbidity occurred in 1 patient (0.9%). Among the 101 patients who had angiographic follow-up, the Raymond-Roy occlusion classifications were I (complete aneurysm occlusion) in 85 (84.2%), II (residual neck) in 11 (10.9%), and III (residual aneurysm) in 5 (4.9%). CONCLUSION In our experience, flow diversion for ICA ophthalmic segment aneurysms resulted in low rates of visual morbidity, which was mostly transient in occurrence.
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Affiliation(s)
- Bennett R Levy
- George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Kunal P Raygor
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Brianna M Donnelly
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo , New York , USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo , New York , USA
- Jacobs Institute, Buffalo , New York , USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo , New York , USA
| | - Dimitri Sigounas
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington , District of Columbia , USA
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Kusdiansah M, Benet A, Kiko K, Okada Y, Ota N, Tanikawa R. Salvage Bypass for Intraoperative Rupture of a Blood Blister-Like Aneurysm of the Internal Carotid Artery: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:360-361. [PMID: 37856766 DOI: 10.1227/ons.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Muhammad Kusdiansah
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo , Hokkaido , Japan
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, Jakarta , Indonesia
| | - Arnau Benet
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo , Hokkaido , Japan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix , Arizona , USA
| | - Katsunari Kiko
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo , Hokkaido , Japan
| | - Yasuaki Okada
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo , Hokkaido , Japan
| | - Nakao Ota
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo , Hokkaido , Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Stroke Center, Sapporo Teishinkai Hospital, Sapporo , Hokkaido , Japan
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19
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Charan BD, Thanneru S, Sebastian LJD, Jain S. Reconstructive endovascular treatment of petrous ICA pseudoaneurysm in skull base osteomyelitis: a hidden catastrophe. BMJ Case Rep 2024; 17:e258539. [PMID: 38417939 PMCID: PMC10900339 DOI: 10.1136/bcr-2023-258539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Skull base osteomyelitis can be more life-threatening in immunocompromised patients and patients with diabetes. Here, we present a case of a petrous internal carotid artery pseudoaneurysm resulting from skull base osteomyelitis in a diabetic male in his 50s. This case report highlights the need to be conscious of the various complications associated with skull base osteomyelitis, be proficient in detecting them and treat them as early as possible for better outcomes. After adequate control of the disease process with medical treatment, immediate management of the aneurysm with balloon angioplasty and stenting was done. Acknowledging the trivial nasal and ear bleed, radiological evaluation is necessary to rule out rare complications like pseudoaneurysms in a diagnosed case of skull base osteomyelitis. In the discussion, we have cited the various treatment methods and similar cases of pseudoaneurysm caused by osteomyelitis. Currently, the patient continues to live a disease and disability-free life.
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Tatsuta Y, Endo H, Ogino T, Yamaguchi Y, Kamiyama K, Osato T, Nakamura H. Internal carotid artery-persistent primitive anterior choroidal artery aneurysms: report of two cases and literature review. Acta Neurochir (Wien) 2024; 166:94. [PMID: 38376611 DOI: 10.1007/s00701-024-05988-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE Persistent primitive anterior choroidal artery (PPAChA) is a rare vascular anomaly. The clinical course of internal carotid artery (ICA)-PPAChA aneurysms has not been well described. CASE REPORTS We report two patients with an ICA-PPChA aneurysm and summarize previously reported cases. RESULTS Including our two, a total of 10 patients with an ICA-PPAChA aneurysm have been reported. Data were not described for one. Among the remaining nine, five patients (56%) experienced aneurysmal rupture. Five patients underwent surgical clipping and four underwent endovascular coiling. The procedure was completed in all but one patient who had a tiny branch artery adherent to the aneurysm; this patient was converted from clipping to aneurysm coating with a cotton sheet. Among the other eight patients, one who underwent coiling experienced an internal capsule infarction. The remaining seven had a satisfactory postoperative course; however, an asymptomatic occlusion of the PPAChA at its origin was noted on postoperative angiography in one. CONCLUSION PPChA is associated with a high incidence of aneurysm formation and rupture. During treatment of ICA-PPAChA aneurysms, obstruction of the PPAChA and any surrounding perforating arteries should be avoided to prevent ischemic stroke.
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Affiliation(s)
- Yasuyuki Tatsuta
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan.
| | - Hideki Endo
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Tatsuya Ogino
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Yohei Yamaguchi
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Toshiaki Osato
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, South 1, West 14, Chuo-Ku, Sapporo, Hokkaido, 060-8570, Japan
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21
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Oishi T, Neki H, Sakamoto T, Hashimoto M, Mochizuki Y, Kamio Y, Kurozumi K. Dolichoectasia of the ophthalmic artery: a case report on the treatment strategy in endovascular therapy and literature review. BMC Cardiovasc Disord 2024; 24:100. [PMID: 38341582 PMCID: PMC10859006 DOI: 10.1186/s12872-024-03771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Dolichoectasia is a rare arterial condition characterized by the dilatation, tortuosity, and elongation of cerebral blood vessels. The vertebrobasilar artery and internal carotid artery are the common sites of dolichoectasia. However, dolichoectasia of the branch arteries, such as the ophthalmic artery (OA), is extremely rare. To the best of our knowledge, this is the first case of ophthalmic dolichoectasia that was successfully treated with endovascular internal coil trapping. CASE PRESENTATION A 54-year-old female patient presented with transient left ophthalmalgia and visual disturbance. Magnetic resonance imaging revealed a dilated and elongated left OA compressing the optic nerve at the entrance of the optic canal. However, a previous image that was taken 17 years back revealed that the OA was normal, which suggested the change in dolichoectasia was acquired. Cerebral angiography showed that the dilated and tortuous OA was running from the ophthalmic segment of the left internal carotid artery into the orbit. The symptoms could have been attributed to the direct compression of the dolichoectatic OA in the optic canal. A sufficient anastomosis between the central retinal artery and the middle meningeal artery was identified on external carotid angiography with balloon occlusion of the internal carotid artery. Endovascular treatment with internal trapping of the OA was performed due to ophthalmic symptom progression. Internal coil trapping of the OA was performed at the short segment between the OA bifurcation and the entrance of the optic canal. As expected, the central retinal artery was supplied via the middle meningeal artery after the treatment. The transient visual disturbance was immediately resolved. Ophthalmalgia worsened temporarily after the treatment. However, it completely resolved after several days of oral corticosteroid therapy. Postoperative angiography showed that the origin of the OA was occluded and that the OA in the optic canal was shrunk. The flow of the central retinal arteries via the middle meningeal artery was preserved. CONCLUSIONS OA dolichoectasia is rare, and its pathogenesis and long-term visual prognosis are still unknown. However, endovascular therapy can improve symptom by releasing the pressure site in the optic canal.
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Affiliation(s)
- Tomoya Oishi
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Hiroaki Neki
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
| | - Tomoya Sakamoto
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Muneaki Hashimoto
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yuichi Mochizuki
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Yoshinobu Kamio
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan
| | - Kazuhiko Kurozumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-Ku, Hamamatsu City, Shizuoka, 431-3192, Japan
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Su X, Jin K, Song J, Kang D. How I do it? Surgical clipping of a large right internal carotid artery-superior hypophyseal artery aneurysm. Acta Neurochir (Wien) 2024; 166:61. [PMID: 38305984 DOI: 10.1007/s00701-024-05939-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/03/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND Microsurgery alone often proves to be challenging in treating paraclinoid internal carotid artery (ICA) aneurysms, which are known for their complex anatomy. METHOD A 53-year-old female with a large right ICA-superior hypophyseal artery (SHA) aneurysm underwent clipping repair. Mixed reality technology was utilized in the preoperative planning and anatomical study. During the surgery, the anterior clinoid process was removed intradurally to improve access to the aneurysm neck. The aneurysm was then secured with a long curved clip. The patient's recovery was successful without any complications. CONCLUSION This report aims to shed light on the intricacies involved in clipping ICA-SHA aneurysms.
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Affiliation(s)
- Xinfeng Su
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China
- Department of Neurosurgery, National Regional Medical Center, The First Affiliated Hospital Binhai Campus, Fujian Medical University, Fuzhou, 350209, Fujian, China
| | - Ke Jin
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China
- Department of Neurosurgery, National Regional Medical Center, The First Affiliated Hospital Binhai Campus, Fujian Medical University, Fuzhou, 350209, Fujian, China
| | - Jianping Song
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
- Department of Neurosurgery, National Regional Medical Center, Huashan Hospital Fujian Campus, Fudan University, Fuzhou, 350209, Fujian, China.
- Neurosurgical Institute of Fudan University, Shanghai, 200040, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China.
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China.
- Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China.
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350004, Fujian, China
- Department of Neurosurgery, National Regional Medical Center, The First Affiliated Hospital Binhai Campus, Fujian Medical University, Fuzhou, 350209, Fujian, China
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Khan NR, Labib M, Xu B, Lawton MT, Baskaya MK, Morcos JJ. Commentary: In Response to Extracranial-Intracranial Bypass in Symptomatic Arterial Occlusion Trial (CMOSS). Neurosurgery 2024; 94:e30-e32. [PMID: 38038433 DOI: 10.1227/neu.0000000000002784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Nickalus R Khan
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis , Tennessee , USA
- Department of Neurosurgery, University of Tennessee Health Sciences Center, Memphis , Tennessee , USA
| | - Mohamed Labib
- Department of Neurosurgery, University of Maryland, Baltimore , Maryland , USA
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai , China
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix , Arizona , USA
| | - Mustafa K Baskaya
- Department of Neurosurgery, University of Wisconsin, Madison , Wisconsin , USA
| | - Jacques J Morcos
- Department of Neurosurgery, University of Miami, Miami , Florida , USA
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24
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Mutimer CA, Campbell BCV. Recurrent Bilateral Extracranial Internal Carotid Artery Stenosis. Stroke 2024; 55:e27-e28. [PMID: 38189120 DOI: 10.1161/strokeaha.123.045184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Affiliation(s)
- Chloe A Mutimer
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Bruce C V Campbell
- Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
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25
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Zhu H, Liang S, Zhang Y, Jiang C. Retrograde placement of flow diversion for the treatment of giant internal carotid artery aneurysm. J Neuroradiol 2024; 51:89. [PMID: 37951570 DOI: 10.1016/j.neurad.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/08/2023] [Indexed: 11/14/2023]
Abstract
The use of flow diverters has been well-validated for the treatment of giant internal carotid artery aneurysms. However, in certain complex cases, the navigation of stent microcatheters across the neck may pose a relative challenge.1-3 In this technical video (video 1), we present the case of a patient in their 50s experiencing discomfort in the left eye. Angiography identified a giant aneurysm in the ophthalmic segment of the left internal carotid artery. Before seeking care at our institution, the patient had two interventional procedures, both unsuccessful due to difficulties in navigating the microcatheter past the aneurysm neck.4-5 In our management, after multiple unsuccessful anterograde attempts, we employed a retrograde strategy via the vertebral-basilar-posterior communicating artery route. This approach facilitated the successful deployment of the flow diverter and led to effective aneurysm embolization, underscoring the value of retrograde techniques for challenging cases.
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Affiliation(s)
- Haoyu Zhu
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yupeng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuhan Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Sgreccia A, Desilles JP, Costalat V, Dargazanli C, Bourcier R, Tessier G, Rouchaud A, Saleme S, Spelle L, Caroff J, Marnat G, Barreau X, Clarençon F, Shotar E, Eugene F, Houdart E, Gory B, Zhu F, Labreuche J, Piotin M, Lapergue B, Consoli A. Combined Technique for Internal Carotid Artery Terminus or Middle Cerebral Artery Occlusions in the ASTER2 Trial. Stroke 2024; 55:376-384. [PMID: 38126181 DOI: 10.1161/strokeaha.123.045227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The aim of this study was to report the results of a subgroup analysis of the ASTER2 trial (Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion) comparing the safety and efficacy of the combined technique (CoT) and stent retriever as a first-line approach in internal carotid artery (ICA) terminus±M1-middle cerebral artery (M1-MCA) and isolated M1-MCA occlusions. METHODS Patients enrolled in the ASTER2 trial with ICA terminus±M1-MCA and isolated M1-MCA occlusions were included in this subgroup analysis. The effect of first-line CoT versus stent retriever according to the occlusion site was assessed on angiographic (first-pass effect, expanded Treatment in Cerebral Infarction score ≥2b50, and expanded Treatment in Cerebral Infarction score ≥2c grades at the end of the first-line strategy and at the end of the procedure) and clinicoradiological outcomes (24-hour National Institutes of Health Stroke Scale, ECASS-III [European Cooperative Acute Stroke Study] grades, and 3-month modified Rankin Scale). RESULTS Three hundred sixty-two patients were included in the postsubgroup analysis according to the occlusion site: 299 were treated for isolated M1-MCA occlusion (150 with first-line CoT) and 63 were treated for ICA terminus±M1-MCA occlusion (30 with first-line CoT). Expanded Treatment in Cerebral Infarction score ≥2b50 (odds ratio, 11.83 [95% CI, 2.32-60.12]) and expanded Treatment in Cerebral Infarction score ≥2c (odds ratio, 4.09 [95% CI, 1.39-11.94]) were significantly higher in first-line CoT compared with first-line stent retriever in patients with ICA terminus±M1-MCA occlusion but not in patients with isolated M1-MCA. CONCLUSIONS First-line CoT was associated with higher reperfusion grades in patients with ICA terminus±M1-MCA at the end of the procedure. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03290885.
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Affiliation(s)
- Alessandro Sgreccia
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Vincent Costalat
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Cyril Dargazanli
- Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, France (V.C., C.D.)
| | - Romain Bourcier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Guillaume Tessier
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nantes, France (R.B., G.T.)
| | - Aymeric Rouchaud
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Suzana Saleme
- Interventional Neuroradiology Department, Centre Hospitalier Universitaire Limoges, France (A.R., S.S.)
| | - Laurent Spelle
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Jildaz Caroff
- Interventional Neuroradiology Department, Kremlin Bicêtre Hospital, France (L.S., J.C.)
| | - Gaultier Marnat
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Xavier Barreau
- Interventional Neuroradiology Department, Centre Hospitalier Régional Universitaire Bordeaux, France (G.M., X.B.)
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France (F.C., E.S.)
| | - François Eugene
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (F.E.)
| | - Emmanuel Houdart
- Department of Neuroradiology, Lariboisière Hospital, Paris, France (E.H.)
| | - Benjamin Gory
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - François Zhu
- Department of Neuroradiology, Centre Hospitalier Universitaire de Rennes, France (B.G., F.Z.)
| | - Julien Labreuche
- Department of Biostatistics, Centre Hospitalier Universitaire Lille, Equipe d'accueil 2694 Santé Publique: Epidémiologie et Qualité des Soins, University Lille, France (J.L.)
| | - Michel Piotin
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France (J.-P.D., M.P.)
| | - Bertrand Lapergue
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
| | - Arturo Consoli
- Diagnostic and Interventional Neuroradiology, Foch Hospital, Suresnes, France (A.S., B.L., A.C.)
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Lasica N, Parikh KA, Arnautovic KI. Cranioorbital Pretemporal Skull Base Approach with Anterior Clinoidectomy for Removal of Large Left Clinoid Meningioma: "Unwrapping" Encircled Internal Carotid Artery and Decompressing Optic Nerve: 2-Dimensional Operative Video. World Neurosurg 2024; 182:43-44. [PMID: 37972917 DOI: 10.1016/j.wneu.2023.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
Clinoidal meningiomas are meningiomas arising from or in the vicinity of the anterior clinoid process.1 Despite advanced microsurgical techniques, clinoidal meningiomas remain challenging.2 Extradural anterior clinoidectomy with optical unroofing remains an important tool in skull base surgery, which provides a safe operative corridor, facilitating greater extent of resection and enhancing overall outcome, particularly visual function.2-13 A 66-year-old woman presented with history of visual disturbances. Magnetic resonance imaging revealed a dural-based tumor consistent with a large left clinoidal meningioma, with tumor wrapping (encircling) around the left trunk and internal carotid artery (ICA) bifurcation, elevating the left middle cerebral artery M1 segment, and invading the left optic canal. Left cranio-orbital craniotomy with pretemporal exposure was used (Video 1).1,9 A high-speed diamond drill with irrigation completed the extradural anterior clinoidectomy and optical canal unroofing. Use of a 1-mm Kerrison rongeur should be done with utmost care. The tumor was unwrapped via meticulous piecemeal removal. Final dissection and ICA unwrapping was done when the tumor was debulked enough that dissecting it off the artery was safe and under less tension. Due to its obscurity, final decompression of the left optic nerve with incision and opening of the falciform ligament was performed at the end of the procedure.10 Postoperative neuro-ophthalmologic examination showed a grossly unchanged left visual field with some visual acuity improvement. Resection of tumor encircling the ICA has been described previously;14 however, to the best of our knowledge, this is the first video describing removal of a tumor surrounding the ICA (perfomed by senior author K.I.A.), essentially "unwrapping" the left ICA trunk and its bifurcation. The patient consented to publication.
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Affiliation(s)
- Nebojsa Lasica
- Clinic of Neurosurgery, University Clinical Center of Vojvodina, Novi Sad, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Kara A Parikh
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kenan I Arnautovic
- Department of Neurosurgery, The University of Tennessee Health Science Center, Memphis, Tennessee, USA; Semmes-Murphey Clinic, Memphis, Tennessee, USA.
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Bram R, Almadidy Z, Souter J, Roskova I, Charbel FT. Vertebral Artery to Middle Cerebral Artery Bypass for Flow Augmentation. Oper Neurosurg (Hagerstown) 2024; 26:222-225. [PMID: 37856761 DOI: 10.1227/ons.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/13/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Extracranial-intracranial bypass remains an enduring procedure for a select group of patients suffering from steno-occlusive cerebrovascular disease. Although the superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is most familiar among neurosurgeons, particular circumstances preclude the use of an STA donor. In such cases, alternative revascularization strategies must be pursued. CLINICAL PRESENTATION A 63-year-old female presented with symptoms of hemodynamic insufficiency and was found to have left common carotid artery occlusion at the origin. She experienced progressive watershed ischemia and pressure-dependent fluctuations in her neurological examination despite maximum medical therapy. The ipsilateral STA was unsuitable for use as a donor vessel. We performed an extracranial vertebral artery (VA) to MCA bypass with a radial artery interposition graft. CONCLUSION This technical case description and accompanying surgical video review the relevant anatomy and surgical technique for a VA-MCA bypass. The patient was ultimately discharged home at her preoperative neurological baseline with patency of the bypass. The VA can serve as a useful donor vessel for cerebral revascularization procedures in pathologies ranging from malignancies of the head and neck to cerebral aneurysms and cerebrovascular steno-occlusive disease.
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Affiliation(s)
- Richard Bram
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Zayed Almadidy
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - John Souter
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
| | - Ivana Roskova
- Department of Neurosurgery, University Hospital Brno, Brno , Czech Republic
- Faculty of Medicine, Masaryk University, Brno , Czech Republic
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago , Illinois , USA
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Liu Z, Ma X, Yang T. Sudden cardiac arrest during endovascular embolization of carotid artery aneurysm: A case report and literature review. Medicine (Baltimore) 2024; 103:e36888. [PMID: 38277550 PMCID: PMC10817150 DOI: 10.1097/md.0000000000036888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/18/2023] [Indexed: 01/28/2024] Open
Abstract
RATIONALE Endovascular embolization has been widely applied in carotid artery aneurysm due to less trauma and simpler procedures than open surgery. Sudden cardiac arrest is a rare event that may cause severe consequences during endovascular embolization. Risk factors of perioperative cardiac arrest include cardiac surgery, younger age, comorbid conditions, and emergency surgery. PATIENT CONCERNS A 62-year-old male patient had hypertension for 15 years and experienced sudden cardiac arrest of pulseless electrical activity during endovascular embolization. DIAGNOSES He was diagnosed with a 3.5 × 2.5 mm aneurysm. INTERVENTIONS Chest compression and effective interventions were given. OUTCOMES He was resuscitated by cardiopulmonary resuscitation and systematic therapy. LESSONS This case may provide experience in the management of sudden cardiac arrest during endovascular embolization of a carotid artery aneurysm.
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Affiliation(s)
- Ziqiang Liu
- Department of Anesthesiology, Weihai Municipal Hospital, Waihai, China
| | - Xuecai Ma
- Department of Anesthesiology, Weihai Municipal Hospital, Waihai, China
| | - Tianhui Yang
- Department of Anesthesia Surgery, Wuming Hospital Affiliated to Guangxi Medical University, Nanning, China
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Ma Y, Zhou Y, Li B, Zhang Y, Chen Y, Chai E. A nomogram predicting the relationship between recanalization time and successful endovascular recanalization of non-acute internal carotid artery occlusion in a Chinese population. Neurosurg Rev 2024; 47:38. [PMID: 38196057 DOI: 10.1007/s10143-024-02282-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
Different recanalization times for endovascular interventions may affect the success of non-acute internal carotid artery occlusion procedures. Nomograms can provide personalized and more accurate risk estimates based on predictive values. Therefore, we developed a nomogram to predict the probability of success of endovascular recanalization procedures for non-acute internal carotid artery occlusion. We performed a single-center retrospective analysis of data collected from patients who underwent endovascular treatment for non-acute internal carotid artery occlusion between January 2015 and December 2022. Multifactorial logistic regression analyses were performed to identify independent predictors affecting the success rate of non-acute internal carotid artery occlusion procedures and to create nomograms. The model was differentiated and calibrated using the area under the ROC curve (AUC-ROC) and calibration plots. Internal validation of the model was performed by using resampling (1000 replications). In total, 46 patients were identified and a total of 39 patients met the study criteria. Predictors in the nomogram included vascular occlusion proximal morphology, reversed flow of the ophthalmic artery, and recanalization time. The model showed good resolution with an ROC area of 0.917 (95% CI: 0.814-0.967). The nomogram can be used to personalize, visualize, and accurately predict the surgical success of endovascular treatment of non-acute internal carotid artery occlusion.
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Affiliation(s)
- Yong Ma
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia, China
- Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 24 Donggang East Road, Lanzhou, 730000, Gansu, China
| | - Yu Zhou
- Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 24 Donggang East Road, Lanzhou, 730000, Gansu, China
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Bin Li
- Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 24 Donggang East Road, Lanzhou, 730000, Gansu, China
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | | | - Yuwen Chen
- Cerebrovascular Disease Center, Gansu Provincial Hospital, No. 24 Donggang East Road, Lanzhou, 730000, Gansu, China
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Erqing Chai
- The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China.
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Gansu Provincial Hospital, Lanzhou, China.
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Kazantsev A, Shmatov D, Korotkikh A, Lebedev OV, Artyukhov S, Mukhtorov O, Leader R, Wang S, Roshkovskaya L, Chernyavin M, Unguryan V, Nonye NOG. A Multicentric Study of Different Methods of Open Surgical Cerebral Revascularization for Internal Carotid Artery Orifice Stenosis. Curr Probl Cardiol 2024; 49:102082. [PMID: 37714319 DOI: 10.1016/j.cpcardiol.2023.102082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
To analyze the long-term results of transposition of the internal carotid artery (ICA) into the lateral wall of the external carotid artery (ECA) in the presence of hemodynamically significant stenosis of the ICA. During the period from 3.10.2017 to 28.12.2020, 784 patients with isolated hemodynamically significant ICA orifice stenosis were included in the present retrospective multicentric open comparative study "Russian Birch." Depending on the implemented surgical technique, groups were formed: group 1 (n = 517) - eversion carotid endarterectomy (eCEA); group 2 (n = 193) classic CEA with implantation of a xenopericardium patch treated with di-epoxy compounds; group 3 (n = 74) - transposition of the ICA into the lateral wall of the ECA. Transposition of the ICA into the lateral wall of the ECA is performed as follows. The common carotid artery, ECA, and ICA are isolated and then they are clamped with vascular clamps. At the same time, the ICA and ECA are clamped 4 cm above the orifice. The ICA is cut 2.5 cm above the orifice. Then the section of the ICA with local stenosis in the orifice is sutured with a polypropylene suture. At the same time, the redundant nonfunctioning ICA stump is not resected due to the fact that there are receptors of the carotid sinus at the ICA orifice. Thus, such manipulation may damage the sinus, causing arterial hypertension that is difficult to control in the postoperative period. Then, in the lateral wall of the ECA 2.5 cm above the orifice, a 0.5 cm diameter round hole is formed using a scalpel and angled vascular scissors. Then an end-to-side anastomosis between the severed section of the ICA and the rounded opening formed in the lateral wall of the ECA is performed using a polypropylene suture. Vascular clamps are removed and blood flow is started. No complications were detected in the hospital postoperative period. No adverse cardiovascular events were registered in group 3 in the long-term follow-up period. The group of classic CEA with implantation of a xenopericardium patch treated with di-epoxy compounds showed the highest number of fatal outcomes from acute cerebrovascular accident (CVA) (Group 1: 0.2%, n = 1; group 2: 2.6%; n = 5; p = 0.008); nonfatal ischemic CVA (group 1: 0.6%, n = 3; group 2: 14.0%, n = 27; p < 0.0001); ICA restenosis (more than 60%) requiring a repeat revascularization (group 1: 0.8%, n = 4; group 2: 16.6%, n = 32; p < 0.0001). The cause of all CVAs after classical CEA was restenosis of the ICA due to neointimal hyperplasia; after eversion CEA and progression of atherosclerosis. The composite end point was statistically more frequent after classical CEE with plasty of the reconstruction area with a diepoxy-treated xenopericardium patch (group 1: 1.0%, n = 5; group 2: 17.7%, n = 33; p < 0.0001). When analyzing the survival curves free of ICA restenosis, it was determined that the overwhelming number of all ICA restenosis requiring revascularization in the group of classical CEA with implantation of a diepoxy-treated xenopericardium patch is diagnosed as early as 6 months after surgery. In the group of eversion CEA, the loss of the vessel lumen is most often visualized more than a year after the intervention. When comparing the survival curves (Logrank test), it was determined that restenosis of the ICA develops statistically more frequently (p < 0.0001) after classical CEA with implantation of a diepoxytreated xenopericardium patch. Transposition of the ICA into the lateral wall of the ECA is not accompanied by the risk of ICA restenosis due to the absence of inflammation of the internal artery wall after endarterectomy. Thus, this technique can be an alternative to CEA and be routinely used in case of local hemodynamically significant stenosis of the ICA orifice. Classical CEA with patch implantation is the least preferable operation due to the high risk of ICA restenosis in the mid-term and long-term follow-up.
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Affiliation(s)
- Anton Kazantsev
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation.
| | - Dmitry Shmatov
- Clinic of High Medical Technologies Named After. N.I. Pirogov St. Petersburg State University, St. Petersburg, Russian Federation
| | - Alexander Korotkikh
- Clinic of Cardiac Surgery, Amur State Medical Academy, Ministry of Health of Russia, Blagoveshchensk, Russian Federation
| | - Oleg Vladimirovich Lebedev
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation; Yaroslavl State Medical University, Yaroslavl, Russian Federation
| | - Sergey Artyukhov
- North-Western State Medical University. I.I. Mechnikov, St. Petersburg, Russian Federation; City Alexander Hospital, St. Petersburg, Russian Federation
| | - Otabek Mukhtorov
- Kostroma Regional Clinical Hospital Named After Korolev E.I., Kostroma, Russian Federation
| | - Roman Leader
- Federal State Budgetary Educational Institution of Higher Education "Kemerovo State Medical University" of the Ministry of Health of Russia, Kemerovo, Russian Federation
| | - Shouwen Wang
- First Moscow State Medical University. THEM. Sechenov, Moscow, Russian Federation
| | | | - Maxim Chernyavin
- Clinical Hospital №1 of the Presidential Administration of the Russian Federation, Moscow, Russian Federation
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Kimura S, Yagi R, Kishi F, Tamaki R, Ogawa D, Yamada K, Taniguchi H, Wanibuchi M. Mechanical Thrombectomy for Acute Cardiogenic Internal Carotid Artery Occlusion with Cross-Flow through the Communicating Artery. Turk Neurosurg 2024; 34:160-166. [PMID: 38282595 DOI: 10.5137/1019-5149.jtn.45181-23.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
AIM To report mechanical thrombectomy (MT) for internal carotid artery (ICA) occlusion with cross-flow through the communicating artery ("with" group), and to compare it with ICA or middle cerebral artery occlusion without cross-flow ("without" group). MATERIAL AND METHODS This study included 10 and 57 cases of the "with" and "without" groups, respectively. Cases analyzed by rapid processing of perfusion and diffusion (RAPID) since October 2020 were included. RESULTS Puncture-to-reperfusion time was 78.5 and 39 min (p=0.0155), the National Institutes of Health Stroke Scale score at discharge was 10.5 and 4 (p=0.0166), decline from pre to post Diffusion-Weighted Image-Alberta Stroke Program Early computed tomography (CT) Score was 0.5 and 0 (p=0.0495), and the modified Rankin Scale score at 90 days was 4 and 2 (p=0.0195) in the "with" and "without" groups, respectively. Furthermore, Tmax values of > 6 s (50 cc vs. 164 cc; p=0.0277) and Tmax > 4 s/Tmax > 6 s ratio (3.23 vs. 1.55) (p=0.0074) were significantly different between the "with" and "without" groups. CONCLUSION The "with" group may have been affected by the longer treatment time and being at high risk of distal migration of thrombus due to poor prognosis. Although the region with a Tmax of > 6 s tends to be small in patients of the "with" group, it indicates a low-perfusion state that can lead to cerebral infarction, and MT should be performed.
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Affiliation(s)
- Seigo Kimura
- Kouzenkai Yagi Neurosurgical Hospital, Osaka, Japan
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Bu C, Liu X, Zhang Y, Chen J, Wang J. Internal Carotid Artery Dissecting Aneurysm Associated with Persistent Trigeminal Artery: A Case Report. Curr Med Imaging 2024; 20:1-6. [PMID: 38389372 DOI: 10.2174/0115734056263907231127170341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/28/2023] [Accepted: 11/07/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Persistent trigeminal artery (PTA) is the most common vascular anastomosis between the carotid artery and vertebrobasilar systems. We report a very rare case of dissecting aneurysm in the right internal carotid artery (ICA) with ipsilateral PTA and discuss its clinical importance. CASE REPORT A 38-year-old male presented to the emergency department with paroxysmal dysphasia for 6h. Brain magnetic resonance (MR) imaging showed acute cerebral infarction of the right corona radiata and right parietal lobe. Three-dimensional time-of-flight MR angiography (3D TOF MRA) revealed severe stenosis of the petrous segment (C1 portion) of the right internal carotid artery and a PTA originating from the right ICA cavernous segment (C4 portion), with a length of approximately 1.8cm and a diameter of approximately 0.2cm. The ICA segments are all named according to the Bouthilier classification. The basilar artery (BA) under union was well developed. The bilateral posterior communicating arteries were also present. One day later, the high-resolution vessel-wall MR demonstrated a dissecting aneurysm in the C1 portion of the right ICA. The length of the dissecting aneurysm is approximately 4.4cm, the diameter of the true lumen at the most severe stenosis is approximately 0.2cm, and the diameter of the false lumen is approximately 0.8cm. Subsequent digital subtraction angiography (DSA) confirmed a dissecting aneurysm in the C1 portion of the right ICA. The patient was treated conservatively and did not undergo interventional surgery. Four months later, head and neck MRA showed that the right ICA blood flow was smooth and that the dissecting aneurysm had disappeared. The Ethics Committee of Liaocheng People's Hospital approved the research protocol in compliance with the Helsinki Declaration. Written informed consent was obtained from the individual for the publication of any potentially identifiable images or data included in this article. CONCLUSION Flow alteration with PTA may have influenced the formation of ICA dissection in this patient. Awareness of this is crucial in clinical practice because it can influence treatment options and intervention procedures.
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Affiliation(s)
- Chunqing Bu
- Department of Radiology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, Shandong Province 252000, China
| | - Xiaomin Liu
- Department of Radiology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, Shandong Province 252000, China
| | - Yanfeng Zhang
- Department of Radiology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, Shandong Province 252000, China
| | - Jun Chen
- Department of Radiology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, Shandong Province 252000, China
| | - Jinshen Wang
- Department of Pediatrics, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng, Shandong Province 252000, China
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Gavrilenko AV, Abramyan AV, Kochetkov VA, Tarabrin EA. [Efficacy and safety of surgical treatment of patients with pathological tortuosity of the internal carotid artery]. Khirurgiia (Mosk) 2024:64-70. [PMID: 38258690 DOI: 10.17116/hirurgia202401164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
No multicenter randomized clinical trial has been conducted worldwide to date on indications, types of surgery and their comparison with conservative treatment in patients with PI BSA. OBJECTIVE Of the study is to improve the results of surgical treatment in patients with pathological tortuosity of the internal carotid artery. MATERIAL AND METHODS The study included 119 patients (41 (34%) men and 78 (66%) women) with PI ICA aged 34 to 71 years (average age 53.2±7.5 years) divided into 2 groups. 64 patients (54%) of group I underwent BSA resection with lower mouth and 55 patients (46%) of group II underwent BSA prosthetics. Depending on the degree of neurological disorders, patients were distributed according to the classification of A.V. Pokrovsky. RESULTS In the early postoperative period, TIA was noted in one patient, and transient lesions of the cranial nerves were observed in 5 patients. During 5 years of follow-up, none of the patients developed TIA, IS or other vascular events. In the early surgical period, there were no significant differences in effectiveness between the groups of patients. In the long-term period (5 years after surgery), a higher frequency of asymptomatic patients was noted in group I. CONCLUSION Resection and replacement of a pathologically tortuous internal carotid artery (ICA) is a safe and effective surgical treatment. A multicenter randomized trial should be conducted to compare the effectiveness of surgical treatment of PI ICA with a conservative approach to effectively treat patients.
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Affiliation(s)
- A V Gavrilenko
- Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russia
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A V Abramyan
- Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russia
| | - V A Kochetkov
- Russian Scientific Center for Surgery named after Academician B.V. Petrovsky, Moscow, Russia
| | - E A Tarabrin
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Pathuri SC, Johnson WC, Webb MR, Fielder TC, Al-Saiegh F, Morton RP, Rodriguez P, Birnbaum L, Mascitelli JR. Development of the Circle of Willis Score (COWS) to help guide decision making during acute tandem occlusion treatment: Preliminary analysis. Clin Neurol Neurosurg 2024; 236:108116. [PMID: 38244414 DOI: 10.1016/j.clineuro.2024.108116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Acute tandem occlusions (TOs) are challenging to treat. Although acute carotid stenting of the proximal lesion is well tolerated, there are certain situations when the practitioner may be wary of acute stenting (bleeding concerns). OBJECTIVE The purpose of this study was to retrospectively study patients with tandem occlusions who had re-occlusion of the extracranial ICA and develop a Circle of Willis Score (COWS) to help predict which patients could forego acute stenting. METHODS This is a retrospective review of TO patients with a persistent proximal occlusion following intervention (either expected or unexpected). Pre intervention CTA and intraoperative DSA were reviewed, and each patient was assigned a score 2 (complete COW), 1a (patent A1-Acomm-A1), 1p (patent Pcomm), or 0 (incomplete COW). Findings from the DSA took precedence over the CTA. Two cohorts were created, the complete COW cohort (COWS 2) versus the incomplete COW cohort (COWS 1a,1p, or 0). Angiographic outcomes were assessed using the mTICI score (2b-3) and clinical outcomes were assessed using discharge mRS (good outcome mRS 0-3). RESULTS Of 68 TO cases, 12 had persistent proximal occlusions. There were 5/12 (42 %) patients in the complete COW cohort, and 7/12 (58 %) in the incomplete COW cohort (5/12 with scores of 1a/1p and 2/12 with a score of 0). In the complete COW cohort, there were 2 ICA-ICA and 3 ICA-MCA occlusions. In the incomplete COW cohort, there was one ICA-ICA occlusion and 6 ICA-MCA occlusions. LKW-puncture was shorter in the complete COW cohort (208 min vs. 464 min, p = 0.16). Successful reperfusion was higher in the complete COW cohort (100 % vs. 71 %). There was a trend toward better clinical outcomes in the complete COW cohort (80 % vs 29 %, p = 0.079). CONCLUSION The COWS is a simple score that may help predict a successful clinical outcome without proximal revascularization when concerned about performing an acute carotid stent during TO treatment. Evaluation in larger TO cohort is warranted.
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Affiliation(s)
- Sarath C Pathuri
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - William C Johnson
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Matthew R Webb
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Tristan C Fielder
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Fadi Al-Saiegh
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Ryan P Morton
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA; Department of Neurosurgery, Brooke Army Medical Center, San Antonio, TX, USA.
| | - Pavel Rodriguez
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Lee Birnbaum
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
| | - Justin R Mascitelli
- Department of Neurosurgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX, USA.
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Ma L, Ren HC, Huang Y, Yin L. Hybrid Surgery for Revascularization of Chronic Occlusion of Internal Carotid Artery. J Craniofac Surg 2024; 35:168-171. [PMID: 37815293 DOI: 10.1097/scs.0000000000009760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/26/2023] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to conclude the safety and effectiveness of hybrid surgery for revascularization of chronic occlusion of internal carotid artery (COICA). METHODS A total of 56 COCIA patients underwent hybrid surgery (carotid endarterectomy+carotid artery stenting) from September 2017 to September 2021 in our department. The clinical material and radiology data (preoperation and postoperation) were retrospectively analyzed to conclude the safety and effectiveness of hybrid surgery for revascularization of COICA. RESULTS All 56 patients underwent hybrid surgery got revascularization successfully (with a successful rate of 100%) and improved intracranial blood flow. The computed tomography perfusion results indicate that the postoperative cerebral blood flow perfusion of the patient is significantly improved compared with before surgery. In 1 patient, postoperative brain magnetic resonance imaging within 24 hours showed spotted fresh infarction with head magnetic resonance imaging, without any clinical symptoms; 3 patients developing symptoms of ipsilateral neural-functional defect (hypoglossal nerve, superior laryngeal nerve, and mandibular branch of facial nerve, respectively), 2 weeks later the symptoms were disappeared. Imaging study at 3 and 6 months during the follow-up showed no abnormalities. CONCLUSION Hybrid surgery is safe and effective for revascularization of COICA.
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Affiliation(s)
- Lin Ma
- Department of Neurosurgery, Tianjin Huanhu Hospital
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin, China
| | - He-Cheng Ren
- Department of Neurosurgery, Tianjin Huanhu Hospital
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin, China
| | - Ying Huang
- Department of Neurosurgery, Tianjin Huanhu Hospital
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin, China
| | - Long Yin
- Department of Neurosurgery, Tianjin Huanhu Hospital
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Disease, Tianjin, China
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Ma X, Zhang Y, Yang ZJ, Bo W, Wang XC, Zhang C, Liu PN, Bi ZY. Internal carotid artery injury during endoscopic transsphenoidal pituitary surgery: risk factors, management. Neurochirurgie 2024; 70:101515. [PMID: 38052154 DOI: 10.1016/j.neuchi.2023.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/25/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Transsphenoidal surgeons should try to avoid internal carotid artery (ICA) injury but also be prepared to manage it. We analyzed our experience with ICA injury during endoscopic transsphenoidal pituitary surgery and present associated risk factors and a management protocol. METHODS We retrospectively reviewed and analyzed the medical records of 1596 patients who underwent endoscopic transsphenoidal surgery for pituitary tumor resection in our institution from January 2009 to October 2022. RESULTS Six patients experienced an ICA injury. All received timely and effective hemostasis with immediate direct tamponade followed by endovascular treatment. No serious postoperative complications occurred. CONCLUSIONS We proposed a treatment plan for ICA injuries encountered during endoscopic transsphenoidal surgery and described our hemostasis process, methods of endovascular treatment, and means of postoperative follow-up in detail.
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Affiliation(s)
- Xin Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Yu Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Zhi-Jun Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Wang Bo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Xin-Chao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
| | - Chao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Pi-Nan Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China.
| | - Zhi-Yong Bi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Sheih YT, Wang CC. Successful mechanical recanalization of a complete left internal carotid artery occlusion. Am J Med Sci 2024; 367:e16. [PMID: 37716597 DOI: 10.1016/j.amjms.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 07/02/2023] [Accepted: 08/21/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Yu-Tse Sheih
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan (R.O.C.).
| | - Chih-Chiang Wang
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan (R.O.C.)
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Zdilla MJ, Cusick AM, Cowher AE, Choi JS, Lambert HW. Optic Canal Size is an Indicator for the Accessory Optic Canal: Applications for Anterior Clinoidectomy. World Neurosurg 2024; 181:e826-e832. [PMID: 37925149 PMCID: PMC10872940 DOI: 10.1016/j.wneu.2023.10.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The ophthalmic artery normally travels with the optic nerve through the optic canal. However, sometimes, the ophthalmic artery travels through a foramen within the optic strut named an accessory optic canal, double optic canal, or ophthalmic canal. This variant puts individuals at an increased risk for blindness or death during anterior clinoidectomy due to unforeseen hemorrhage of the ophthalmic artery or internal carotid artery when the optic strut is separated from the body of the sphenoid bone. Several features make the accessory optic canal difficult to recognize on imaging: its variant nature, small size, and ability to masquerade as a caroticoclinoid foramen or a pneumatized sphenoidal structure. Hence, improved methods of presurgical identification are warranted. The aim of this study was to assess the size and shape of the optic canal, with and without a concomitant accessory optic canal, to determine whether measurement of the optic canal may provide useful information regarding the presence of an accessory optic canal. METHODS In 191 dry crania, optic canals with and without concomitant accessory optic canals were assessed for the following parameters: canal area, canal perimeter, circularity, solidity, the axes and aspect ratio of a best-fit ellipse, and roundness. RESULTS Normal optic canals were found to have a larger area (P = 0.036), perimeter (P = 0.043), and minor axis of a best-fit ellipse (P = 0.031) than the optic canals that occurred alongside accessory optic canals. CONCLUSIONS Asymmetry in optic canal size can help indicate the presence of a unilateral accessory optic canal before surgery.
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Affiliation(s)
- Matthew J Zdilla
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, West Virginia, USA; Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, West Virginia, USA.
| | - Abbey M Cusick
- Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, West Virginia, USA; WVU Medicine Heart and Vascular Institute, Wheeling Hospital, Wheeling, West Virginia, USA
| | - Abigail E Cowher
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Janie S Choi
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - H Wayne Lambert
- Department of Pathology, Anatomy, and Laboratory Medicine (PALM), West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Kutovaya AS, Golovyuk AL, Chupin AV. [Evolution of surgical approaches to carotid bifurcation]. Khirurgiia (Mosk) 2024:104-110. [PMID: 38344967 DOI: 10.17116/hirurgia2024021104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Carotid endarterectomy is preferable for prevention of acute cerebrovascular accident associated with atherosclerotic lesions of internal carotid artery. Modern interest in minimizing local complications and small excisions is also actual in carotid surgery. The authors review the modern literature data on evolution of carotid arteries exposure. Cutaneous mini-incision, transverse skin incision and retrojugular approach are discussed. The authors consider the advantages and possible complications of each technique.
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Affiliation(s)
- A S Kutovaya
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A L Golovyuk
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A V Chupin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Baykara E, Topcu A, Celiker O. Middle Cerebral Artery Ischemic Complications After Flow Diverter Deployment from Internal Carotid Artery Extending into M1 Segment. Turk Neurosurg 2024; 34:268-273. [PMID: 38497180 DOI: 10.5137/1019-5149.jtn.43174-23.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
AIM To gain a better understanding of ischemia risk related to in-stent stenosis (ISS) or in-stent thrombosis (IST) of the middle cerebral artery (MCA) and lenticulostriate arteries after flow-diverting devices (FDD) deployment from the internal carotid artery (ICA) to proximal middle cerebral artery (M1). MATERIAL AND METHODS Using data from a prospectively maintained database, we retrospectively evaluated patients who were treated with FDD between January 2015 and 2020 at a single academic center. Only patients with unruptured ICA aneurysms where the FDD was extended into M1 were included. RESULTS In total, 89 patients with 94 ICA aneurysms were treated with FDD. A total of 34 patients with 36 aneurysms had FDD extending into M1. Of the 34 patients, four experienced MCA, and lenticulostriate territory ischemia. Three patients had in-stent thrombosis (IST), and one patient had severe in-stent stenosis (ISS). The overall ischemic complication rate was 17.6%, which resulted in a permanent neurological deficit in 11.7% of the patients. CONCLUSION If the distance of the distal neck of the aneurysm to the ICA terminus (ICAT) is ≤5 mm, or if the aneurysm is located directly at the ICAT, FDD should be considered only as a last option when other treatment modalities are not suitable. In addition, in the treatment of distal ICA aneurysms, extra effort should be exerted during the procedure to deploy the FDD without extending into M1. However, when traditional microsurgical clipping and other endovascular procedures are not suitable, the use of FDD is effective in terms of high aneurysm occlusion rates and preventing aneurysm rupture.
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Affiliation(s)
- Eyup Baykara
- Biruni University - Medicana International Istanbul Hospital, Department of Neurosurgery, İstanbul, Türkiye
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Chen JA, Kappel AD, Torio EF, Bass DI, Feroze A, Patel NJ. Combination endovascular and microsurgical treatment of partially thrombosed ruptured ICA terminus aneurysm, with common carotid artery to MCA bypass via saphenous vein graft and parent vessel sacrifice after coil embolization. J Clin Neurosci 2024; 119:62-63. [PMID: 37984189 DOI: 10.1016/j.jocn.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
A 63-year-old woman presented with ruptured giant ICA terminus aneurysm, temporized with coil embolization and definitively treated with parent vessel sacrifice and high-flow bypass.
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Affiliation(s)
- Jason A Chen
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Ari D Kappel
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Erickson F Torio
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - David I Bass
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Abdullah Feroze
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Nirav J Patel
- Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Tang Y, Yang Y, Feng J, Geng Y, Wang Y, Wang R, Zhang D, Zhao J. Hybrid surgery can improve neurocognitive function in patients with internal carotid artery occlusion. Sci Rep 2023; 13:22793. [PMID: 38129543 PMCID: PMC10739823 DOI: 10.1038/s41598-023-50270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023] Open
Abstract
Internal carotid artery occlusion (ICAO) is a relatively uncommon but important cause of transient ischaemic attack and cerebral infarction. Hybrid surgery (HS) improves cerebral perfusion, but its impact on neurocognitive function has been controversial. Patients with symptomatic chronic ICAO treated by hybrid surgery or medical treatment from 2016 to 2019 were included. We recorded and analysed the clinical characteristics, angiographic data, outcomes and cognitive status. Functional assessments, including the National Institutes of Health Stroke Scale (NIHSS), the Barthel Index, and a battery of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Alzheimer Disease Assessment Scale-Cognitive Subtest (ADAS-cog), verbal fluency, and Colour Trail test Parts 1 and 2, were administered. Significant improvements in the ADAS (before, 7.5 ± 6.2 versus after, 5.2 ± 5.7; P = 0.022), MMSE (before, 25.5 ± 2.8 versus after, 28.1 ± 2.3; P = 0.013), and Colour Trail test Part 1 (before, 118.3 ± 26.5 versus after, 96.2 ± 23.1; P = 0.016) were observed six months after HS. Moreover, the abovementioned postprocedure scales were ameliorated in the HS group. This study found that in patients with multiple symptomatic ICAO and objective ipsilateral ischaemia, successful HS leads to improvement in the scores of three cognitive tests.
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Affiliation(s)
- Yudi Tang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yunna Yang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
| | - Junqiang Feng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yibo Geng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Hospital, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Radu RA, Cagnazzo F, Derraz I, Gascou G, Costalat V. Retrograde endovascular recanalization of chronic common carotid total occlusion: a technical video. J Neurointerv Surg 2023; 16:107. [PMID: 37019625 DOI: 10.1136/jnis-2023-020099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
Common carotid artery (CCA) occlusion with patency of the internal carotid artery (ICA) is a rare cause of stroke with no consensus on optimal management.1 Open surgery, most often CCA-subclavian or CCA-aortic arch bypass techniques, have been used to recanalize short proximal occlusions.1 2 Endovascular revascularization of chronic total ICA occlusion was proposed with promising results in previous reports.3-5 However, endovascular recanalization for chronic CCA occlusion has rarely been described in the literature, and the reports involved mainly right-sided occlusions or occlusions with residual CCA stumps.6 Anterograde endovascular management of chronic long left-sided CCA occlusions is problematic due to lack of support, notably when no proximal stump is present.4 In this video, we present a case of known long-chronic CCA occlusion managed by retrograde echo-guided ICA puncture and stent-assisted reconstruction.(video 1) neurintsurg;16/1/107/V1F1V1Video 1 .
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Imad Derraz
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Grégory Gascou
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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张 陈, 陈 旭, 吴 圣, 冯 莉, 王 琰, 陈 妤, 段 敏, 王 科, 宋 琳. [Internal carotid artery pseudoaneurysm caused by parapharyngeal abscess: A case report]. Beijing Da Xue Xue Bao Yi Xue Ban 2023; 55:1135-1138. [PMID: 38101801 PMCID: PMC10724003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Indexed: 12/17/2023]
Abstract
Pseudoaneurysms of the neck are seldom, and those caused by neck infections especially parapharyngeal abscess are even rarer. However, it is life-threatening and may bring sudden death due to the obstruction of airway and the pseudoaneurysms rupture. We analyzed the clinical features, diagnosis and treatment of the disease through a case summary and literature review in order to guide clinical diagnosis and treatment of pseudoaneurysms. The patient, whom we presented was an 87-year-old male and admitted in emergency of our hospital with the chief complaint of neck swelling for 7 days and shortness of breath for 2 days. Cervical ultrasound examination showed that there was an liquid dark area next to the left common carotid artery which was approximately 8.0 cm × 5.0 cm, consideration of formation of left carotid artery pseudoaneurysm, and the liquid dark area which was visible on the right considered of pseudoaneurysm or infection. Angiography of neck showed a clustered high-density shadow around the bifurcation of the left carotid artery, with an overall range of approximately 65 mm × 52 mm × 72 mm, the pseudoaneurysms for sure, while on the right side of the lesion, mixed low density shadows with air could be seen, the parapharyngeal abscess for sure.Then he was diagnosed as the pseudoaneurysm of left internal carotid artery which was caused by parapharyngeal abscess. After tracheal intubation and anti-infection treatment, the patient died due to hemorrhagic shock of the ruptured of the pseudoaneurysm. Morever we performed literature search on PubMed, Wanfang database and CNKI with keywords of "neck pseudoaneurysm, neck infection, parapharyngeal abscess" and enrolled 10 cases. Then we summarized the clinical characteristics and treatment. We analyzed and summarized the 10 case reports, in which the number of male was 7. Among them, there were 4 pediatric, and 6 adults were enrolled overall. Most of the symptoms were neck swelling, and the diseased blood vessel was mainly the right internal carotid artery which accounted for half overall. All the patients underwent surgical intervention, and recovered well. So we draw the conclusion that the clinical incidence of cervical pseudoaneurysms is low and can be caused by a variety of factors, especially caused by infectious factors. When a patient has a progressive pulsating mass in the neck, the preliminary diagnosis should be made by ultrasound as soon as possible, and the aortic enhancement CT should be used to further confirm.For a patient with cervical pseudo-aneurysms caused by parapharyngeal infections, he should take operation timely combined with antibiotic treatment in time.
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Affiliation(s)
- 陈光 张
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 旭岩 陈
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 圣 吴
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 莉莉 冯
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 琰 王
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 妤 陈
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 敏 段
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 科 王
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - 琳琳 宋
- />清华大学附属北京清华长庚医院急诊科, 清华大学临床医学院, 北京 102218Department of Emergency, Beijing Tsinghua Changgung Hospital; School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Kaszczewski P, Elwertowski M, Leszczyński J, Ostrowski T, Kaszczewska J, Stępkowski K, Maciąg R, Lamparski K, Gałązka Z. Impact of Internal Carotid Stenosis Treatment on Cerebral Blood Flow Volume: A Comparative Study between Preoperative and Postoperative Values. Med Sci Monit 2023; 29:e941958. [PMID: 38071424 PMCID: PMC10720253 DOI: 10.12659/msm.941958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Among patients with ICA stenosis, there are some cases with elevated, undisrupted, and diminished cerebral blood flow (CBF). The aim of this study was to assess the influence of ICA stenosis treatment on postoperative CBF changes in relation to preoperative CBF values. MATERIAL AND METHODS We qualified 58 patients ≥65 years old (28 males, 30 females, mean age 71.02±6.34 years) for surgical intervention due to symptomatic ≥70% ICA stenosis. In all patients, a flow volume in all extracranial arteries (internal carotid [ICA], external carotid [ECA], and vertebral arteries [VA]) was measured preoperatively and 2-3 days following the surgery. The CBF values were compared with the ones established for a healthy population of the same age. RESULTS Preoperatively, there were 3 subgroups of patients, comparing to healthy population: with elevated CBF - "significant compensation," with undisrupted CBF - "mild compensation," and with diminished CBF - "no compensation." Postoperatively, a significant CBF increase was observed in patients with preoperative "no" and "mild compensation" - 277.18±154.26 ml/min (P=0.0000001) and 221.56±98.8 ml/min (P=0.0000001). In a "significant compensation" group, there was no flow increase observed (CBF change of 2.57±58.5 ml/min, P=0.954) - a redistribution of flow was observed. CONCLUSIONS In patients with lower preoperative CBF values, surgical treatment caused a significant increase in global cerebral inflow, which was more prominent in patients with the lowest preoperative CBF. In patients with high preoperative CBF, surgical treatment resulted in a flow redistribution, but did not cause a CBF increase. Volumetric flow assessment in DUS can predict hemodynamic benefit from surgery in terms of CBF increase.
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Affiliation(s)
- Piotr Kaszczewski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Michał Elwertowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Jerzy Leszczyński
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Tomasz Ostrowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Joanna Kaszczewska
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Kamil Stępkowski
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
| | - Rafał Maciąg
- II Division of Radiology, Medical University of Warsaw, Warsaw,
Poland
| | | | - Zbigniew Gałązka
- Department of General, Vascular, Endocrine and Transplant Surgery, Medical University of Warsaw, Warsaw,
Poland
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Tan G, Wang J, Xing W, He Z. Safety and Efficacy of Hybrid Surgery in Chronic Internal Carotid Artery Occlusion: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2023; 53:205-215. [PMID: 38061340 PMCID: PMC10997257 DOI: 10.1159/000535373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION Chronic internal carotid artery occlusion (CICAO) is a common cause of stroke and ischemia recurrence. An increasing number of reports have highlighted the potential of hybrid surgery for treating CICAO. There are few studies, specifically nonrandomized controlled trials, on the safety and effectiveness of hybrid surgery for the treatment of CICAO, so in this study, we hypothesized that hybrid surgery would be safe, have an acceptable complication rate and a high success rate. METHODS MEDLINE, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies published up to January 30, 2023. The primary endpoint was recanalization rates of occluded vessels, and the secondary endpoint was perioperative death and procedure-related complications. Subgroup analysis focused on the recanalization rates of endovascular intervention (EI) and hybrid surgery, as well as the rates of recanalization below the clinoid segment and at the clinoid segment and beyond. The follow-up visit was conducted at least 3 months after surgery, and stenosis or occlusion recurrence was confirmed by review of CTA or DSA scan. RESULTS The databases were searched and 1,709 records were identified, of which 16 articles were used in the meta-analysis, and 464 CICAO patients with complete data who underwent hybrid surgery were enrolled. Hybrid surgery was associated with higher success rates (RD = 0.87, 95% CI [0.84-0.91], p < 0.00001) than EI (OR = 4.71, 95% CI [2.32-9.56], p < 0.0001). The procedural success rate in the below-clinoid segment group was significantly higher than that in the clinoid segment and beyond group (OR = 13.76, 95% CI [5.31-35.66], p < 0.00001). The total periprocedural complication rate was low (RD = 0.11, 95% CI [0.07-0.15], p < 0.00001 and RD = 0.04, 95% CI [0.00-0.07], p = 0.03). Target vessel restenosis or reocclusion occurred in 35 patients (8%) during the follow-up period (RD = 0.08, 95% CI [0.04-0.12], p < 0.0001). CONCLUSION Hybrid surgery is the combination of the advantages of open surgery and EI, has a high success rate and a low risk of recurrence of stenosis and occlusion in the long term. Randomized controlled trials on hybrid surgery for internal carotid artery occlusion are necessary.
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Affiliation(s)
- Guanping Tan
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China,
- Department of Cerebrovascular Diseases, Suining Central Hospital, Suining, China,
| | - Jing Wang
- Department of Oncology, Suining Central Hospital, Suining, China
| | - Wenli Xing
- Department of Cerebrovascular Diseases, Suining Central Hospital, Suining, China
| | - Zhaohui He
- Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Nariai Y, Takigawa T, Kawamura Y, Hyodo A, Suzuki K. Inflow Angle and Height-Width Ratio are Predictors of Incomplete Occlusion at One and Two Years After Flow Diverter Treatment for Small- and Medium-Sized Internal Carotid Artery Aneurysms. World Neurosurg 2023; 180:e716-e728. [PMID: 37821031 DOI: 10.1016/j.wneu.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE We investigated the association between the inflow angle of aneurysms and their occlusion status at 1 and 2 years after flow diverter (FD) treatment. METHODS We retrospectively analyzed 42 consecutive patients from a single center with 43 untreated, unruptured internal carotid artery (ICA) proximal to communicating segment, saccular aneurysms sized <12 mm. RESULTS At 1 year posttreatment, the complete occlusion (CO) rate was 58.1%. On univariate analyses, the proportion of inflow angle >90° was significantly lower in the CO group than in the incomplete occlusion group (20.0% VS. 83.3%; P < 0.001). The CO incidence decreased with a height-width (H/W) ratio of <1.2 (P = 0.059). On multivariate analysis, an H/W ratio of <1.2 (odds ratio [OR], 0.076; P = 0.027) and an inflow angle of >90° (OR, 0.020; P = 0.0011) significantly influenced CO at 1 year post FD. At 2 years posttreatment, the CO rate was 76.3% (29/38 cases with available follow-up data). On univariate analyses, in the CO group compared to the incomplete occlusion group, the proportion of H/W ratio <1.2 was significantly lower (P = 0.005) and the proportion of inflow angle >90° was significantly lower (P = 0.021); aneurysm dome size tended to be larger (8.5 mm vs. 7.1 mm; P = 0.080). On multivariate analysis, an H/W ratio <1.2 (OR, 0.042; P = 0.015) and an inflow angle >90° (OR: 0.088; P = 0.031) significantly influenced CO at 2 years post FD. CONCLUSIONS The inflow angle of >90° and H/W ratio <1.2 may significantly influence the CO rate in small- or medium-sized internal carotid artery aneurysms 1 and 2 years post FD.
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Affiliation(s)
- Yasuhiko Nariai
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Yosuke Kawamura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Akio Hyodo
- Department of Neurosurgery, Kamagaya General Hospital, Chiba, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
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Kam J, Rebchuk A, Tan D, Huang H, Kim B, Castle-Kirszbaum M, Sher I, Lai L. Microsurgical clipping of ruptured supraclinoid internal carotid artery aneurysm with extradural clinoidectomy. J Clin Neurosci 2023; 118:44-45. [PMID: 37864935 DOI: 10.1016/j.jocn.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Supraclinoid Internal Carotid Artery (ICA) aneurysms require additional access to standard pterional craniotomy via extradural clinoidectomy. Existing texts and surgical videos lack clarity, explanation and a clear step by step process. CASE DESCRIPTION We present a case of a ruptured supraclinoid ICA aneurysm and extradural clinoidectomy along with 3D reconstructed imaging of the case anatomy to guide its resection. Real-time unedited on table rerupture provides an example of management. CONCLUSION Extradural Anterior Clinoidectomy is a key maneuver in cerebrovascular surgical armamentarium for clipping of supraclinoid aneurysms. Stereotypical Pathological or Surgical Anatomy, its application, and availability with 3D imaging should be facilitates the framing and learning of normal physiological anatomy.
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Affiliation(s)
- Jeremy Kam
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia; Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Division of Neurosurgery , University of British Columbia, Vancouver, British Columbia, Canada.
| | - Alexander Rebchuk
- Division of Neurosurgery , University of British Columbia, Vancouver, British Columbia, Canada
| | - Darius Tan
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Helen Huang
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Boaz Kim
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | | | - Idrees Sher
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Leon Lai
- Department of Neurosurgery, Monash Medical Centre, Melbourne, Victoria, Australia
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Dostal J, Mracek J, Heidenreich F, Priban V. Delayed microsurgical revascularization in an acute ischemic stroke based on perfusion study. Acta Neurochir (Wien) 2023; 165:3825-3830. [PMID: 37910307 DOI: 10.1007/s00701-023-05860-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/20/2023] [Indexed: 11/03/2023]
Abstract
A 58-year-old patient presented with a severe neurological deficit due to a stroke caused by an occlusion of the left internal carotid artery siphon. Standard treatment failed and neurosurgical consult was delayed. Because of a favorable perfusion imaging finding, microsurgical revascularization via an extra-intracranial bypass (left superficial temporal artery - left middle cerebral artery) was performed 36 hours after the onset of the symptoms. The outcome of the patient was favorable. The authors want to emphasize the need to actively seek patients with a severe neurological deficit and still viable brain tissue. The time window and treatment alternatives are discussed.
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Affiliation(s)
- Jiri Dostal
- Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.
| | - Jan Mracek
- Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Filip Heidenreich
- Department of Imaging Methods, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Vladimir Priban
- Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
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