Concomitant Unruptured Intracranial Aneurysms and Carotid Artery Stenosis: An Institutional Review of Patients Undergoing Carotid Revascularization

Borkon, Matthew J.; Hoang, Han; Rockman, Caron; Mussa, Firas F.; Cayne, Neal S.; Riles, Thomas S.; Jafar, Jafar J.; Veith, Frank J.; Adelman, Mark A.; Maldonado, Thomas S.

doi:10.1016/j.avsg.2013.06.013

Cited by 18 publications

(12 citation statements)

References 32 publications

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“…On the other hand, surgical or endovascular treatment for the UIA under general anesthesia in the setting of carotid artery stenosis might have a higher risk of ischemic stroke. Safety of carotid revascularization in patient having carotid stenosis with coexistent UIAs was investigated in several clinical studies [4][5][6][7][9][10][11][12]. Tallarita et al [4] reported their case series including 53 patients with 63 concomitant non-cavernous UIAs, in which more than half of the patients received CEA (32/58, 58%).…”

Section: Discussionmentioning

confidence: 99%

Three-Month Outcome of Carotid Artery Stenting in Patients with/without Coexistent Unruptured Intracranial Aneurysms

Yang

Wang

et al. 2020

Cerebrovasc Dis

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Introduction: Safety of carotid artery stenting (CAS) in patients having carotid stenosis with coexistent unruptured intracranial aneurysms (UIAs) is rarely reported. Thus, we studied the 3-month outcome of CAS in the presence of coexistent UIAs in our institution. Methods: A retrospective analysis of patients receiving CAS at our institution from September 2011 to December 2019 was carried out. Patients were stratified into 2 groups: group of CAS with UIAs (CAS-UIA) and group of CAS without UIAs (CAS). The main complications within 3 months after stenting were TIA, ischemic stroke, symptomatic intracranial hemorrhage (sICH), rupture of UIAs, and death. The baseline characteristics and complications of the 2 groups were compared. Results: Five hundred fifty-six patients (CAS, n = 468; CAS-UIA, n = 88) were included and 604 stenting procedures were performed. More patients had hypertension in the CAS-UIA group (87.5 vs. 73.7%, p = 0.006). There was no significant difference in TIAs, ischemic stroke, sICH, and death within 3 months after stenting between the CAS and CAS-UIA groups. None of the 113 coexistent UIAs detected in 88 patients had aneurysm rupture within 3 months after CAS. Conclusions: In our large cohort of CAS patients, coexistent UIAs are not uncommon. Stenting of a carotid artery in the presence of coexistent UIAs could be conducted safely. Together with 3-month dual antiplatelet therapy, CAS did not increase the rupture risk of the coexistent UIAs within 3 months.

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Section: Discussionmentioning

confidence: 99%

Three-Month Outcome of Carotid Artery Stenting in Patients with/without Coexistent Unruptured Intracranial Aneurysms

Yang

Wang

et al. 2020

Cerebrovasc Dis

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“…One meta-analysis has shown no increased risk of aneurysm rupture caused by carotid endarterectomy [ 13 ]. Other study has also suggested that carotid arterial stenting and carotid endarterectomy are not related to increased aneurysm rupture [ 14 ]. It is worth noting that 82% of intracranial aneurysms have a diameter less than 5 mm in that study [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other study has also suggested that carotid arterial stenting and carotid endarterectomy are not related to increased aneurysm rupture [ 14 ]. It is worth noting that 82% of intracranial aneurysms have a diameter less than 5 mm in that study [ 14 ]. Thus, ischemic cerebrovascular diseases were generally believed to receive surgical treatment before that of intracranial aneurysms with a diameter less than 5 mm.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment and perioperative management of intracranial aneurysms in Chinese patients with ischemic cerebrovascular diseases: a case series

Zheng

2018

BMC Neurol

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BackgroundPatients with ischemic cerebrovascular diseases are more likely to suffer from intracranial aneurysms, and their surgical treatment has a growing controversy in this condition. The current case series was aimed at exploring surgical treatment and perioperative management of intracranial aneurysms in Chinese patients with ischemic cerebrovascular diseases.MethodsMinimally invasive surgical approach through small pterion or inferolateral forehead was applied in 31 patients. Anti-platelet drugs were withdrawn 1 week before surgical operation. Systolic blood pressure was controlled to be more than 110 mmHg and increased by 20% after the clipping of intracranial aneurysms. Branches of external carotid artery were spared to ensure collateral circulation. Temporary blocking was minimized and ischemic time was shortened during surgical operation.ResultsPatients had an average age of 66 (46–78) years, and proportion of males was 39% (12 males). There were 35 unruptured intracranial aneurysms with a diameter more than 5 mm. There were 20 posterior communicating and anterior choroidal aneurysms (57%), seveb middle cerebral aneurysms (20%), and eight anterior communicating aneurysms (23%), with 21 lobular aneurysms (60%). Twenty-nine patients had normal neurological function (Glasgow Outcome Scale [GOS] 5), one patient with mild neurological defect (GOS 4), and one patient with severe neurological defect (GOS 3) at discharge. Meanwhile, there were 26 patients with modified Rankin Scale (MRS) 0–1, 4 patient with MRS 2, and one patient with MRS 3 at discharge. There were four patients lost during the follow-up. During the follow-up, 26 patients had normal neurological function (GOS 5), and one patient with severe neurological defect (GOS 3). Meanwhile, there were 25 patients with MRS 0–1, one patient with MRS 2, and one patient with MRS 3. All patients had no recurrence of intracranial aneurysms after operation.ConclusionsThe current case series found that minimally invasive surgical approach and intraoperative monitoring, supplemented by effective management of cerebrovascular perfusion, circulation and coagulation, can promote the treatment of intracranial aneurysms and prevent the development of cerebral ischemia and aneurysm rupture in Chinese patients with ischemic cerebrovascular diseases. Future studies with large sample size will be needed to confirm the results from the current case series.

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“…Many patients with concomitant carotid stenosis and ipsilateral UIA underwent endovascular treatment have been reported. The overall complication rate is not high and clinical outcome turn out to be good [2][3][4][5][6][7]. However, rare authors have reported endovascular treatment results of concomitant UIAs and cerebral vascular stenosis despite location and degree of stenosis, as well as location and morphology characteristics of UIAs.…”

Section: Introductionmentioning

confidence: 99%

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Jin¹,

Jing²,

Meng³

et al. 2020

Preprint

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Abstract Background To evaluate the safety of endovascular therapy for concomitant unruptured intracranial aneurysms (UIAs) and cerebral vascular stenosis. Methods Patients between January to August 2019 were retrospectively reviewed at our institution. Concomitant UIA and cerebral vascular stenosis patients underwent endovascular treatment were included. The demographics and clinical information were collected. Patients were divided into 4 groups according to lesions that was treated (aneurysm, stenosis, both lesions in a single session or in separated sessions). Patients were divided into another 2 groups based on locations of aneurysm and stenosis (ipsilateral and non-ipsilateral). The demographics and clinical data were compared among groups. Results A total of 105 (4.9%) cases have concomitant UIA and cerebral vascular stenosis. Eighty-one patients underwent endovascular treatment for the stenosis(n=18), aneurysm(n=41) or both lesions (one session=10; separated sessions n=12). Seven (8.6%) patients experienced procedural related complications, including 1 (1.2%) hemorrhagic and 6 (7.4%) ischemic types. In terms of procedures, 4 (6.3%) complications is related with UIA embolization, 2(5.0%) related with intracranial stenosis angioplasty. Complication rate of patients underwent intracranial angioplasty and aneurysm embolization simultaneously is much higher (20%) than that of the other groups (5.6%-8.3%). Patients with ipsilateral lesions also had higher complication rate (11.1%) than non-ipsilateral patients (6.7%). Follow-up (74 patients, mean=6.5months) result showed good clinical outcome in 70 (94.6%) patients. Conclusions Simultaneous treatment for concomitant UIA and extracranial stenosis may not pose additional risks. Ipsilateral lesions and single session procedure for intracranial stenosis and UIA are potential risk factors for periprocedural complications.

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Concomitant Unruptured Intracranial Aneurysms and Carotid Artery Stenosis: An Institutional Review of Patients Undergoing Carotid Revascularization

Cited by 18 publications

References 32 publications

Three-Month Outcome of Carotid Artery Stenting in Patients with/without Coexistent Unruptured Intracranial Aneurysms

Three-Month Outcome of Carotid Artery Stenting in Patients with/without Coexistent Unruptured Intracranial Aneurysms

Surgical treatment and perioperative management of intracranial aneurysms in Chinese patients with ischemic cerebrovascular diseases: a case series

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

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