Direct carotid exposure approach in the treatment of anterior circulation unruptured intracranial aneurysms for elderly patients

Abstract

Background and purpose The direct carotid exposure approach (DCEA) is a technical option for elderly patients with severe vessel tortuosity due to arteriosclerosis. We evaluated complications related to antiplatelet/anticoagulant management and compared the DCEA to standard transfemoral/transbrachial approaches (TFBA) in the treatment of unruptured intracranial aneurysms for elderly patients. Methods From August 2017 to August 2020, 52 patients (53 procedures) aged over 75 years with unruptured aneurysms in the anterior circulation were treated at our institution. All patients received dual antiplatelet drugs before the procedure. Eleven patients (21.2%) (12 procedures) were treated with the DCEA. The rest were treated with TFBA. The main indication of the DCEA was an unfavorable aortic arch or vessel tortuosity. Complications and the duration of the procedure were compared between the two groups. Results There were no significant differences between the two groups in age, aneurysm location, preoperative antiplatelet use, heparin use, or maximum activated clotting time (ACT) values. All endovascular treatments were successfully performed by DCEA. Among all parameters, the DCEA group had only bigger average aneurysm diameter (14 mm) and higher number of pipeline embolic device (PED) placement (58%). Time to the guiding-catheter placement was not significantly different between the groups (DCEA vs TFBA = 31.0 min vs 24.7 min, p = 0.178). No significant complications of DCEA, such as subcutaneous hematomas, were observed. Conclusion Even with the use of antiplatelet and anticoagulation therapy, the DCEA can be performed safely for unruptured aneurysms in elderly patients.

Efficacy and safety of preoperative embolization in carotid body tumor treatment: A propensity score matching retrospective cohort study

“…The embolization of CBT was performed by a team of vascular surgeons 24–72 h before surgical resection. During the embolization procedure, heparin was administrated intravenously to keep an activated clotting time (ACT) of over 250 s 20 . Transfemoral access was established using a 5F microsheath and 5F micropuncture needle.…”

“…The embolization of CBT was performed by a team of vascular surgeons 24-72 h before surgical resection. During the embolization procedure, heparin was administrated intravenously to keep an activated clotting time (ACT) of over 250 s. 20 Transfemoral access was established using a 5F microsheath and 5F micropuncture needle. After 5F diagnostic catheter was successfully placed into the CCA, angiography was conducted for the assessment of Circle of Willis, and in the ECA with selective branches to determine important feeding arteries of the CBT.…”