Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage Associated with Bilateral Common Carotid Artery Occlusion

Abstract

<jats:p> Cases of aneurysm associated with the occlusion of both common carotid arteries are very rare. We present a case of ruptured aneurysms of the basilar bifurcation and posterior cerebral artery coexisting with bilateral common carotid artery occlusion, successfully treated by endovascular coil embolization with a double-balloon remodeling technique. Finally, we review the literature. A 62-year-old woman presented with severe headache; a computed tomography scan demonstrated subarachnoid hemorrhage. Angiography revealed that the bilateral common carotid arteries were occluded. </jats:p><jats:p> The muscle branches of the vertebral arteries had anastomosed to the bilateral external carotid arteries. Bilateral posterior communicating arteries had developed and supplied the bilateral internal carotid arteries. Two aneurysms (a saccular aneurysm of the P1 portion of the left posterior cerebral artery and a wide-necked aneurysm of the basilar bifurcation) were also observed. Endovascular embolization of the aneurysms was successfully performed using a double-balloon remodeling technique. </jats:p><jats:p> The patient made a full recovery after treatment, and the aneurysms remained obliterated 12 months after embolization. We believe that this is the first report of ruptured aneurysms associated with bilateral common carotid artery occlusion successfully treated by endovascular coiling. The double-balloon remodeling technique was useful for treatment of wide-necked basilar bifurcation aneurysm. </jats:p>

Aneurysmal Remodeling in the Circle of Willis after Carotid Occlusion in an Experimental Model

“…the basilar terminus (BT). [12][13][14][15] However, anterior de novo aneurysms have been reported to follow bilateral ICA occlusion, 16 presumably as a result of hemodynamic forces due to flow rerouting into the external carotid arteries and their anastomotic intracranial branches including the ophthalmic artery (OA). Such aneurysm presentation has also mirrored anterior de novo IAs observed in Moyamoya disease, 17 which involves progressive bilateral carotid occlusion.…”

Endovascular Treatment of Bilateral Carotid Artery Occlusion with Concurrent Basilar Apex Aneurysm: A Case Report and Literature Review

“…Three of the 6 cases we reviewed above showed such changes, including aneurysms of the posterior communicating, posterior cerebral, superior cerebellar, anterior inferior cerebellar, and posterior inferior cerebellar arteries 9,11,12. For such aneurysms combined aggressive treatment should be performed, but is more difficult.…”

Coil Embolization of a Ruptured Basilar Tip Aneurysm Associated with Bilateral Cervical Internal Carotid Artery Occlusion: A Case Report and Literature Review

“…Thus, these aneurysms have been recently treated with endovascular procedures using soft platinum coils. There have been several reports have showing excellent results of endovascular embolization for the basilar tip aneurysms in patients with moyamoya disease and bilateral ICA occlusion 4)6)7)10)12)17). Of course, if increased blood burden through the vertebrobasilar system is not alleviated, the aneurysm will probably regrow.…”

“…Thanks to the development of endovascular techniques, the aneurysms that are difficult to reach by craniotomy can now be treated with excellent results 3)4)6). To the best of our knowledge, there have been only seven cases of bilateral carotid artery occlusion with concurrent basilar tip aneurysm not being related to moyamoya disease 5)7)8)11)12)17)18). Among them, only three cases were treated with coil embolization 7)12)17).…”