Ischemic Complications after Radial Artery Grafting and Aneurysmal Trapping for Ruptured Internal Carotid Artery Anterior Wall Aneurysm

Murai, Yasuo; Mizunari, Takayuki; Umeoka, Katsuya; Tateyama, Kojiro; Kobayashi, Shiro; Teramoto, Akira

doi:10.1016/j.wneu.2011.05.020

Cited by 35 publications

(18 citation statements)

References 29 publications

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“…postoperative ischemic complications caused by ICA stenosis or occlusion. 23,25 While direct clipping is feasible in most cases of true berry aneurysms, which have firm vessel walls that tolerate clipping or coiling, BBAs and dissecting aneurysms frequently require more complicated surgical procedures, including clipping on wrapping materials, 15,19,31,42 ICA trapping with or without a bypass, 3,16,23,25,32 and endovascular treatment with a variety of advanced assisting techniques. 6,22,34,47 Therefore, the pathogenesis of the aneurysm is obviously critical in determining the treatment strategy for ICA anterior wall aneurysms.…”

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High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

Indo

Oya

Tanaka

et al. 2014

JNS

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Object Surgery for aneurysms at the anterior wall of the internal carotid artery (ICA), which are also referred to as ICA anterior wall aneurysms, is often challenging. A treatment strategy needs to be determined according to the pathology of the aneurysm—namely, whether the aneurysm is a saccular aneurysm with firm neck walls that would tolerate clipping or coiling, a dissecting aneurysm, or a blood blister–like aneurysm. However, it is not always possible to properly evaluate the condition of the aneurysm before surgery solely based on angiographic findings. Methods The authors focused on the location of the ophthalmic artery (OA) in determining the pathology of ICA anterior wall aneurysms. Between January 2006 and December 2012, diagnostic cerebral angiography, for any reason, was performed on 1643 ICAs in 855 patients at Saitama Medical Center. The authors also investigated the relationship between the origin of the OA and the incidence of ICA anterior wall aneurysms. The pathogenesis was also evaluated for each aneurysm based on findings from both angiography and open surgery to identify any correlation between the location where the OA originated and the conditions of the aneurysm walls. Results Among 1643 ICAs, 31 arteries (1.89%) were accompanied by an anomalous origin of the OA, including 26 OAs originating from the C3 portion, 3 originating from the C4 portion, and 2 originating from the anterior cerebral artery. The incidence of an anomalous origin of the OA had no relationship to age, sex, or side. Internal carotid artery anterior wall aneurysms were observed in 16 (0.97%) of 1643 ICAs. Female patients had a significantly higher risk of having ICA anterior wall aneurysms (p = 0.026). The risk of ICA anterior wall aneurysm formation was approximately 50 times higher in patients with an anomalous origin of the OA (25.8% [8 of 31]) than in those with a normal OA (0.5% [8 of 1612], p < 0.0001). Based on angiographic classifications, saccular aneurysms were significantly more common in patients with an anomalous origin of the OA than in those with a normal OA (p = 0.041). Ten of 16 patients with ICA anterior wall aneurysms underwent craniotomies. Based on the intraoperative findings, all 6 aneurysms with normal OAs were dissecting or blood blister–like aneurysms, not saccular aneurysms. Conclusions There was a close relationship between the location of the OA origin and the predisposition to ICA anterior wall aneurysms. Developmental failure of the OA and subsequent weakness of the vessel wall might account for this phenomenon, as previously reported regarding other aneurysms related to the anomalous development of parent arteries. The data also appear to indicate that ICA anterior wall aneurysms in patients with an anomalous origin of the OA tend to be saccular aneurysms with normal neck walls. These findings provide critical information in determining therapeutic strategies for ICA anterior wall aneurysms.

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High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

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Oya

Tanaka

et al. 2014

JNS

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“…All aneurysms in our series and those we found in the literature could be readily classified into 1 of these 4 types (Table 2). 1,2,4,6,7,9,10,[12][13][14][18][19][20][23][24][25][26][27][28][29][31][32][33]35,[39][40][41][42][43][44]47,[49][50][51][52]57 Each type presented distinctive surgical pitfalls, which required a different clip placement technique.…”

Section: Blister Aneurysm Classificationmentioning

confidence: 99%

Morphological aspects of blister aneurysms and nuances for surgical treatment

Bojanowski

Weil

McLaughlin

et al. 2015

JNS

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Blister aneurysms of the internal carotid artery (ICA) arise at a nonbranching site of the dorsal wall of the supraclinoid portion of the ICA. 1,17,30,31,36,38,45,48,53,54 These types of aneurysms are rare and their management remains difficult. Whether the approach to these aneurysms is surgical or endovascular, the literature shows a high mortality and morbidity rate due to their fragile wall with its high rate of rupture during treatment. 28,38,46,48 However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions, thus making different treatment strategies difficult to assess. The first goal of this study was to ascertain whether blister aneurysm morphology played a role in the different pitfalls that may be encountered during surgery, and whether this morphology would require adapted surgical strategies. The second goal was to investigate whether any morphological differences could be categorized into abbreviatioN ICA = internal carotid artery. obJect Blister aneurysms of the supraclinoid part of the internal carotid artery (ICA) are known for their high morbidity and mortality rates related to treatment, regardless of whether the treatment is surgical or endovascular. However, this grim prognosis is based on results that indiscriminately group all blister aneurysms together without taking into account the heterogeneous appearance of these lesions. The goal of this study was 2-fold: to determine whether different blister aneurysm morphologies present different pitfalls, which would then require different surgical strategies, as well as to determine whether there are identifiable subgroups of these types of aneurysms based on morphology. methods The authors reviewed the charts, cerebral catheter angiograms, surgical reports, and intraoperative videos of all ICA blister aneurysms treated surgically at the Centre Hospitalier de l'Université de Montréal from 2005 to 2012 to investigate whether there was a relationship between morphology and pitfalls, and whether different surgical strategies had been used according to these pitfalls. During this review process the authors noted 4 distinct morphological aspects. These 4 aspects led to a review of the English and French literature on blister aneurysms in which imaging was available, to determine whether other cases could also be classified into the same 4 subgroups based on these morphological aspects. results The retrospective review of the authors' series of 10 patients allowed a division into 4 distinct subtypes: Type I (classic), Type II (berry-like), Type III (longitudinal), and Type IV (circumferential). These subtypes may at times be progressive stages in the arterial anomaly, and could represent a continuum. Each subtype described in this paper presented its own pitfalls and required specific surgical adaptations. Upon reviewing the literature the authors retained 35 studies involving a total of 61 cases of blister aneurysms, and all cases...

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“…This leaves a very limited amount of normal vessel wall onto which it is possible to place aneurysm clips and can make clip reconstruction, with preservation of a vessel diameter sufficient to sustain adequate perfusion in the territory supplied by the artery, impossible [12]. Extracranial to intracranial (EC-IC) bypass followed by parent artery occlusion or trapping has therefore been increasingly advocated by several authors as a means of treating blister aneurysms [13,18,37,38]. Various bypass techniques are used depending on the magnitude of the blood flow the bypass needs to sustain and the inherent availability of collateral blood flow.…”

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“…A high-flow bypass between the external carotid artery (ECA) and the MCA with an interposed arterial or venous graft (e.g., radial artery (RA) or saphenous vein (SV)) can provide much more substantial blood flow. When treating aneurysms of the supraclinoid internal carotid artery (ICA), a high-flow bypass such as the ECA-RA-MCA bypass is usually required [37,38].…”

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confidence: 99%

“…In one small study, 4 out of 5 patients with ruptured internal carotid artery blister aneurysms had good outcomes after treatment with ECA-RA-MCA bypass surgery and parent artery occlusion [38]. A temporary low-flow STA-MCA bypass was used during the procedure to provide adequate perfusion to the MCA territory while the permanent anastomosis between the ICA and MCA using a RA graft was established (so-called double-insurance bypass) [38].…”

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Blister Aneurysms

Byrne¹,

Mørkve²

2014

Neurovascular Imaging

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Blister aneurysms comprise about 1 % of ruptured intracranial aneurysms. They are associated with higher rates of rebleeding and, as a result, with greater mortality and morbidity than typical aneurysms. Because of rarity, the etiology and pathology are poorly understood. Diagnosis relies on a stereotypical appearance and location at non-branch points on the internal carotid artery at angiography, together with inspection at surgery. They are increasingly seen involving other intracranial arteries and generally considered to be caused by atherosclerotic mural disease.Surgical clipping is difficult because of their small size, sessile shape, and thin sac walls. It is frequently complicated by operative rupture, and alternative wrapping and trapping are often required. For these reasons, endovascular treatments are increasingly used as an alternative. The recent introduction of high mesh density stents, designed to redirect blood flow away from aneurysms and reinforce the parent artery, has stimulated the development of new procedures to manage these lesions. Initial experiences with flow-diverting stents have shown a substantial improvement in outcomes, and stent procedures are rapidly being accepted as the intervention of choice.

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Ischemic Complications after Radial Artery Grafting and Aneurysmal Trapping for Ruptured Internal Carotid Artery Anterior Wall Aneurysm

Cited by 35 publications

References 29 publications

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

High incidence of ICA anterior wall aneurysms in patients with an anomalous origin of the ophthalmic artery: possible relevance to the pathogenesis of aneurysm formation

Morphological aspects of blister aneurysms and nuances for surgical treatment

Blister Aneurysms

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