Modifying flow in the ACA–ACoA complex: endovascular treatment option for wide-neck internal carotid artery bifurcation aneurysms

Nossek, Erez; Chalif, David J.; Levine, Mitchell; Setton, Avi

doi:10.1136/neurintsurg-2014-011183

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…Wide-neck and giant ICAb aneurysms are rare entities and its management remains challenging independently of the choice between endovascular or surgical treatment. [ 18 19 20 21 22 23 24 25 26 27 28 29 ] Several options have already been proposed, including coiling, ballooning, stenting, bypass, and clipping. [ 13 22 23 24 27 28 29 ]…”

Section: Discussionmentioning

confidence: 99%

“…Nossek et al . [ 17 18 ] pioneered the utility of the pipeline embolization device to modify the flow in the ACA-ACoA complex using a single FD extending from the supraclinoid ICA to the proximal M1 segment. Supraclinoid ICA aneurysms treated in this fashion showed early or delayed reversal of flow in the “covered” A1 segment, with size regression and retrograde filling through the ACoA.…”

Section: Discussionmentioning

confidence: 99%

“…All the four cases showed good flow into the ipsilateral medial lenticulostriate arteries from the contralateral A1 segment. [ 17 18 ]…”

Section: Discussionmentioning

confidence: 99%

“…Direct clipping and clip reconstruction may be hindered due to the intraluminal thrombus, wide neck of the aneurysm, and the ACA and MCA that may arise from its walls. [ 17 18 19 20 21 22 23 ]…”

Section: Introductionmentioning

confidence: 99%

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Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

Al³

et al. 2016

Surg Neurol Int

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Background:Internal carotid artery bifurcation (ICAb) aneurysms account for about 2–15% of all intracranial aneurysms. In giant and complex cases, treatment may be difficult and dangerous, once some aneurysms have wide neck and anterior cerebral artery (ACA) and middle cerebral artery (MCA) may arise from the aneurysm itself. Clip reconstruction may be difficult in such cases. Whenever possible, the occlusion of ACA transform the bifurcation in a single artery reconstruction (ICA to MCA), much easier than a bifurcation reconstruction.Methods:In patients with giant and complex ICAb aneurysms, we propose routine preoperative angiography with anatomical evaluation of anterior communicating artery (ACoA) patency during cervical common carotid compression with concomitant contralateral carotid artery injection. This allowed visualization of the expected reversal of flow in the A1 segment–ACoA complex. When test is positive, we can perform ipsilateral ACA (A1 segment) clip occlusion and flow modification of the ACA-ACoA complex transforming a three vessel (ICA, ACA, and MCA) reconstruction into a two vessel (ICA and MCA) reconstruction.Results:Two patients were treated, with 100% of occlusion and good outcome.Conclusions:Surgical treatment of giant and complex ICAb may be achieved with acceptable morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…All the four cases showed good flow into the ipsilateral medial lenticulostriate arteries from the contralateral A1 segment. [ 17 18 ]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

Al³

et al. 2016

Surg Neurol Int

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“…1 These techniques can be achieved via a communicating vessel, and they are especially efficacious when the angulation of the parent or branching vessel would be difficult or impossible to catheterize from an antegrade approach. 1,8,11,12,16,17,19,20 Transcirculation techniques for treatment of intracranial aneurysms have been extensively described for intrasaccular coiling, but not for extrasaccular flow diversion treatment. 1,7,8,11,12,16,17,19,20 They are associated with increased risk of thromboembolic complications due to navigation of smaller communicating cerebral arteries with the microcatheters, 1 and these procedures should only be attempted after careful evaluation of the anatomy, when the ipsilateral parent vessel approach is difficult or contraindicated.…”

Section: Discussionmentioning

confidence: 99%

Transcirculation Pipeline embolization device deployment: a rescue technique

Valle-Giler

Atallah

Tjoumakaris

et al. 2017

Neurosurgical Focus

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The Pipeline embolization device (PED) has become a very important tool in the treatment of nonruptured cerebral aneurysms. However, a patient’s difficult anatomy or vascular stenosis may affect the device delivery. The purpose of this article was to describe an alternate technique for PED deployment when ipsilateral anatomy is not amenable for catheter navigation.A 44-year-old woman with a symptomatic 6-mm right superior hypophyseal artery aneurysm and a known history of right internal carotid artery dissection presented for PED treatment of her aneurysm. An angiogram showed persistence of the arterial dissection with luminal stenosis after 6 months of dual antiplatelet treatment. The contralateral internal carotid artery was catheterized and the PED was deployed via a transcirculation approach, using the anterior communicating artery. Transcirculation deployment of a PED is a viable option when ipsilateral anatomy is difficult or contraindicated for this treatment.

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Risk factor analysis of changes in blood flow in the A1 segment of the anterior cerebral artery after flow-diverter coverage of it

Ma,

Deng,

Chen

et al. 2024

Neurosurg Rev

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BackgroundFew studies have explored the effect of ow diverter device (FD) on blood ow in A1 segment of the anterior cerebral artery (ACA), after treatment of intracranial aneurysms in the bifurcation region of the internal carotid artery (ICA). The main objective of this article is to investigate the factors that affecting A1 blood ow after FD cover the A1 artery. Materials and MethodThis is a single-center, retrospective study. Data were collected retrospectively from our center, patients whose FDs were placed for treatment from the terminal of the ICA to the M1 segment were analyzed. ResultsA total of 42 patients were included in the study. Immediate post-procedural angiography following device placement revealed decreased blood ow in the A1 of 15 (35.7%) patients and complete occlusion of the A1 segment in 11 (26.2%) patients. During an average follow-up period of 9.8 months, the A1 segment was ultimately occluded in 25 patients (59.5%), decreased blood ow in 4 patients (9.5%). ConclusionWhen using FD to cover the A1 artery for the treatment of intracranial aneurysms, patients with preoperative opening of the anterior communicating artery (AcomA) are more prone to occlusion or decreased blood ow of the A1 artery, compared to patients without opening.

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Modifying flow in the ACA–ACoA complex: endovascular treatment option for wide-neck internal carotid artery bifurcation aneurysms

Abstract: We found that the proposed technique of flow modification can allow for hemodynamic conversion of ICAb to 'side-wall' aneurysm. In patients with good collateral flow through the anterior communicating complex, this treatment paradigm is safe and effective.

Cited by 12 publications

References 17 publications

Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

Surgical flow modification of the anterior cerebral artery-anterior communicating artery complex in the management of giant aneurysms of internal carotid artery bifurcation: An alternative for a difficult clip reconstruction

Transcirculation Pipeline embolization device deployment: a rescue technique

Risk factor analysis of changes in blood flow in the A1 segment of the anterior cerebral artery after flow-diverter coverage of it

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