Safety of carotid ligation and its role in the management of intracranial aneurysms.

Abstract

From the MRC Group for the Study of the Cerebral Circulation, Institute of Neurological Sciences, Glasgow S U MM AR RY By using measurements of cerebral blood flow and internal carotid artery pressure it is possible to select patients in whom carotid ligation can be performed with a very low risk of postoperative cerebral ischaemia. A study has been carried out in 100 patients comparing this method with clinical predictions of the type used in aneurysm surgery based on age of the patient, arterial hypertension, time from latest subarachnoid haemorrhage, and neurological status on a modified Botterell scale. These clinical factors were found to be of little value in predicting which patients would and would not develop cerebral ischaemia after carotid occlusion.

Use of Flow-Diverting Devices in Fusiform Vertebrobasilar Giant Aneurysms: A Report on Periprocedural Course and Long-Term Follow-Up

“…The incidence of FVBGAs is estimated to be only Ͻ1% of all intracranial aneurysms. [1][2][3][4][5][6][7][8][9][10][11][12] Little is known about the natural history of FVBGAs, but the data available indicate poor outcome and continuous progression of aneurysm size and related symptoms (brain stem compression, brain stem ischemia, subarachnoid hemorrhage in particular). 13,14 The treatment of FVBGAs presents enormous challenges.…”

Extracranial-Intracranial Bypass Surgery Using a Radial Artery Interposition Graft for Cerebrovascular Diseases

“…Acute occlusion of the ICA either accidentally or intentionally during treatment of ICA aneurysms or tumors results in stroke in 30-37% of patients 18,19) . EC-IC bypass has been used to avoid ischemic complications after ICA occlusion.…”

“…Occlusion rates have decreased over time, and are reported to be 5-29% 13,16,18) . A study by Lawton et al 16) analyzed 61 patients with 63 intracranial complex aneurysms treated with surgery and revascularization.…”

Superficial temporal artery to middle cerebral artery bypass: past, present, and future

“…20,29,37,46,49,90,117 Possible mechanisms of ischemia include embolic phenomena, failure to provide enough blood supply to the entire MCA territory, and retrograde thrombosis of the M 1 segment when the MCA is clipped just proximal to its bifurcation. 20,37,46,49,94,95,106 Based on an analysis of the known risks of the balloon occlusion test, 92 de novo aneurysm formation, 58 possible contralateral aneurysm enlargement, and the fact that some patients who pass a CAO test will still suffer an ischemic event, 74,77,92,118,129 some neurosurgeons have adopted the approach of performing an EC-IC bypass in all cases that require sacrifice of a major cerebral vessel. 58,73,101 Others will perform a bypass based on the analysis of clinical, angiographic, and balloon occlusion test results.…”