Simultaneous Endovascular Treatment of Tandem Internal Carotid Lesions

Cvetić, Vladimir; Dragaš, Marko; Colić, Momcilo; Vukašinović, Ivan; Radmili, Oliver; Ilić, Nikola; Končar, Igor; Baščarević, Vladimir; Ristanovic, Natasa; Davidović, Lazar

doi:10.1177/1538574416652246

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…As the safety of endovascular modalities for UIA treatment and carotid stenosis continues to improve, the notion of single-staged treatment has increasing appeal. Cases reports have demonstrated the feasibility of simultaneous single-staged treatment of concomitant carotid stenosis and ipsilateral UIAs [7,17,20,21]. Some authors hold different views.…”

Section: Discussionmentioning

confidence: 99%

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Jin¹,

Jing²,

Meng³

et al. 2020

Preprint

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Abstract Background To evaluate the safety of endovascular therapy for concomitant unruptured intracranial aneurysms (UIAs) and cerebral vascular stenosis. Methods Patients between January to August 2019 were retrospectively reviewed at our institution. Concomitant UIA and cerebral vascular stenosis patients underwent endovascular treatment were included. The demographics and clinical information were collected. Patients were divided into 4 groups according to lesions that was treated (aneurysm, stenosis, both lesions in a single session or in separated sessions). Patients were divided into another 2 groups based on locations of aneurysm and stenosis (ipsilateral and non-ipsilateral). The demographics and clinical data were compared among groups. Results A total of 105 (4.9%) cases have concomitant UIA and cerebral vascular stenosis. Eighty-one patients underwent endovascular treatment for the stenosis(n=18), aneurysm(n=41) or both lesions (one session=10; separated sessions n=12). Seven (8.6%) patients experienced procedural related complications, including 1 (1.2%) hemorrhagic and 6 (7.4%) ischemic types. In terms of procedures, 4 (6.3%) complications is related with UIA embolization, 2(5.0%) related with intracranial stenosis angioplasty. Complication rate of patients underwent intracranial angioplasty and aneurysm embolization simultaneously is much higher (20%) than that of the other groups (5.6%-8.3%). Patients with ipsilateral lesions also had higher complication rate (11.1%) than non-ipsilateral patients (6.7%). Follow-up (74 patients, mean=6.5months) result showed good clinical outcome in 70 (94.6%) patients. Conclusions Simultaneous treatment for concomitant UIA and extracranial stenosis may not pose additional risks. Ipsilateral lesions and single session procedure for intracranial stenosis and UIA are potential risk factors for periprocedural complications.

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Section: Discussionmentioning

confidence: 99%

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Jin¹,

Jing²,

Meng³

et al. 2020

Preprint

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“…Surgical planning for single-stage treatment of concomitant extracranial carotid stenosis and ipsilateral intracranial aneurysms must address of the sequence of neurointerventions with particular attention to the plaque morphology 7. Recent case reports and small-volume case series suggest CAS takes precedent over aneurysm embolisation in the single-stage treatment of both concomitant vasculopathologies 6–9.…”

Section: Discussionmentioning

confidence: 99%

Tandem cervical carotid stenting for stenosis with flow diversion embolisation for the treatment of intracranial aneurysms

et al. 2018

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BackgroundAn estimated 2%–3% of the population harbour an intracranial aneurysm. Concomitant atherosclerotic cervical carotid disease is not uncommon. The management of these two entities remains a challenge within the field.Case presentationWe report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.DiscussionNo consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis. Here, we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment. The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

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“…The prevalence of concurrent unruptured intracranial aneurysms (UIAs) with carotid artery stenosis is significant, and the incident rate of concomitant UIAs and internal carotid artery (ICA) stenosis is approximately between 1% and 14.2% [1,2]. Most of the cases were screened incidentally in the preoperative radiology evaluations [3]. However, the optimal treatment decision for these patients is still a therapeutic dilemma in front of endovascular and surgeon teams [4].…”

Section: Introductionmentioning

confidence: 99%

“…However, the optimal treatment decision for these patients is still a therapeutic dilemma in front of endovascular and surgeon teams [4]. Treatment of UIAs first may lead to an intra-operative ischemic stroke due to the compromised cerebral blood flow (CBF) [3]. Revascularization of ICA stenosis first, contrariwise, not only elevates the cerebral perfusion but also requires post-operative anticoagulation, which could subsequently elevate the rupture risk of the UIA [5,6].…”

Section: Introductionmentioning

confidence: 99%

Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

Zhu

Wei

et al. 2019

Applied Sciences

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The optimal management strategy of patients with concomitant anterior communicating artery aneurysm (ACoAA) and internal carotid artery (ICA) stenosis is unclear. This study aims to evaluate the impacts of unilateral ICA revascularization on hemodynamics factors associated with rupture in an ACoAA. In the present study, a multiscale computational model of ACoAA was developed by coupling zero-dimensional (0D) models of the cerebral vascular system with a three-dimensional (3D) patient-specific ACoAA model. Distributions of flow patterns, wall shear stress (WSS), relative residence time (RRT) and oscillating shear index (OSI) in the ACoAA under left ICA revascularization procedure were quantitatively assessed by using transient computational fluid dynamics (CFD) simulations. Our results showed that the revascularization procedures significantly changed the hemodynamic environments in the ACoAA. The flow disturbance in the ACoAA was enhanced by the resumed flow from the affected side. In addition, higher OSI (0.057 vs. 0.02), prolonged RRT (1.14 vs. 0.39) and larger low WSS area (66 vs. 50 mm2) in ACoAA were found in the non-stenotic case. These acute changes in hemodynamics after revascularization may elevate the rupture risk of ACoAA. The preliminary results validated the feasibility of predicting aneurismal hemodynamics characteristics in revascularization procedures by using multiscale CFD simulations, which would benefit the management of this group of patients.

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Simultaneous Endovascular Treatment of Tandem Internal Carotid Lesions

Cited by 7 publications

References 12 publications

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Safety of Endovascular Treatment for Concomitant Unruptured Intracranial Aneurysms and Cerebral Vascular Stenosis

Tandem cervical carotid stenting for stenosis with flow diversion embolisation for the treatment of intracranial aneurysms

Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

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