The Treatment of Large and Giant Paraclinoid Internal Carotid Artery Aneurysms

Abstract

Paraclinoid internal carotid artery aneurysms originate from the internal carotid artery between the distal dural ring and the posterior communicating artery. Surgical treatment of these aneurysms is technically challenging because of the surrounding neurovascular structures. There are several ways to treat these lesions: direct clipping with retrograde suction decompression, endovascular coiling, coiling with stent, and flow diverter stent. Here, I briefly review the surgical and endovascular options.

Paraclinoid unruptured giant aneurysm with therapeutic success

“…Both treatments carry a risk of morbidity and mortality. In this context, it is suggested that the treatment of this pathology occur in centers with a high flow of cases and high experience in the management and choice of the most appropriate treatment [2,[4][5][6][7][8]. The treatment of this pathology is complex and requires strict, meticulous planning before treatment, as described previously in our paper and based on the articles.…”

“…New studies may allow greater precision and resolution. It is a non-invasive technique that may provide benefit for the diagnosis of these patients [5].…”

“…As described in previous studies, the risk of rupture in UIA depends essentially on the size, location and shape of the aneurysm. Preventive treatment is justified when the benefits outweigh the anticipated risks of carrying out the treatment [4][5][6][7]. The decision to treat depends on risk of rupture, because the treatment in UIA is to prevent the SAH and the potentially devastating effects, as described in all studies evaluated.…”

Surgery of Giant Aneurysm

“…In a study by van Rooij et al [25], it is found that nearly all giant aneurysms show reopening after endovascular treatment in the 6-month postoperative period, even up to several years of stable condition. The follow-up strategy for these patients is to schedule additional coiling procedures along with routine follow-up, with decreased patient compliance as a result [25,37]. MRA has also been suggested as a routine follow-up procedure after endovascular treatment [37].…”

“…The follow-up strategy for these patients is to schedule additional coiling procedures along with routine follow-up, with decreased patient compliance as a result [25,37]. MRA has also been suggested as a routine follow-up procedure after endovascular treatment [37].…”