Consecutive low-flow and high-flow EC-IC bypass in ischemia prevention during internal carotid artery sacrifice in intracavernous aneurysm

2020 ◽  
Vol 83/116 (5) ◽  
pp. 563
Author(s):  
Vladimír Pribáň ◽  
Jiří Dostál ◽  
Irena Holečková ◽  
Jan Mraček
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
High Flow ◽  
Low Flow ◽  
Intracavernous Aneurysm

scholarly journals High flow bypass for right giant cavernous internal carotid artery aneurysm with fibromuscular dysplasia of cervical internal carotid artery: microsurgical 2-D video

2020 ◽  
Vol 11 ◽  
pp. 177
Author(s):  
Miguel Angel Lopez-Gonzalez ◽  
Xiaochun Zhao ◽  
Dinesh Ramanathan ◽  
Timothy Marc Eastin ◽  
Song Minwoo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Radial Artery ◽  
Fibromuscular Dysplasia ◽  
Internal Carotid ◽  
High Flow ◽  
Oculomotor Nerve Palsy ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Cervical Internal Carotid Artery

Background: It is well known that intracranial aneurysms can be associated to fibromuscular dysplasia (FMD). Nevertheless, it is not clear the best treatment strategy when there is an association of giant symptomatic cavernous carotid aneurysm with extensive cervical internal carotid artery (ICA) FMD. Case Description: We present the case of 63 year-old right-handed female with hypothyroidism, 1 month history of right-sided pulsatile headache and visual disturbances with feeling of fullness sensation and blurry vision. Her neurological exam showed partial right oculomotor nerve palsy with mild ptosis, asymmetric pupils (right 5 mm and left 3mm, both reactive), and mild exotropia, normal visual acuity. Computed tomography angiogram and conventional angiogram showed 2.5 × 2.6 × 2.6 cm non-ruptured aneurysm arising from cavernous segment of the right ICA. She had right hypoplastic posterior communicant artery, and collateral flow through anterior communicant artery during balloon test occlusion and the presence of right cervical ICA FMD. The patient was started on aspirin. After lengthy discussion of treatment options in our neurovascular department, between observations, endovascular treatment with flow diverter device, or high flow bypass, recommendation was to perform high flow bypass and patient consented for the procedure. We performed right-sided pterional trans-sylvian microsurgical approach and right neck dissection at common carotid bifurcation under electrophysiology monitoring (somatosensory evoked potentials and electroencephalography); while vascular surgery department assisted with the radial artery graft harvesting. The radial artery graft was passed through preauricular tunnel, cranially was anastomosed at superior trunk of middle cerebral artery, and caudally at external carotid artery (Video). Intraoperative angiogram showed adequate bypass patency and lack of flow within aneurysm. The patient was extubated postoperatively and discharged home with aspirin in postoperative day 5. Improvement on oculomotor deficit was complete 3 weeks after surgery. Conclusion: Nowadays, endovascular therapy can manage small to large cavernous ICA aneurysms even if associated to FMD, although giant symptomatic cavernous carotid aneurysms impose a different challenge. Here, we present the management for the association of symptomatic giant cavernous ICA aneurysm and cervical ICA FMD with high flow bypass. We consider important to keep the skills in the cerebrovascular neurosurgeon armamentarium for the safe management of these lesions.

scholarly journals Treatment of Carotid Cavernous Fistula Secondary to Rupture of a Giant Intracavernous Carotid Aneurysm

2003 ◽  
Vol 9 (3) ◽  
pp. 293-298 ◽  
Author(s):  
C.K. Kam ◽  
H. Alvarez ◽  
P. Lasjaunias
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Cavernous Fistula ◽  
Cavernous Fistula ◽  
Therapeutic Challenge ◽  
Intracavernous Aneurysm ◽  
Complete Closure ◽  
Direct Carotid Cavernous Fistula ◽  
Ophthalmic Arteries

Carotid cavernous fistula secondary to ruptured giant intracavernous aneurysm of the internal carotid artery is rare. We report a case of direct carotid cavernous fistula secondary to rupture of a giant intracavernous ICA aneurysm. The presence of mirror or twin aneurysms of bilateral ophthalmic arteries raises therapeutic challenge. Coiling of the intracavernous aneurysm could partially occlude the fistula. Complete closure of the fistula was facilitated by secondary carotid compression.

scholarly journals Traumatic Carotid Cavernous Fistula: Failure of Endovascular Treatment with Two Stent-Grafts

2005 ◽  
Vol 11 (4) ◽  
pp. 369-375 ◽  
Author(s):  
G. La Tessa ◽  
L. Pasqualetto ◽  
G. Catalano ◽  
M. Marino ◽  
C. Gargano ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
High Flow ◽  
Stent Grafts ◽  
Carotid Cavernous Fistula ◽  
Detachable Balloon ◽  
Cavernous Fistula ◽  
Endovascular Approach ◽  
Stenting Procedure

We describe an unconventional endovascular approach in a young patient with large high-flow traumatic carotid cavernous fistula that could not be treated by detachable balloon procedure. Two coronary stent-grafts were used to close the large tear of internal carotid artery. After the failure of stenting procedure, the fistula was successfully treated by trapping with two detachable balloons.

scholarly journals Balloon Test Occlusion for an Option to Decide Whether Simple ICA Ligation is Better Option than Trapping and High Flow Bypass of The Giant ICA Cavernous Aneurysm

2017 ◽  
Vol 14 (2) ◽  
pp. 32-35
Author(s):  
Saujanya Rajbhandari ◽  
Pravesh Rajbhandari ◽  
Pranaya Shrestha ◽  
Basant Pant ◽  
Anish Neupane
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Cross Flow ◽  
Balloon Occlusion ◽  
High Flow ◽  
Aneurysm Neck ◽  
Balloon Test Occlusion ◽  
Therapeutic Occlusion ◽  
Temporary Balloon Occlusion

Balloon Test occlusion (BTO) is a preoperative angiographic test used to estimate the risk of stroke after permanent therapeutic occlusion of an internal carotid artery (ICA) involved by aneurysms. Temporary balloon occlusion at the cavernous ICA aneurysm neck was performed in an attempt to assess the adequacy of cross flow from the opposite ICA. Adequate fl ow following BTO are preferred to have simple ICA ligation and incase of those who did not pass BTO trapping and high flow bypass is preferred .We have done Right ICA Ligation on our case report.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:32-35

scholarly journals Posttraumatic Carotid-Cavernous Fistulae Treated by Internal Carotid Artery Trapping and High-Flow Bypass Using a Radial Artery Graft

2011 ◽  
Vol 51 (2) ◽  
pp. 113-116 ◽  
Author(s):  
Takayuki MIZUNARI ◽  
Yasuo MURAI ◽  
Kyongsong KIM ◽  
Shiro KOBAYASHI ◽  
Hiroyasu KAMIYAMA ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Radial Artery ◽  
Internal Carotid ◽  
High Flow ◽  
Radial Artery Graft ◽  
Artery Graft
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