scholarly journals Endovascular Treatment for Lateral Wall Paraclinoid Aneurysms and the Influence of Internal Carotid Artery Angle

2021 ◽  
Vol 61 (4) ◽  
pp. 275-283
Author(s):  
Natsuki SUGIYAMA ◽  
Takashi FUJII ◽  
Kenji YATOMI ◽  
Kosuke TERANISHI ◽  
Hidenori OISHI ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Paraclinoid Aneurysms

Shaping and Navigating Methods of Microcatheters for Endovascular Treatment of Paraclinoid Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 67 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Bae Ju Kwon ◽  
So-Hyang Im ◽  
Jung Cheol Park ◽  
Young Dae Cho ◽  
Hyun-Seung Kang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Clinical Data ◽  
Internal Carotid ◽  
Simple Shape ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Specific Shape ◽  
Medial Group

Abstract OBJECTIVE To determine whether the use of a specific shape and a navigating method of microcatheters are suitable for placement at paraclinoid aneurysms. METHODS The clinical data from 122 patients with 132 paraclinoid aneurysms that underwent endovascular treatments during a 2.5-year period were retrospectively reviewed. Microcatheter shapes were classified as “straight,” “primary curves” (45, 90, and J), “preshaped-C,” “pigtail” (simple, right, and left), and “S” (simple, right, left, and preshaped). The navigating methods were classified as antegrade/retrograde microcatheter shift, wire-steering, looping, and coil/wire guiding. The shapes and navigating methods were compared among 3 aneurysm groups, which were categorized as superior, medial, and other, based on direction. RESULTS Shapes were significantly different between the 3 groups; the most commonly engaged shape in the superior group, medial group, and other group was S (55%), pigtail (60%), and primary (56%), respectively. The straight and S shapes were used in 5 (83%) and 18 (86%) cases, respectively, in the superior group, whereas the pigtail shape was used in 50 (86%) cases in the medial group. Aside from pigtail-simple shape, the side of pigtail, right vs left, coincided with the side of the internal carotid artery involved in every case of the medial group. The navigating methods were not significantly different among the 3 groups. CONCLUSION A specific shape by paraclinoid aneurysm direction tends to be suitable for the first trial of microcatheter shapes. Operators may reduce unnecessary struggling time of intra-aneurysmal placement of microcatheters by practicing the use of that shape.

Temporary Clipping of the Intracavernous Internal Carotid Artery: A Novel Technique for Proximal Control

2020 ◽  
Author(s):  
Jaafar Basma ◽  
Khaled M Krisht ◽  
Paul Lee ◽  
Li Cai ◽  
Ali F Krisht
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Senior Author ◽  
Horizontal Segment ◽  
Safe Alternative ◽  
Paraclinoid Aneurysms ◽  
Horizontal Portion ◽  
Temporary Clipping

Abstract BACKGROUND Securing proximal control in complex paraclinoid aneurysm surgery through traditional techniques may be challenging and risky in certain situations. Advancements of anatomical knowledge of the cavernous sinus (CS) and hemostasis have made it more accessible as a surgical option. OBJECTIVE To describe the technique of temporary clipping of the horizontal segment of the intracavernous internal carotid artery (IC-ICA) in preparation for permanent clipping of complex paraclinoid aneurysms. METHODS Through an extradural pretemporal approach, the lateral wall of the CS is exposed. The dura between the trochlear nerve and V1 is opened, and access is made to the horizontal segment of the IC-ICA. After circumferential dissection, the temporary clip can be introduced to the artery, and the extradural clinoidectomy can be continued under secured proximal control. RESULTS Seven patients with complex paraclinoid aneurysms were treated between May 2013 and May 2016 by the senior author. Temporary clipping of the IC-ICA was performed in all cases. Average time to achieve proximal control was 22.6 min (22.6 ± 13.8). One patient developed transient oculomotor palsy postoperatively. There were no other complications. CONCLUSION When the exposed clinoidal segment of the internal carotid artery does not offer sufficient proximal space for temporary clipping, the extradural approach can be extended to the horizontal portion of the IC-ICA. In our experience, this technique is a quick, reliable, and safe alternative to the classical modalities of temporary occlusion.

scholarly journals Ruptured Petrous Carotid Pseudoaneurysm Due to Tuberculous Otitis: Endovascular Treatment

2006 ◽  
Vol 12 (1) ◽  
pp. 53-56 ◽  
Author(s):  
A.B. Yagci ◽  
F.N. Ardiç ◽  
I. Oran ◽  
F. Bir ◽  
N. Karabulut
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Unusual Case ◽  
Internal Carotid ◽  
Surgical Intervention ◽  
Imaging Findings ◽  
Parent Vessel ◽  
Detachable Balloon ◽  
Artery Pseudoaneurysm

We report the imaging findings and endovascular treatment in an unusual case of petrous internal carotid artery pseudoaneurysm due to primary tuberculous otitis. The aneurysm was recognized and ruptured during a surgical intervention for otitis. Successful endovascular treatment of the aneurysm was performed by occlusion of the parent vessel using detachable balloon and coils.

Microsurgical Anatomy and Surgical Exposure of the Petrous Segment of the Internal Carotid Artery

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS210-ONS239 ◽  
Author(s):  
Shigeyuki Osawa ◽  
Albert L. Rhoton ◽  
Necmettin Tanriover ◽  
Satoru Shimizu ◽  
Kiyotaka Fujii
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Sphenoid Sinus ◽  
Internal Carotid ◽  
Lateral Wall ◽  
Common Trunk ◽  
Microsurgical Anatomy ◽  
Carotid Canal ◽  
Complex Relationships ◽  
Arteries And Veins

Abstract Objective: The petrous segment of the internal carotid artery has been exposed in the transpetrosal, subtemporal, infratemporal, transnasal, transmaxillary, transfacial, and a variety of transcranial approaches. The objective of the current study was to examine anatomic features of the petrous carotid and its branches as related to the variety of approaches currently being used for its exposure. Methods: Twenty middle fossae from adult cadaveric specimens were examined using magnification of ×3 to ×40 after injection of the arteries and veins with colored silicone. Results: The petrous carotid extends from the entrance into the carotid canal of the petrous part of the temporal bone to its termination at the level of the petrolingual ligament laterally and the lateral wall of the sphenoid sinus medially. The petrous carotid from caudal to rostral was divided into 5 segments: posterior vertical, posterior genu, horizontal, anterior genu, and anterior vertical. Fourteen (70%) of the 20 petrous carotids had branches. The branch that arose from the petrous carotid was either a vidian or periosteal artery or a common trunk that gave rise to both a vidian and 1 or more periosteal arteries. The most frequent branch was a periosteal artery. Conclusion: An understanding of the complex relationships of the petrous carotid provides the basis for surgically accessing any 1 or more of its 5 segments.

scholarly journals The Efficacy of Endovascular Treatment of Ruptured Blood Blister-Like Aneurysms Using Stent-Assisted Coil Embolization

2012 ◽  
Vol 18 (4) ◽  
pp. 432-441 ◽  
Author(s):  
Y.K. Ihn ◽  
S.H. Kim ◽  
J.H. Sung ◽  
T-G. Kim
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Endovascular Treatment ◽  
Coil Embolization ◽  
Internal Carotid ◽  
Treatment Strategies ◽  
Additional Treatment ◽  
Stent Insertion ◽  
Supraclinoid Internal Carotid Artery

We report our experience with endovascular treatment and follow-up results of a ruptured blood blister-like aneurysm (BBA) in the supraclinoid internal carotid artery. We performed a retrospective review of ruptured blood blister-like aneurysm patients over a 30-month period. Seven patients (men/women, 2/5; mean age, 45.6 years) with ruptured BBAs were included from two different institutions. The angiographic findings, treatment strategies, and the clinical (modified Rankin Scale) and angiographic outcomes were retrospectively analyzed. All seven BBAs were located in the supraclinoid internal carotid artery. Four of them were ≥ 3 mm in largest diameter. Primary stent-assisted coiling was performed in six out of seven patients, and double stenting was done in one patient. In four patients, the coiling was augmented by overlapping stent insertion. Two patients experienced early re-hemorrhage, including one major fatal SAH. Complementary treatment was required in two patients, including coil embolization and covered-stent placement, respectively. Six of the seven BBAs showed complete or progressive occlusion at the time of late angiographic follow-up. The clinical midterm outcome was good (mRS scores, 0–1) in five patients. Stent-assisted coiling of a ruptured BBA is technically challenging but can be done with good midterm results. However, as early regrowth/re-rupture remains a problem, repeated, short-term angiographic follow-up is required so that additional treatment can be performed as needed.

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