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Unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery: aneurysmal characteristics and outcomes following endovascular treatment

  • Clinical Article
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Abstract

Background

This study was undertaken to evaluate the aneurysmal characteristics and clinico-radiological outcomes of unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery (ICA).

Methods

The data of 34 patients that underwent endovascular treatment for 36 unruptured ICA anterior wall aneurysms were reviewed. ICA anterior wall aneurysms were defined as aneurysms that projected superiorly from the anterior wall of the ICA ophthalmic (n = 35) or communicating (n = 1) segment on lateral angiograms, without any branch vessel relationship. In addition, aneurysmal characteristics and treatment outcomes were compared with those of 60 unruptured aneurysms originating from the posterior (ventral) wall of the ICA ophthalmic segment.

Results

Patients with an ICA anterior wall aneurysm frequently had a mirror aneurysm on the contralateral side (14.7 % versus 3.3 %) or another ICA aneurysm (35.3 % versus 15 %). Two of the 36 ICA anterior wall aneurysms exhibited ICA narrowing suggestive of dissection, and another five had dysplastic ICA dilatation around the neck. Stent-assisted embolization was more frequently performed for ICA anterior wall aneurysms (66.7 % versus 36.7 %) because of unfavorable dome/neck (mean, 1.21) and aspect (mean, 1.15) ratios, and because of microcatheter instability associated with superior aneurysmal projections against the abrupt curvature of the carotid siphon. Procedure-related thromboembolic complications occurred in three patients in the anterior aneurysm group, but no patient deteriorated clinically. Immediate radiological outcomes were more unfavorable for ICA anterior wall aneurysms (residual sac, 36.1 % versus 16.7 %). Nevertheless, rates of recanalization (2.9 % versus 5.2 %) and progressive occlusion (24.7 % versus 8.1 %) during follow-up slightly favored ICA anterior wall aneurysms. Two stent-treated ICA anterior wall aneurysms developed asymptomatic ICA steno-occlusion (8.3 %).

Conclusions

Stent-assisted embolization is safe and effective for the treatment of unruptured ICA anterior wall aneurysms exhibiting unfavorable aneurysmal geometries and projections for coil embolization.

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References

  1. Abe M, Tabuchi K, Yokoyama H, Uchino A (1998) Blood blisterlike aneurysms of the internal carotid artery. J Neurosurg 89:419–424

    Article  PubMed  CAS  Google Scholar 

  2. al-Rodhan NR, Piepgras DG, Sundt TM Jr (1993) Transitional cavernous aneurysms of the internal carotid artery. Neurosurgery 33:993–996, discussion 997–998

    Article  PubMed  CAS  Google Scholar 

  3. Barami K, Hernandez VS, Diaz FG, Guthikonda M (2003) Paraclinoid carotid aneurysms: surgical management, complications, and outcome based on a new classification scheme. Skull Base 13:31–41

    Article  PubMed  Google Scholar 

  4. Boet R, Wong GK, Poon WS, Lam JM, Yu SC (2005) Aneurysm recurrence after treatment of paraclinoid/ophthalmic segment aneurysms—a treatment-modality assessment. Acta Neurochir (Wien) 147:611–616, discussion 616

    Article  CAS  Google Scholar 

  5. Bouthillier A, van Loveren HR, Keller JT (1996) Segments of the internal carotid artery: a new classification. Neurosurgery 38:425–432, discussion 432–423

    PubMed  CAS  Google Scholar 

  6. Chen L, Kato Y, Karagiozov KL, Yoneda M, Imizu S, Hayakawa M, Sadato A, Irie K, Negoro M, Sano H (2008) Usefulness of a simplified management scheme for paraclinoid aneurysms based on a modified classification. Cerebrovasc Dis 26:388–396

    Article  PubMed  Google Scholar 

  7. Day AL (1990) Aneurysms of the ophthalmic segment. A clinical and anatomical analysis. J Neurosurg 72:677–691

    Article  PubMed  CAS  Google Scholar 

  8. Horiuchi T, Kusano Y, Yako T, Murata T, Kakizawa Y, Hongo K (2011) Ruptured anterior paraclinoid aneurysms. Neurosurg Rev 34:49–55

    Article  PubMed  Google Scholar 

  9. Hwang G, Park H, Bang JS, Jin SC, Kim BC, Oh CW, Kang HS, Han MH, Kwon OK (2011) Comparison of 2-year angiographic outcomes of stent- and nonstent-assisted coil embolization in unruptured aneurysms with an unfavorable configuration for coiling. AJNR Am J Neuroradiol 32:1707–1710

    Article  PubMed  CAS  Google Scholar 

  10. Iihara K, Murao K, Sakai N, Shindo A, Sakai H, Higashi T, Kogure S, Takahashi JC, Hayashi K, Ishibashi T, Nagata I (2003) Unruptured paraclinoid aneurysms: a management strategy. J Neurosurg 99:241–247

    Article  PubMed  Google Scholar 

  11. King RM, Chueh JY, van der Bom IM, Silva CF, Carniato SL, Spilberg G, Wakhloo AK, Gounis MJ (2012) The effect of intracranial stent implantation on the curvature of the cerebrovasculature. AJNR Am J Neuroradiol (in press)

  12. Kinouchi H, Mizoi K, Nagamine Y, Yanagida N, Mikawa S, Suzuki A, Sasajima T, Yoshimoto T (2002) Anterior paraclinoid aneurysms. J Neurosurg 96:1000–1005

    Article  PubMed  Google Scholar 

  13. Kwon BJ, Im SH, Park JC, Cho YD, Kang HS, Kim JE, Han MH (2010) Shaping and navigating methods of microcatheters for endovascular treatment of paraclinoid aneurysms. Neurosurgery 67:34–40, discussion 40

    Article  PubMed  Google Scholar 

  14. Lawson MF, Newman WC, Chi YY, Mocco JD, Hoh BL (2011) Stent-associated flow remodeling causes further occlusion of incompletely coiled aneurysms. Neurosurgery 69:598–603, discussion 603–594

    Article  PubMed  Google Scholar 

  15. Lee CC, Hsieh TC, Wang YC, Lo YL, Lee ST, Yang TC (2010) Ruptured symptomatic internal carotid artery dorsal wall aneurysm with rapid configurational change. Clinical experience and management outcome: an original article. Eur J Neurol 17:1277–1284

    Article  PubMed  Google Scholar 

  16. Lubicz B, Bandeira A, Bruneau M, Dewindt A, Baleriaux D, De Witte O (2009) Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms. Neuroradiology 51:419–425

    Article  PubMed  Google Scholar 

  17. Mocco J, Fargen KM, Albuquerque FC, Bendok BR, Boulos AS, Carpenter JS, Fiorella DJ, Hoh BL, Howington JU, Liebman KM, Natarajan SK, Rai AT, Rodriguez-Mercado R, Siddiqui AH, Snyder KV, Veznedaroglu E, Hopkins LN, Levy EI (2011) Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. Neurosurgery 69:908–913, discussion 913–904

    Article  PubMed  CAS  Google Scholar 

  18. Nakagawa F, Kobayashi S, Takemae T, Sugita K (1986) Aneurysms protruding from the dorsal wall of the internal carotid artery. J Neurosurg 65:303–308

    Article  PubMed  CAS  Google Scholar 

  19. Ogawa A, Suzuki M, Ogasawara K (2000) Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms. Neurosurgery 47:578–583, discussion 583–576

    PubMed  CAS  Google Scholar 

  20. Ohkuma H, Nakano T, Manabe H, Suzuki S (2002) Subarachnoid hemorrhage caused by a dissecting aneurysm of the internal carotid artery. J Neurosurg 97:576–583

    Article  PubMed  Google Scholar 

  21. Park HK, Horowitz M, Jungreis C, Kassam A, Koebbe C, Genevro J, Dutton K, Purdy P (2003) Endovascular treatment of paraclinoid aneurysms: experience with 73 patients. Neurosurgery 53:14–23, discussion 24

    Article  PubMed  Google Scholar 

  22. Park JH, Park IS, Han DH, Kim SH, Oh CW, Kim JE, Kim HJ, Han MH, Kwon OK (2007) Endovascular treatment of blood blister-like aneurysms of the internal carotid artery. J Neurosurg 106:812–819

    Article  PubMed  Google Scholar 

  23. Roy D, Milot G, Raymond J (2001) Endovascular treatment of unruptured aneurysms. Stroke 32:1998–2004

    Article  PubMed  CAS  Google Scholar 

  24. Roy D, Raymond J, Bouthillier A, Bojanowski MW, Moumdjian R, L’Esperance G (1997) Endovascular treatment of ophthalmic segment aneurysms with Guglielmi detachable coils. AJNR Am J Neuroradiol 18:1207–1215

    PubMed  CAS  Google Scholar 

  25. Satoh A, Sugiyama T, Hongo K, Kakizawa Y, Ishihara S, Matsutani M (2008) Nationwide surveillance of IC anterior (or dorsal) wall aneurysm: with special reference to its dissecting nature. Acta Neurochir Suppl 103:51–55

    Article  PubMed  CAS  Google Scholar 

  26. Shapiro M, Becske T, Sahlein D, Babb J, Nelson PK (2012) Stent-supported aneurysm coiling: a literature survey of treatment and follow-up. AJNR Am J Neuroradiol 33:159–163

    Article  PubMed  CAS  Google Scholar 

  27. Sherif C, Gruber A, Dorfer C, Bavinzski G, Standhardt H, Knosp E (2009) Ruptured carotid artery aneurysms of the ophthalmic (C6) segment: clinical and angiographic long term follow-up of a multidisciplinary management strategy. J Neurol Neurosurg Psychiatry 80:1261–1267

    Article  PubMed  CAS  Google Scholar 

  28. Tanaka Y, Hongo K, Tada T, Nagashima H, Horiuchi T, Goto T, Koyama J, Kobayashi S (2002) Radiometric analysis of paraclinoid carotid artery aneurysms. J Neurosurg 96:649–653

    Article  PubMed  Google Scholar 

  29. Yadla S, Campbell PG, Grobelny B, Jallo J, Gonzalez LF, Rosenwasser RH, Jabbour PM (2011) Open and endovascular treatment of unruptured carotid-ophthalmic aneurysms: clinical and radiographic outcomes. Neurosurgery 68:1434–1443, discussion 1443

    PubMed  Google Scholar 

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No funds were received in support of this work.

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Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, Republic of Korea, 135-710

    Je Young Yeon, Seung-Chyul Hong & Jong-Soo Kim

  2. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, Gangnam-Gu, Seoul, Republic of Korea, 135-710

    Keon Ha Kim & Pyoung Jeon

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  1. Je Young Yeon
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  2. Seung-Chyul Hong
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  3. Jong-Soo Kim
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  4. Keon Ha Kim
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Correspondence to Seung-Chyul Hong or Pyoung Jeon.

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Yeon, J.Y., Hong, SC., Kim, JS. et al. Unruptured non-branching site aneurysms located on the anterior (dorsal) wall of the supraclinoid internal carotid artery: aneurysmal characteristics and outcomes following endovascular treatment. Acta Neurochir 154, 2163–2171 (2012). https://doi.org/10.1007/s00701-012-1509-8

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  • DOI: https://doi.org/10.1007/s00701-012-1509-8

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