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Early and midterm results of treatment of giant internal carotid artery paraclinoid aneurysms with trapping and flow diverters

  • Original Article - Vascular Neurosurgery - Aneurysm
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Abstract

Background

Flow diverter devices (FDD) carry risks of postoperative complications when treating aneurysms with wide necks, stenosis, and severe tortuosity of the parent vessel. In this study, we evaluated early and midterm results for the treatment of giant paraclinoid aneurysms managed by trapping and endovascular deployment of FDD.

Methods

Medical records were analyzed for patients with giant paraclinoid aneurysms treated between July 2008 and December 2017 at National Centre for Neurosurgery with either a flow diverter or by trapping the aneurysm with or without extracranial-intracranial (EC-IC) bypass surgery. We recorded age, sex, clinical presentation, treatment modality, morbidity, and mortality. Clinical outcomes were assessed using a modified Rankin scale (mRS).

Results

Among 29 consecutive patients, 13 were treated with FDD, and 16 patients were managed by trapping the aneurysm, where 7/16 cases had preliminary EC-IC bypass. Of 16 trapping patients, six were trapped endovascularly and ten were trapped surgically. During the follow-up period (mean 33 months, range 6–96), total exclusion of the aneurysm from the circulation was observed 100% of aneurysms in the trapping group and 84.6% in the FDD group (P = 0.192). Early postoperative morbidity was observed in three (23%) cases in the FDD group, and four (25%) in trapping group (P = 0.525). The FDD group had one (7.7%) fatal complication due to stent occlusion and severe ischemic stroke after three months postoperatively, despite appropriate antiplatelet therapy. There were no mortalities in the trapping group (P = 0.149). The rate of mRS 0–2 did not differ significantly across groups at discharge (81.3% vs. 69.2%; P = 0.667), and all patients had mRS 0–2 at follow-up (P = 1.000).

Conclusions

FDD deployment for giant paraclinoid aneurysms results in comparable angiographic and clinical outcomes to aneurysm trapping. Despite implementation of modern endovascular treatment methods, aneurysm trapping remains a valuable treatment option in carefully selected patients with giant paraclinoid aneurysms.

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References

  1. Allen EV (1929) Thromboanginitis obliterans: methods of diagnosis of chronic occlusive arterial lesion distal to the wrist with illustrative cases. Am J Med Sci 178:237–244

    Article  Google Scholar 

  2. Becske T, Potts MB, Shapiro M, Kallmes DF, Brinjikji W, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Nelson PK (2017) Pipeline for uncoilable or failed aneurysms: 3-year follow-up results. J Neurosurg 127:81–88. https://doi.org/10.3171/2015.6.JNS15311

    Article  PubMed  Google Scholar 

  3. Drake CG, Vanderlinden RG, Amacher AL (1968) Carotid-ophthalmic aneurysms. J Neurosurg 29:24–31. https://doi.org/10.3171/jns.1968.29.1.0024

    Article  CAS  PubMed  Google Scholar 

  4. Elhammady MS, Wolfe SQ, Farhat H, Ali Aziz-Sultan M, Heros RC (2010) Carotid artery sacrifice for unclippable and uncoilable aneurysms: endovascular occlusion vs common carotid artery ligation. Neurosurgery 67:1431–1436; discussion 1437. https://doi.org/10.1227/NEU.0b013e3181f076ac

    Article  PubMed  Google Scholar 

  5. Fiorella D, Lylyk P, Szikora I, Kelly ME, Albuquerque FC, McDougall CG, Nelson PK (2009) Curative cerebrovascular reconstruction with the Pipeline embolization device: the emergence of definitive endovascular therapy for intracranial aneurysms. J Neurointerv Surg 1:56–65. https://doi.org/10.1136/jnis.2009.000083

    Article  CAS  PubMed  Google Scholar 

  6. Fox AJ, Vinuela F, Pelz DM, Peerless SJ, Ferguson GG, Drake CG, Debrun G (1987) Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg 66:40–46. https://doi.org/10.3171/jns.1987.66.1.0040

    Article  CAS  PubMed  Google Scholar 

  7. Hanel RA, Spetzler RF (2008) Surgical treatment of complex intracranial aneurysms. Neurosurgery 62:1289–1297; discussion 1297-1289. https://doi.org/10.1227/01.neu.0000333794.13844.d9

    Article  PubMed  Google Scholar 

  8. Hauck EF, Welch BG, White JA, Replogle RE, Purdy PD, Pride LG, Samson D (2009) Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms. Surg Neurol 71:19–24; discussion 24. https://doi.org/10.1016/j.surneu.2008.01.025

    Article  PubMed  Google Scholar 

  9. Heran NS, Song JK, Kupersmith MJ, Niimi Y, Namba K, Langer DJ, Berenstein A (2007) Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy. J Neurosurg 106:968–975. https://doi.org/10.3171/jns.2007.106.6.968

    Article  PubMed  Google Scholar 

  10. Jahromi BS, Mocco J, Bang JA, Gologorsky Y, Siddiqui AH, Horowitz MB, Hopkins LN, Levy EI (2008) Clinical and angiographic outcome after endovascular management of giant intracranial aneurysms. Neurosurgery 63:662–674; discussion 674-665. https://doi.org/10.1227/01.NEU.0000325497.79690.4C

    Article  PubMed  Google Scholar 

  11. Kaliyev AB (2016) Endovascular treatment of complex ICA aneurysms. Review of the literature. Neurosurg Neurol Kazakhstan 1:19–23

    Google Scholar 

  12. Kim LJ, Tariq F, Levitt M, Barber J, Ghodke B, Hallam DK, Sekhar LN (2014) Multimodality treatment of complex unruptured cavernous and paraclinoid aneurysms. Neurosurgery 74:51–61; discussion 61; quiz 61. https://doi.org/10.1227/NEU.0000000000000192

    Article  PubMed  Google Scholar 

  13. Li J, Lan ZG, Liu Y, He M, You C (2012) Large and giant ventral paraclinoid carotid aneurysms: surgical techniques, complications and outcomes. Clin Neurol Neurosurg 114:907–913. https://doi.org/10.1016/j.clineuro.2012.01.039

    Article  PubMed  Google Scholar 

  14. Lv X, Ge H, He H, Jiang C, Li Y (2017) A systematic review of pipeline embolization device for giant intracranial aneurysms. Neurol India 65:35–38. https://doi.org/10.4103/0028-3886.198200

    Article  PubMed  Google Scholar 

  15. Matsuda M, Shiino A, Handa J (1985) Rupture of previously unruptured giant carotid aneurysm after superficial temporal-middle cerebral artery bypass and internal carotid occlusion. Neurosurgery 16:177–184

    Article  CAS  PubMed  Google Scholar 

  16. Murayama Y, Nien YL, Duckwiler G, Gobin YP, Jahan R, Frazee J, Martin N, Vinuela F (2003) Guglielmi detachable coil embolization of cerebral aneurysms: 11 years’ experience. J Neurosurg 98:959–966. https://doi.org/10.3171/jns.2003.98.5.0959

    Article  PubMed  Google Scholar 

  17. Nakajima N, Nagahiro S, Satomi J, Tada Y, Nakajima K, Sogabe S, Hanaoka M, Matsubara S, Uno M, Satoh K (2015) Prevention of retrograde blood flow into large or giant internal carotid artery aneurysms by endovascular coil embolization with high-flow bypass: surgical technique and long-term results. World Neurosurg 83:1127–1134. https://doi.org/10.1016/j.wneu.2015.01.037

    Article  PubMed  Google Scholar 

  18. Shi X, Qian H, Fang T, Zhang Y, Sun Y, Liu F (2015) Management of complex intracranial aneurysms with bypass surgery: a technique application and experience in 93 patients. Neurosurg Rev 38:109–119; discussion 119-120. https://doi.org/10.1007/s10143-014-0571-5

    Article  PubMed  Google Scholar 

  19. Shimizu T, Naito I, Aihara M, Fujimaki H, Asakura K, Miyamoto N, Yoshimoto Y (2015) Visual outcomes of endovascular and microsurgical treatment for large or giant paraclinoid aneurysms. Acta Neurochir 157:13–20. https://doi.org/10.1007/s00701-014-2251-1

    Article  PubMed  Google Scholar 

  20. Silva MA, See AP, Dasenbrock HH, Patel NJ, Aziz-Sultan MA (2017) Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis. Neurosurg Focus 42:E15. https://doi.org/10.3171/2017.3.FOCUS1718

    Article  PubMed  Google Scholar 

  21. Xu BN, Sun ZH, Romani R, Jiang JL, Wu C, Zhou DB, Yu XG, Hernesniemi J, Li BM (2010) Microsurgical management of large and giant paraclinoid aneurysms. World Neurosurg 73:137–146; discussion e117, e119. https://doi.org/10.1016/j.surneu.2009.07.042

    Article  PubMed  Google Scholar 

  22. Ye G, Zhang M, Deng L, Chen X, Wang Y (2016) Meta-analysis of the efficiency and prognosis of intracranial aneurysm treated with flow diverter devices. J Mol Neurosci 59:158–167. https://doi.org/10.1007/s12031-016-0723-x

    Article  CAS  PubMed  Google Scholar 

  23. Zhang Z, Lv X, Yang X, Shiqing MU, Wu Z, Shen C, Xu R (2015) Endovascular management of giant aneurysms: an introspection. Neurol India 63:184–189. https://doi.org/10.4103/0028-3886.156278

    Article  PubMed  Google Scholar 

  24. Zhu W, Tian YL, Zhou LF, Song DL, Xu B, Mao Y (2011) Treatment strategies for complex internal carotid artery (ICA) aneurysms: direct ICA sacrifice or combined with extracranial-to-intracranial bypass. World Neurosurg 75:476–484. https://doi.org/10.1016/j.wneu.2010.07.043

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge Medtronic, Inc. for editorial assistance.

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Authors and Affiliations

  1. National Centre for Neurosurgery, Turan Ave 34/1, Nur-Sultan, 010000, Kazakhstan

    Yerbol Makhambetov, Assylbek Kaliyev, Faizulla Smagulov, Yerkin Medetov, Marat Kulmirzayev, Talgat Kerimbayev, Nurlan Kissamedenov, Aigerim Tursynkhan, Aidos Doskaliyev & Serik Akshulakov

  2. University of Fukui, Fukui, Japan

    Ken-ichiro Kikuta

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  1. Yerbol Makhambetov
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Correspondence to Assylbek Kaliyev.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (local bioethical committee, protocol no. 1 dated February 12, 2018) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Makhambetov, Y., Kaliyev, A., Kikuta, Ki. et al. Early and midterm results of treatment of giant internal carotid artery paraclinoid aneurysms with trapping and flow diverters. Acta Neurochir 161, 1755–1761 (2019). https://doi.org/10.1007/s00701-019-04002-3

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