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

被引:11
作者
Nakajima, Norio [1 ]
Nagahiro, Shinji [1 ]
Satomi, Junichiro [1 ]
Tada, Yoshiteru [1 ]
Nakajima, Kohei [1 ]
Sogabe, Shu [1 ]
Hanaoka, Mami [1 ]
Matsubara, Shunji [2 ]
Uno, Masaaki [2 ]
Satoh, Koichi [3 ]
机构
[1] Univ Tokushima, Inst Hlth Biosci, Dept Neurosurg, Tokushima 770, Japan
[2] Kawasaki Med Sch, Dept Neurosurg, Okayama, Japan
[3] Tokushima Red Cross Hosp, Dept Neurosurg, Tokushima, Japan
关键词
Coil embolization; Giant aneurysm; High-flow bypass; Internal carotid artery; Retrograde blood flow; THERAPEUTIC OCCLUSION; PARENT ARTERY; FOLLOW-UP; REVASCULARIZATION;
D O I
10.1016/j.wneu.2015.01.037
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Recanalization has been reported in large or giant aneurysms of the internal carotid artery (ICA) addressed by high-flow bypass and endovascular treatment. Aneurysmal recanalization may be attributable to retrograde blood flow into the aneurysm through the ICA branches, such as the ophthalmic artery or the meningohypophyseal trunk, or through the surgically created bypass. We modified the endovascular treatment of aneurysms to prevent retrograde flow and evaluated the long-term efficacy of our method. METHODS: We used a hybrid operative/endovascular technique to treat 5 patients with large or giant aneurysms arising from the C2-C4 segment of the ICA who presented with visual symptoms due to the mass effect of the aneurysm. To prevent retrograde flow into the aneurysm our modified endovascular treatment involves coil embolization of the aneurysmal orifice and the ICA, including the origin of the ophthalmic artery and meningohypophyseal trunk, and placement of a high-flow bypass using a radial artery graft. RESULTS: During the 5- to 12-year follow-up period, 4 aneurysms disappeared, and the other decreased in size. There were no subarachnoid hemorrhages. All bypass grafts remained patent. Visual preservation was achieved in 2 patients; 1 patient manifested visual improvement. Although 2 patients experienced transient neurological deficits we encountered no permanent complications in this series. The final modified Rankin scale of the 5 patients was 0 or 1. CONCLUSIONS: Prevention of retrograde flow into the aneurysm by coil embolization with high-flow bypass is a safe and effective method. It prevents the recanalization of large or giant ICA aneurysms.
引用
收藏
页码:1127 / 1134
页数:8
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