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Carotid Artery Sacrifice for Unclippable and Uncoilable Aneurysms: Endovascular Occlusion Vs Common Carotid Artery Ligation
- Source :
- Neurosurgery. 67:1431-1437
- Publication Year :
- 2010
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2010.
-
Abstract
- Background Optimal treatment of intracranial aneurysms involves complete occlusion of the aneurysm with preservation of the parent artery and all of its branches. Attempts to occlude the aneurysm and preserve the parent artery may be associated with a higher level of risk than parent vessel occlusion or trapping. Objective To evaluate our series of patients with large and giant aneurysms who underwent treatment via endovascular coiling with parent artery sacrifice or surgical ligation of the common carotid artery (CCA) and gain insight into the advantages and risks of each of these alternatives. Methods We retrospectively reviewed all patients with aneurysms who underwent carotid sacrifice via endovascular occlusion or surgical CCA ligation during an 8-year period at our institution. Results Twenty-seven patients with large and giant aneurysms of the internal carotid artery underwent carotid artery sacrifice via endovascular occlusion (n = 15) or CCA ligation (n = 12). Of the patients who underwent endovascular occlusion, 3 developed groin complications, 1 developed a new sixth nerve palsy, 1 died from vasospasm related to subarachnoid hemorrhage, and 1 died secondary to rupture of an associated 3-mm anterior communicating artery aneurysm 5 days postoperatively. Of the patients undergoing CCA ligation, 1 patient developed a partial hypoglossal palsy. Clinical improvement of presenting symptoms was observed in all surviving patients regardless of the method of treatment. Complete aneurysm obliteration was documented in all patients during the initial hospital stay. The mean radiographic long-term follow-up was 14.2 months, which was available in 20 of the 25 surviving patients (80%). Complete obliteration was confirmed at follow-up in all but 2 patients with large cavernous aneurysms; 1 was initially treated with endovascular occlusion and the other with carotid ligation. Conclusion Parent artery sacrifice is still a viable treatment for some complex aneurysms of the internal carotid artery. CCA ligation is a reasonable alternative to endovascular arterial sacrifice.
- Subjects :
- Adult
Male
medicine.medical_specialty
Subarachnoid hemorrhage
Carotid Artery, Common
medicine.medical_treatment
Aneurysm
medicine.artery
Occlusion
medicine
Humans
Carotid Stenosis
cardiovascular diseases
Artery occlusion
Common carotid artery
Embolization
Ligation
Aged
Aged, 80 and over
Endovascular coiling
business.industry
Intracranial Aneurysm
Middle Aged
medicine.disease
Embolization, Therapeutic
Surgery
Treatment Outcome
cardiovascular system
Female
Neurology (clinical)
Radiology
Internal carotid artery
business
Subjects
Details
- ISSN :
- 0148396X
- Volume :
- 67
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....cdaf561f96639fb7afd24064e998340f