Endovascular treatment of patients with cerebral aneurysms associated with carotid stenosis
DOI:
https://doi.org/10.34687/2219-8202.JAD.2023.02.0002Keywords:
Cerebral aneurysm, carotid stenosis, stenting, spiral occlusion, ischemic stroke, subarachnoid hemorrhage.Abstract
Introduction. The combination of carotid artery stenosis and intracranial aneurysms occurs with a frequency of up to 6.5%. Determination of the optimal approach to treatment of this group of patients includes minimization of risks of both ischemic stroke and aneurysm rupture.
Objective of the study. To analyze the results of surgical treatment of patients with a combination of cerebral aneurysms and stenoses of the precerebral arteries.
Material and methods. A retrospective analysis of the results of treatment of patients with cerebral aneurysms combined with carotid artery stenosis who underwent surgical treatment in our institution during the period from 2019 to 2020 was performed. A comparative analysis was performed according to the main parameters: gender, history of subarachnoid hemorrhage and transient ischemic attack, unilateral or bilateral carotid artery stenosis, number of aneurysms, ipsilateral or contralateral location of aneurysm, degree of artery stenosis, stability of atherosclerotic plaque, intra- and postoperative complications.
Results. Sixteen patients were included in the study. Angioplasty with carotid stenting was the first stage in 3 patients, occlusion or embolization of aneurysm in 9 patients, one-stage treatment was performed in 4 patients. The most frequent aneurysm localization was the ophthalmic segment of the internal carotid artery. Multiple aneurysmal lesions of cerebral vessels were detected in 8 patients. Initial carotid angioplasty was not associated with aneurysm rupture in any patient in the study subsequently.
Conclusion. Combined carotid artery stenosis and intracranial aneurysms are relatively uncommon. Carotid angioplasty as the first stage of treatment does not increase the risk of aneurysm rupture in the short term, in our opinion. One-stage aneurysm occlusion and angioplasty with carotid stenting are the methods of choice if technically possible.
Downloads
References
Zhao, H. Y., Jia, Z. C., & Fan, D. S. (2018). Zhonghua nei ke za zhi, 57(3), 196–200. https://doi.org/10.3760/cma.j.issn.0578-1426.2018.03.009
Clifton A. G. (2000). MR angiography. British medical bulletin, 56(2), 367–377. https://doi.org/10.1258/0007142001903274
Бобинов В.В., Рожченко Л.В., Горощенко С.А., Коломин Е.Г., Петров А.Е. Ближайшие и отдаленные результаты внутрисосудистой окклюзии церебральных аневризм отделяемыми спиралями. Российский нейрохирургический журнал им. профессора А.Л. Поленова. 2022. Т. 14. № 2. С. 29-36.
Suh, B. Y., Yun, W. S., & Kwun, W. H. (2011). Carotid artery revascularization in patients with concomitant carotid artery stenosis and asymptomatic unruptured intracranial artery aneurysm. Annals of vascular surgery, 25(5), 651–655. https://doi.org/10.1016/j.avsg.2011.02.015
Tallarita, T., Sorenson, T. J., Rinaldo, L., Oderich, G. S., Bower, T. C., Meyer, F. B., & Lanzino, G. (2019). Management of carotid artery stenosis in patients with coexistent unruptured intracranial aneurysms. Journal of neurosurgery, 1–4. Advance online publication. https://doi.org/10.3171/2018.9.JNS182155
Badruddin, A., Teleb, M. S., Abraham, M. G., Taqi, M. A., & Zaidat, O. O. (2010). Safety and feasibility of simultaneous ipsilateral proximal carotid artery stenting and cerebral aneurysm coiling. Frontiers in neurology, 1, 120. https://doi.org/10.3389/fneur.2010.00120
Korotkikh, A. V., Nekrasov, D. A., Khilchuk, A. A., Scherbak, S. G., & Sarana, A. M. (2020). Simultaneous internal carotid artery stenosis and ipsilateral anterior communicating artery saccular aneurysm treatment: a case report. Radiology case reports, 15(7), 1083–1086. https://doi.org/10.1016/j.radcr.2020.05.010
Siddiqui, A., Vora, N., Edgell, R. C., Callison, R. C., Kitchener, J., & Alshekhlee, A. (2012). Rupture of a cerebral aneurysm following carotid endarterectomy. Journal of neurointerventional surgery, 4(5), e27. https://doi.org/10.1136/neurintsurg-2011-010091
Jou, L. D., Shaltoni, H. M., Morsi, H., & Mawad, M. E. (2010). Hemodynamic relationship between intracranial aneurysm and carotid stenosis: review of clinical cases and numerical analyses. Neurological research, 32(10), 1083–1089. https://doi.org/10.1179/016164110X12681290831522
Yang, W., Rong, X., Braileanu, M., Jiang, B., Garzon-Muvdi, T., Caplan, J. M., Colby, G. P., Coon, A. L., Tamargo, R. J., & Huang, J. (2016). Is Carotid Revascularization Safe for Patients with Concomitant Carotid Stenosis and Intracranial Aneurysms?. World neurosurgery, 93, 11–18. https://doi.org/10.1016/j.wneu.2016.05.060
Cherednychenko, Y., Engelhorn, T., Miroshnychenko, A., Zorin, M., Dzyak, L., Tsurkalenko, O., & Cherednychenko, N. (2020). Endovascular treatment of patient with multiple extracranial large vessel stenosis and coexistent unruptured wide-neck intracranial aneurysm using a WEB device and Szabo-technique. Radiology case reports, 15(12), 2522–2529. https://doi.org/10.1016/j.radcr.2020.09.020
Усачев Д. И., Лукшин В. А., Яковлев С. Б. Актуальные вопросы реконструктивной хирургии магистральных артерий головы. Часть 1/Д. Ю. Усачев, В. А. Лукшин, С. Б. Яковлев — М.: Издательство ИП «Т. А. Алексеева», 2020 — с. 360.
Borkon, M. J., Hoang, H., Rockman, C., Mussa, F., Cayne, N. S., Riles, T., Jafar, J. J., Veith, F. J., Adelman, M. A., & Maldonado, T. S. (2014). Concomitant unruptured intracranial aneurysms and carotid artery stenosis: an institutional review of patients undergoing carotid revascularization. Annals of vascular surgery, 28(1), 102–107. https://doi.org/10.1016/j.avsg.2013.06.013
Park, J. C., Kwon, B. J., Kang, H. S., Kim, J. E., Kim, K. M., Cho, Y. D., & Han, M. H. (2013). Single-stage extracranial carotid artery stenting and intracranial aneurysm coiling: technical feasibility and clinical outcome. Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 19(2), 228–234. https://doi.org/10.1177/159101991301900213
Вязгина Е. М., Иванова Н. Е., Иванов А. Ю., Петров А. Е., Рожченко Л. В., Благоразумова Г. П., Горощенко С. А., Бобинов В. В., Иванов А. А., Синицын П. С. Двойная антиагрегантная терапия после установки интракраниальных стентов при аневризмах сосудов головного мозга (2019). Российский нейрохирургический журнал им. Проф. А. Л. Поленова, 2019, т. 11, №1, с. 8-14
Рожченко Л. В., Иванов А. Ю., Дрягина Н. В., Петров А. Е., Горощенко С. А., Раджабов С. Д,, Христофорова М. И., Иванов А. А. Коррекция тромбоэмболических осложнений при эндоваскулярных эмболизациях (2016). Трансляционная медицина, 2016, т. 3, №1, с. 98-105.
Kaçar, E., Nas, Ö. F., Erdoğan, C., & Hakyemez, B. (2015). Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm. Diagnostic and interventional radiology (Ankara, Turkey), 21(6), 476–482. https://doi.org/10.5152/dir.2015.15092
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 В. В. Бобинов, Л. В. Рожченко, А. Е. Петров, Н. К. Самочерных, К. А. Самочерных
This work is licensed under a Creative Commons Attribution 4.0 International License.
