ABSTRACT
BACKGROUND: Aneurysms located in the distal middle cerebral artery (DMCA) are relatively rare and lack an established treatment strategy. For DMCA aneurysms, we performed a one-stage combined procedure of endovascular parent artery occlusion (PAO) with coils and superficial temporal artery to middle cerebral artery (STA-MCA) bypass in a hybrid operating room (HOR). The aim of this study was to evaluate the safety and efficacy of this procedure. METHODS: Cases of unruptured DMCA aneurysms treated with the one-stage combined PAO and STA-MCA bypass in HOR were retrospectively examined, and patients' and aneurysmal backgrounds, surgical procedures, and treatment outcomes were analyzed. RESULTS: Six patients were included in the study. The average maximum diameter of the aneurysms was 14.4 mm. One aneurysm was located at M2 and five at M3. All aneurysms had a fusiform shape. No cases were associated with infection, trauma, or malignant tumors. In all 6 cases, the combined PAO and STA-MCA bypass was successfully completed. No postoperative hemorrhagic complications occurred. A symptomatic ischemic complication occurred in 1 case whose symptom disappeared in a week. Three months after surgery, complete obliteration of the aneurysm and patency of the bypass was confirmed in all cases. CONCLUSIONS: The one-stage combined PAO and STA-MCA bypass in the HOR is safe and effective for DMCA aneurysms, potentially serving as a treatment option for this complex aneurysm.
ABSTRACT
Delayed intraparenchymal hemorrhage (DIPH) is one of the complications of flow diverter (FD) treatment, however, the mechanism is unclear. We present the case of a 54-year-old woman with a partially thrombosed large internal carotid artery aneurysm. She presented intraparenchymal hemorrhage in the right parietal lobe three days after the successful FD treatment. We performed endoscopic hematoma removal, and then her consciousness disturbance was fully recovered. IMP single-photon emission computed tomography showed significant increase of cerebral blood flow in the right hemisphere. We diagnosed DIPH associated with hyperperfusion after FD treatment. It is necessary to consider that DIPH due to hyperperfusion may occur after FD treatment.
Subject(s)
Carotid Artery, Internal , Cerebral Hemorrhage/diagnostic imaging , Cerebrovascular Circulation , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Hematoma/diagnostic imaging , Intracranial Aneurysm/therapy , Carotid Artery, Internal/diagnostic imaging , Carotid Artery, Internal/physiopathology , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/physiopathology , Endoscopy , Female , Hematoma/etiology , Hematoma/physiopathology , Hematoma/therapy , Humans , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/physiopathology , Middle Aged , Perfusion Imaging/methods , Time Factors , Tomography, Emission-Computed, Single-Photon , Treatment OutcomeABSTRACT
Objective: Carotid artery stenting (CAS) and carotid endarterectomy are relatively difficult for proximal common carotid artery (CCA) stenosis because of the difficulty in anatomical approach. We treated proximal CCA stenosis by retrograde stenting using a 9Fr Optimo for peripheral intervention with a sheathless method. Case Presentation: A 60-year-old woman was scheduled for total arch replacement (TAR) for an aortic arch aneurysm. Preoperative cervical MRI incidentally revealed tandem stenosis in the left CCA. We intended to treat CCA stenosis prior to aortic arch replacement. Under general anesthesia, distal left CCA was exposed. A 9Fr Optimo was introduced into CCA by retrograde with a sheathless method. The retrograde CAS was performed under distal balloon protection. Her postoperative course was uneventful. Conclusion: Retrograde stenting using a 9Fr Optimo for peripheral intervention with a sheathless method was safe and useful for proximal CCA stenosis.
