GDC Embolisation of Cavernous Internal Carotid Artery Aneurysms with Parent Artery Preservation

Overview

Journal Interv Neuroradiol

Publisher Sage Publications

Specialty Neurology

Date 2010 Jul 30

PMID 20667207

Authors

S J Kim

I S Choi

Affiliations

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Abstract

We evaluated the clinical and angiographic results of endosaccular treatment with Guglielmi detachable coils (GDCs) in 19 cases of cavernous internal carotid artery (ICA) aneurysms. The size of the aneurysms ranged from 10 to 30 mm (mean 18.4 mm) and neck size ranged from 2 to 15 mm (mean 6.7 mm). Intraluminal thrombosis was found in ten cases. Main presenting symptoms were related to mass effect in 17 cases including cranial nerve palsy, headache and vomiting. On initial GDC embolisation, total occlusion was obtained in two cases, subtotal in eight, and incomplete in nine. In two cases with incomplete occlusion, parent arteries were occluded with balloons or GDCs during or just after the procedure because of underlying diseases. A higher rate of initial occlusion was obtained in smaller and non-thrombosed aneurysms. Symptoms resolved or improved in all cases except one after initial treatment. No complication occurred related to the procedure. Follow-up angiography was obtained in 15 cases among which ten cases (66.7%) showed luminal recanalisation. Symptoms recurred in one case with luminal recanalisation. Incidence of recanalisation was similar in both large and giant aneurysms but higher in the thrombosed than non-thrombosed group. Retreatment was done in five cases with success. In conclusion, although embolisation of cavernous ICA aneurysms with GDCs was safe and effective in relieving symptoms, the incidences of initial incomplete occlusion and follow-up recanalisation were high. Therefore, we think judicious selection of the cases is necessary for endosaccular GDC embolisation in cavernous ICA aneurysms.

References

Aletich V, Debrun G, Misra M, Charbel F, Ausman J . The remodeling technique of balloon-assisted Guglielmi detachable coil placement in wide-necked aneurysms: experience at the University of Illinois at Chicago. J Neurosurg. 2000; 93(3):388-96. DOI: 10.3171/jns.2000.93.3.0388. View

Fernandez Zubillaga A, Guglielmi G, Vinuela F, Duckwiler G . Endovascular occlusion of intracranial aneurysms with electrically detachable coils: correlation of aneurysm neck size and treatment results. AJNR Am J Neuroradiol. 1994; 15(5):815-20. PMC: 8332188. View

Tsuura M, Terada T, Nakamura Y, Nakai K, Itakura T . Magnetic resonance signal intensity and volume changes after endovascular treatment of intracranial aneurysms causing mass effect. Neuroradiology. 1998; 40(3):184-8. DOI: 10.1007/s002340050565. View

Little J, Rosenfeld J, Awad I . Internal carotid artery occlusion for cavernous segment aneurysm. Neurosurgery. 1989; 25(3):398-404. DOI: 10.1097/00006123-198909000-00013. View

Linskey M, Sekhar L, Horton J, Hirsch Jr W, Yonas H . Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment. J Neurosurg. 1991; 75(4):525-34. DOI: 10.3171/jns.1991.75.4.0525. View

Moret J, Cognard C, Weill A, Castaings L, Rey A . The "Remodelling Technique" in the Treatment of Wide Neck Intracranial Aneurysms. Angiographic Results and Clinical Follow-up in 56 Cases. Interv Neuroradiol. 2010; 3(1):21-35. DOI: 10.1177/159101999700300103. View

Halbach V, Higashida R, Dowd C, Barnwell S, Fraser K, Smith T . The efficacy of endosaccular aneurysm occlusion in alleviating neurological deficits produced by mass effect. J Neurosurg. 1994; 80(4):659-66. DOI: 10.3171/jns.1994.80.4.0659. View

Fox A, Vinuela F, Pelz D, Peerless S, Ferguson G, Drake C . Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms. J Neurosurg. 1987; 66(1):40-6. DOI: 10.3171/jns.1987.66.1.0040. View

Higashida R, Halbach V, Dowd C, Barnwell S, Dormandy B, Bell J . Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: results in 87 cases. J Neurosurg. 1990; 72(6):857-63. DOI: 10.3171/jns.1990.72.6.0857. View

10.

Barr J, Holmes B, Edgar K . Extradural aneurysms. Neuroimaging Clin N Am. 1997; 7(4):783-802. View

11.

Bavinzski G, Killer M, Ferraz-Leite H, Gruber A, Gross C, Richling B . Endovascular therapy of idiopathic cavernous aneurysms over 11 years. AJNR Am J Neuroradiol. 1998; 19(3):559-65. PMC: 8338241. View

12.

Cognard C, Weill A, Castaings L, Rey A, Moret J . Intracranial berry aneurysms: angiographic and clinical results after endovascular treatment. Radiology. 1998; 206(2):499-510. DOI: 10.1148/radiology.206.2.9457205. View

13.

Guglielmi G, Vinuela F . Intracranial aneurysms. Guglielmi electrothrombotic coils. Neurosurg Clin N Am. 1994; 5(3):427-35. View

14.

Martin D, Rodesch G, Alvarez H, Lasjaunias P . Preliminary results of embolisation of nonsurgical intracranial aneurysms with GD coils: the 1st year of their use. Neuroradiology. 1996; 38 Suppl 1:S142-50. DOI: 10.1007/BF02278143. View

15.

Kupersmith M, Hurst R, Berenstein A, Choi I, Jafar J, Ransohoff J . The benign course of cavernous carotid artery aneurysms. J Neurosurg. 1992; 77(5):690-3. DOI: 10.3171/jns.1992.77.5.0690. View

16.

Vazquez Anon V, Aymard A, Gobin Y, Casasco A, Ruffenacht D, Khayata M . Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects, cerebral monitoring, and results. Neuroradiology. 1992; 34(3):245-51. DOI: 10.1007/BF00596347. View

17.

DEBRUN G, Fox A, Drake C, Peerless S, Girvin J, Ferguson G . Giant unclippable aneurysms: treatment with detachable balloons. AJNR Am J Neuroradiol. 1981; 2(2):167-73. PMC: 8333804. View

18.

Kupersmith M, Berenstein A, Choi I, Ransohoff J, Flamm E . Percutaneous transvascular treatment of giant carotid aneurysms: neuro-ophthalmologic findings. Neurology. 1984; 34(3):328-35. DOI: 10.1212/wnl.34.3.328. View

19.

Richling B, Gruber A, Bavinzski G, Killer M . GDC-system embolization for brain aneurysms - location and follow-up. Acta Neurochir (Wien). 1995; 134(3-4):177-83. DOI: 10.1007/BF01417686. View

20.

Kumon Y, Sakaki S, Kohno K, Ohta S, Ohue S, Oka Y . Asymptomatic, unruptured carotid-ophthalmic artery aneurysms: angiographical differentiation of each type, operative results, and indications. Surg Neurol. 1997; 48(5):465-72. DOI: 10.1016/s0090-3019(97)00175-4. View