Spontaneous Regression of an Intracranial Aneurysm After Carotid Endarterectomy

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2012 Jul 4

PMID 22754731

Citations 3

Authors

Yiping Li

Troy D Payner

Aaron A Cohen-Gadol

Affiliations

Soon will be listed here.

Abstract

Background: Recent studies have hypothesized that hemodynamic changes in parent vessels are responsible for the formation and regression of cerebral aneurysms. One author has described regression of a "flow-related" 4-mm posterior communicating artery (PCoA) aneurysm following ipsilateral carotid endarterectomy (CEA), resulting in reversal of blood flow in the PCoA.

Case Description: We report a 68-year-old woman with a coincidental intracranial aneurysm (ICA) and contralateral internal carotid artery stenosis. The aneurysm spontaneously regressed subsequent to contralateral ICA endarterectomy as documented by repeat computed tomographic angiography. This report also demonstrates the first known case of an ICA in the anterior cerebral artery territory to undergo spontaneous regression.

Conclusions: We conclude that the regression and potentially the formation of this aneurysm correlated with hemodynamic factors associated with stenosis of the contralateral ICA.

Citing Articles

Fatal Subarachnoid Hemorrhage From Ruptured Intracerebral Aneurysm After Carotid Endarterectomy.

Yee S, Portalatin M, Sridhar M, Perrone J, Adunbarin A, Guerrero M J Med Cases. 2021; 11(1):12-15.

PMID: 34434329 PMC: 8383675. DOI: 10.14740/jmc3403.

Butt W, Malik L, Dhillon P, McConachie N Interv Neuroradiol. 2021; 27(5):631-637.

PMID: 33673757 PMC: 8493342. DOI: 10.1177/15910199211001702.

Spontaneous regression of intracranial aneurysm following remote ruptured aneurysm treatment with pipeline stent assisted coiling.

Tsimpas A, Ashley W, Germanwala A BMJ Case Rep. 2015; 2015.

PMID: 26272955 PMC: 4550854. DOI: 10.1136/bcr-2015-011931.

References

Khanna R, Malik G, Qureshi N . Predicting outcome following surgical treatment of unruptured intracranial aneurysms: a proposed grading system. J Neurosurg. 1996; 84(1):49-54. DOI: 10.3171/jns.1996.84.1.0049. View

Suh B, Yun W, Kwun W . Carotid artery revascularization in patients with concomitant carotid artery stenosis and asymptomatic unruptured intracranial artery aneurysm. Ann Vasc Surg. 2011; 25(5):651-5. DOI: 10.1016/j.avsg.2011.02.015. View

Sekhar L, Sclabassi R, Sun M, Blue H, Wasserman J . Intra-aneurysmal pressure measurements in experimental saccular aneurysms in dogs. Stroke. 1988; 19(3):352-6. DOI: 10.1161/01.str.19.3.352. View

Redekop G, terBrugge K, Montanera W, Willinsky R . Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg. 1998; 89(4):539-46. DOI: 10.3171/jns.1998.89.4.0539. View

Navaneethan S, Kannan V, Osowo A, Shrivastava R, Singh S . Concomitant intracranial aneurysm and carotid artery stenosis: A therapeutic dilemma. South Med J. 2006; 99(7):757-8. DOI: 10.1097/01.smj.0000217190.93989.c9. View

HOUSEPIAN E, POOL J . A systematic analysis of intracranial aneurysms from the autopsy file of the Presbyterian Hospital, 1914 to 1956. J Neuropathol Exp Neurol. 1958; 17(3):409-23. DOI: 10.1097/00005072-195807000-00001. View

Haque R, Kellner C, Solomon R . Spontaneous thrombosis of a giant fusiform aneurysm following extracranial-intracranial bypass surgery. J Neurosurg. 2008; 110(3):469-74. DOI: 10.3171/2007.12.17653. View

Brott T, Hobson 2nd R, Howard G, Roubin G, Clark W, Brooks W . Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010; 363(1):11-23. PMC: 2932446. DOI: 10.1056/NEJMoa0912321. View

Pappada G, Fiori L, Marina R, Vaiani S, Gaini S . Management of symptomatic carotid stenoses with coincidental intracranial aneurysms. Acta Neurochir (Wien). 1996; 138(12):1386-90. DOI: 10.1007/BF01411116. View

10.

Chan T, Chan K, Pang P, Kwok J . Pipeline embolisation device for wide-necked internal carotid artery aneurysms in a hospital in Hong Kong: preliminary experience. Hong Kong Med J. 2011; 17(5):398-404. View

11.

Andrews B, Edwards M, Gannon P . Acutely thrombosed aneurysm of the middle cerebral artery presenting as intracranial hemorrhage in a 3-year-old child. Case report. J Neurosurg. 1984; 60(6):1303-7. DOI: 10.3171/jns.1984.60.6.1303. View

12.

Senn P, Krauss J, Remonda L, Godoy N, Schroth G . The formation and regression of a flow-related cerebral artery aneurysm. Clin Neurol Neurosurg. 2000; 102(3):168-72. DOI: 10.1016/s0303-8467(00)00085-8. View

13.

Shoumaker R, Avant W, Cohen G . Coincidental multiple asymptomatic intracranial aneurysms and symptomatic carotid stenosis. Stroke. 1976; 7(5):504-6. DOI: 10.1161/01.str.7.5.504. View

14.

Lv X, Li Y, Yang X, Jiang C, Wu Z . Characteristics of arteriovenous malformations associated with cerebral aneurysms. World Neurosurg. 2011; 76(3-4):288-91. DOI: 10.1016/j.wneu.2011.03.022. View

15.

Riphagen J, Bernsen H . Rupture of an intracerebral aneurysm after carotid endarterectomy: a case report. Acta Neurol Belg. 2010; 109(4):314-6. View

16.

Benedetti A, CURRI C, Colombo F . Rebleeding of an angiographically healed aneurysm. Surg Neurol. 1983; 20(3):206-8. DOI: 10.1016/0090-3019(83)90053-8. View

17.

Wong G, Kwan M, Ng R, Yu S, Poon W . Flow diverters for treatment of intracranial aneurysms: current status and ongoing clinical trials. J Clin Neurosci. 2011; 18(6):737-40. DOI: 10.1016/j.jocn.2010.10.011. View

18.

Yeung T, Lai V, Lau H, Lun Poon W, Tan C, Wong Y . Long-term outcome of endovascular reconstruction with the Pipeline embolization device in the management of unruptured dissecting aneurysms of the intracranial vertebral artery. J Neurosurg. 2012; 116(4):882-7. DOI: 10.3171/2011.12.JNS111514. View

19.

CANTORE G, Santoro A, DA PIAN R . Spontaneous occlusion of supraclinoid aneurysms after the creation of extra-intracranial bypasses using long grafts: report of two cases. Neurosurgery. 1999; 44(1):216-9; discussion 219-20. DOI: 10.1097/00006123-199901000-00132. View

20.

Lu L, Zhang L, Poon C, Wu S, Zhou C, Luo S . Digital subtraction CT angiography for detection of intracranial aneurysms: comparison with three-dimensional digital subtraction angiography. Radiology. 2011; 262(2):605-12. DOI: 10.1148/radiol.11110486. View