Delia Cannizzaro1, Simone Peschillo2, Cristina Mancarella1, Biagia La Pira1, Emanuela Rastelli3, Emiliano Passacantilli1, Antonio Santoro1. 1. Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy. 2. Department of Neurology and Psychiatry, Endovascular Neurosurgery, "Sapienza" University of Rome, Rome, Italy. Electronic address: simone.peschillo@gmail.com. 3. Department of Neurology and Psychiatry, Neuroradiology, "Sapienza" University of Rome, Rome, Italy.
Abstract
BACKGROUND: Intracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis. CLINICAL PRESENTATION: We present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing. CONCLUSIONS: ICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases.
BACKGROUND:Intracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis. CLINICAL PRESENTATION: We present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing. CONCLUSIONS: ICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases.
Authors: Zamzuri Idris; Regunath Kandasamy; Yee Yik Neoh; Jafri Malin Abdullah; Wan Mohd Nazaruddin Wan Hassan; Mohd Erham Mat Hassan Journal: Malays J Med Sci Date: 2018-02-28