Ryuichiro Kajikawa1, Toshiyuki Fujinaka2, Hajime Nakamura3, Manabu Kinoshita4, Takeo Nishida3, Haruhiko Kishima3. 1. 1 Department of Neurosurgery, Osaka Neurological Institute, Osaka, Japan. 2. 2 Department of Neurosurgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 3. 3 Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan. 4. 4 Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Japan.
Abstract
BACKGROUND AND PURPOSE: We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery-vertebral artery anastomosis. METHODS: Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery-vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery. RESULTS: One patient with distal internal carotid artery protection showed a high-intensity lesion at the border of the upper thalamus, internal capsule and lateral ventricle wall after carotid artery stenting. The other patient with the double protection method did not show any high-intensity lesions on postoperative diffusion-weighted imaging in the vertebrobasilar territory. All seven patients with visible occipital artery-vertebral artery anastomosis showed ipsilateral vertebral artery severe stenosis or occlusion. CONCLUSION: Large occipital artery-vertebral artery anastomosis may be a pathway for embolic materials during carotid artery stenting. External carotid artery protection is recommended for carotid artery stenting in such patients.
BACKGROUND AND PURPOSE: We report the outcomes of carotid artery stenting for patients with angiographically visible occipital artery-vertebral artery anastomosis. METHODS: Among 47 consecutive patients who underwent carotid artery stenting from January 2007 to December 2010, seven patients for whom cerebral angiograms clearly showed occipital artery-vertebral artery anastomosis were selected. Four different protection methods were used: distal internal carotid artery protection; carotid flow reversal; seatbelt and airbag technique; and double protection method of protecting both the external and internal carotid artery. RESULTS: One patient with distal internal carotid artery protection showed a high-intensity lesion at the border of the upper thalamus, internal capsule and lateral ventricle wall after carotid artery stenting. The other patient with the double protection method did not show any high-intensity lesions on postoperative diffusion-weighted imaging in the vertebrobasilar territory. All seven patients with visible occipital artery-vertebral artery anastomosis showed ipsilateral vertebral artery severe stenosis or occlusion. CONCLUSION: Large occipital artery-vertebral artery anastomosis may be a pathway for embolic materials during carotid artery stenting. External carotid artery protection is recommended for carotid artery stenting in such patients.