Abstract
A 48-year-old female patient presented with a sudden onset of diplopia. MRI/MRA and DSA demonstrated a large aneurysm of the cavernous segment of the right internal carotid artery (ICA). This aneurysm was treated with partial endovascular coil occlusion and implantation of three flow diverters, two p64, and one Pipeline Embolic Device (PED). The patient demonstrated hyper-response to dual antiplatelet therapy (aspirin and ticagrelor) which was managed by a monitored dosage reduction. The diplopia resolved 4 months after the endovascular treatment and DSA at 4 and 11 months and MRI/MRA at 5 months postprocedure confirmed the complete occlusion of the aneurysm with significant reduction in size. Extrasaccular flow diversion treatment for cavernous ICA aneurysms causing cranial neuropathy is the main topic of this chapter.
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References
Briganti F, Napoli M, Tortora F, Solari D, Bergui M, Boccardi E, Cagliari E, Castellan L, Causin F, Ciceri E, Cirillo L, De Blasi R, Delehaye L, Di Paola F, Fontana A, Gasparotti R, Guidetti G, Divenuto I, Iannucci G, Isalberti M, Leonardi M, Lupo F, Mangiafico S, Manto A, Menozzi R, Muto M, Nuzzi NP, Papa R, Petralia B, Piano M, Resta M, Padolecchia R, Saletti A, Sirabella G, Bolgè LP. Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications – a retrospective data analysis. Neuroradiology. 2012;54(10):1145–52. https://doi.org/10.1007/s00234-012-1047-3.
Brown BL, Lopes D, Miller DA, Tawk RG, Brasiliense LB, Ringer A, Sauvageau E, Powers CJ, Arthur A, Hoit D, Snyder K, Siddiqui A, Levy E, Hopkins LN, Cuellar H, Rodriguez-Mercado R, Veznedaroglu E, Binning M, Mocco J, Aguilar-Salinas P, Boulos A, Yamamoto J, Hanel RA. The fate of cranial neuropathy after flow diversion for carotid aneurysms. J Neurosurg. 2016;124(4):1107–13. https://doi.org/10.3171/2015.4.JNS142790.
Colby GP, Lin LM, Caplan JM, Jiang B, Michniewicz B, Huang J, Tamargo RJ, Coon AL. Flow diversion of large internal carotid artery aneurysms with the surpass device: impressions and technical nuance from the initial North American experience. J Neurointerv Surg. 2016;8(3):279–86. https://doi.org/10.1136/neurintsurg-2015-011769.
Fischer S, Aguilar-Pérez M, Henkes E, Kurre W, Ganslandt O, Bäzner H, Henkes H. Initial experience with p64: a novel mechanically detachable flow diverter for the treatment of intracranial saccular sidewall aneurysms. AJNR Am J Neuroradiol. 2015;36(11):2082–9. https://doi.org/10.3174/ajnr.A4420.
Kan P, Meyers PM, Hanel R. E-022 The Surpass™ IntraCranial Aneurysm Embolization System pivotal trial to treat large or giant wide neck aneurysms (SCENT Trial). J Neurointerv Surg. 2018;8(Suppl 1):A56.2–A57. https://doi.org/10.1136/neurintsurg-2016-012589.94. https://clinicaltrials.gov/ct2/show/NCT01716117
Linskey ME, Sekhar LN, Horton JA, Hirsch WL Jr, Yonas H. Aneurysms of the intracavernous carotid artery: a multidisciplinary approach to treatment. J Neurosurg. 1991;75(4):525–34. https://doi.org/10.3171/jns.1991.75.4.0525.
Moon K, Albuquerque FC, Ducruet AF, Crowley RW, McDougall CG. Resolution of cranial neuropathies following treatment of intracranial aneurysms with the pipeline embolization device. J Neurosurg. 2014;121(5):1085–92. https://doi.org/10.3171/2014.7.JNS132677.
Morais R, Mine B, Bruyère PJ, Naeije G, Lubicz B. Endovascular treatment of intracranial aneurysms with the p64 flow diverter stent: mid-term results in 35 patients with 41 intracranial aneurysms. Neuroradiology. 2017;59(3):263–9. https://doi.org/10.1007/s00234-017-1786-2.
Pierot L, Spelle L, Berge J, Januel AC, Herbreteau D, Aggour M, Piotin M, Biondi A, Barreau X, Mounayer C, Papagiannaki C, Lejeune JP, Gauvrit JY, Costalat V. Feasibility, complications, morbidity, and mortality results at 6 months for aneurysm treatment with the Flow Re-Direction Endoluminal Device: report of SAFE study. J Neurointerv Surg. 2018;10(8):765–70. https://doi.org/10.1136/neurintsurg-2017-013559.
Raper DM, Ding D, Peterson EC, Crowley RW, Liu KC, Chalouhi N, Hasan DM, Dumont AS, Jabbour P, Starke RM. Cavernous carotid aneurysms: a new treatment paradigm in the era of flow diversion. Expert Rev Neurother. 2017;17(2):155–63. https://doi.org/10.1080/14737175.2016.1212661.
Sahlein DH, Fouladvand M, Becske T, Saatci I, McDougall CG, Szikora I, Lanzino G, Moran CJ, Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei Z, Marosfoi M, Cekirge SH, Kallmes DF, Nelson PK. Neuroophthalmological outcomes associated with use of the pipeline embolization device: analysis of the PUFS trial results. J Neurosurg. 2015;123(4):897–905. https://doi.org/10.3171/2014.12.JNS141777.
Starke RM, Chalouhi N, Ali MS, Tjoumakaris SI, Jabbour PM, Fernando Gonzalez L, Rosenwasser RH, Dumont AS. Endovascular treatment of carotid cavernous aneurysms: complications, outcomes and comparison of interventional strategies. J Clin Neurosci. 2014;21(1):40–6. https://doi.org/10.1016/j.jocn.2013.03.003.
Stiebel-Kalish H, Kalish Y, Bar-On RH, Setton A, Niimi Y, Berenstein A, Kupersmith MJ. Presentation, natural history, and management of carotid cavernous aneurysms. Neurosurgery. 2005;57(5):850–7.. discussion 850–7
Turfe ZA, Brinjikji W, Murad MH, Lanzino G, Cloft HJ, Kallmes DF. Endovascular coiling versus parent artery occlusion for treatment of cavernous carotid aneurysms: a meta-analysis. J Neurointerv Surg. 2015;7(4):250–5. https://doi.org/10.1136/neurintsurg-2014-011102.
Wakhloo AK, Lylyk P, de Vries J, Taschner C, Lundquist J, Biondi A, Hartmann M, Szikora I, Pierot L, Sakai N, Imamura H, Sourour N, Rennie I, Skalej M, Beuing O, Bonafé A, Mery F, Turjman F, Brouwer P, Boccardi E, Valvassori L, Derakhshani S, Litzenberg MW, Gounis MJ, Surpass Study Group. Surpass flow diverter in the treatment of intracranial aneurysms: a prospective multicenter study. AJNR Am J Neuroradiol. 2015;36(1):98–107. https://doi.org/10.3174/ajnr.A4078.
Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003;362(9378):103–10.
Zanaty M, Chalouhi N, Starke RM, Barros G, Saigh MP, Schwartz EW, Ajiboye N, Tjoumakaris SI, Hasan D, Rosenwasser RH, Jabbour P. Flow diversion versus conventional treatment for carotid cavernous aneurysms. Stroke. 2014;45(9):2656–61. https://doi.org/10.1161/STROKEAHA.114.006247.
Zhou G, Su M, Zhu YQ, Li MH. Efficacy of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis. World Neurosurg. 2016;85:252–62. https://doi.org/10.1016/j.wneu.2015.09.088.
Zhou G, Su M, Yin YL, Li MH. Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review and meta-analysis. Neurosurg Focus. 2017;42(6):E17. https://doi.org/10.3171/2017.3.FOCUS16450.
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Colgan, F., Aguilar Pérez, M., Bäzner, H., Henkes, H. (2019). Cavernous Internal Carotid Artery Aneurysm: Diplopia Due to a Large Cavernous Aneurysm Causing Oculomotor Nerve Palsy; Partial Coil Occlusion and p64 Flow Diverter Implantation; Resolution of the Cranial Nerve Palsy and Complete Clinical Recovery. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_92-1
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