J Korean Neurosurg Soc.  2012 May;51(5):296-300. 10.3340/jkns.2012.51.5.296.

Stent-Assisted Coil Trapping in a Manual Internal Carotid Artery Compression Test for the Treatment of a Fusiform Dissecting Aneurysm

• Seung WB
• Kim JW
• Park YS

• KMID: 2066930
• DOI: http://doi.org/10.3340/jkns.2012.51.5.296

Abstract

Internal carotid artery (ICA) trapping can be used for the treatment of giant intracranial aneurysms, blood blister-like aneurysms, and fusiform dissecting aneurysms. Fusiform dissecting aneurysms are challenging to treat surgically and endovascularly because of no definite neck and critical perforators. Surgical or endovascular trapping of the ICA with or without an extracranial-intracranial bypass has commonly been used as an effective method to treat these lesions, but balloon test occlusion (BTO) must be performed. Here, we report a case of a ruptured fusiform dissecting aneurysm of the distal ICA, which was successfully treated using an endovascular ICA trapping with a manual ICA compression test instead of BTO.

Keyword

Endovascular treatment; Fusiform aneurysm; Internal carotid artery; Occlusion; Trapping

MeSH Terms

Aneurysm
Aneurysm, Dissecting
Carotid Artery, Internal
Intracranial Aneurysm
Neck

Figure

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  Fig. 1 Initial computed tomography (A) shows diffuse subarachnoid hemorrhage, except left sylvian fissure. Conventional cerebral angiography demonstrats a fusiform dissecting aneurysm involving the right distal internal carotid artery (B) and a bilobulated saccular aneurysm at the middle cerebral artery bifurcation (C).

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  Fig. 2 Anteroposterior view of the conventional angiogram demonstrating a right carotid manual compression test in a patient with a ruptured fusiform dissecting aneurysm. The late arterial phase demonstrating good cross-filling through anterior communicating artery (A and B). One second after the previous image B, there are still veins on the left side and the beginning of venous phase on the right side (C). In an image taken 0.5 seconds later, the venous phase synchronously becomes more evident in both hemispheres (D). This patient had a 1.5-second venous phase delay, and permanent occlusion was performed.

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  Fig. 3 Conventional angiogram (A) that was performed during coil trapping revealed that the anterior choroidal artery (AChA) had disappeared. Fortunately, follow-up angiography (B) in the immediate postoperative period demonstrates the recanalized AChA (black arrow). Three days later, the patient had mild dysarthria and grade IV left hand weakness. Diffusion-weighted MR image (C) shows multiple embolic infarctions of the right hemisphere in the territory of middle cerebral artery within the right internal capsule. We administrated heparinization for one week, and the symptoms were improved at discharge. Follow-up angiography (D) 40 days later reveals good collateral circulation through the anterior communicating artery and the right AChA is saved (white arrow).

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