Yonsei Med J.  2017 Mar;58(2):449-452. 10.3349/ymj.2017.58.2.449.

Retrograde Suction Decompression with an Inahara Carotid Shunt for Clipping a Large Distal Internal Carotid Artery Aneurysm

• Park YS
• Nam TK

• KMID: 2427136
• DOI: http://doi.org/10.3349/ymj.2017.58.2.449

Abstract

We describe a technique to clip a large internal carotid artery (ICA) aneurysm via a retrograde suction decompression (RSD). A large aneurysm in the right distal ICA involving the bifurcation region measuring 1.2×1.1×0.7 cm with posterior projection was managed with assisted RSD technique. The anterior choroidal artery emerged from the side wall of the aneurysm. An Inahara shunt was inserted into the ICA with neck dissection, and RSD was applied after completely clipping the aneurysm. RSD with an Inahara carotid shunt is useful for complete visualization of the aneurysm, including its surrounding structures, and for proximal control of the parent vessels, subsequently achieving satisfactory clip placement.

Keyword

Intracranial aneurysm; carotid artery; decompression

MeSH Terms

Aneurysm/*surgery
Carotid Artery Diseases/*surgery
Carotid Artery, Internal/*surgery
Decompression, Surgical/*methods
Humans
Microsurgery/*methods
Suction
Surgical Instruments

Figure

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  Fig. 1 (A) Intraoperative photographs of a large aneurysm located in the right distal internal carotid artery. (B) After retrograde suction decompression, the aneurysm was deflated. (C) The anterior choroidal artery arising from the side wall of the aneurysm. (D) Clipping with 5 fenestrated clips. (E) Diagram of the 5 fenestration clips. (F) Illustrations of clip placement. ICA, internal carotid artery; ACA, anterior cerebral artery; MCA, middle cerebral artery.

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  Fig. 2 The process of retrograde suction decompression through the internal carotid artery with a Pruitt-Inahara® carotid shunt. (A) Neck dissection was performed to expose the common carotid artery (CCA). Proximal and distal vascular loops entwine the CCA. A purse string suture is placed midway between the two loops. (B) The Pruitt-Inahara® carotid shunt catheter was inserted into the internal carotid artery (ICA) through the incision at the center of the purse string suture. (C) Illustrations of the technique.

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  Fig. 3 Pre (A) and post (B) operative angiograms of the aneurysm. (A) Fusiform dilation of the distal internal carotid artery and eccentric posterior aneurysmal formation measuring 1.2×1.1×0.7 cm. The right M1 and A1 portions were incorporated and the aneurysm was located just distal to the orifice of the posterior communicating artery. The anterior choroidal artery emerged from the side wall of the aneurysm. (B) The aneurysm was completely secured and the anterior choroidal artery was preserved.

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