Bibliographic Details
| Title: |
Combined open revascularization and endovascular treatment of complex intracranial aneurysms: case series |
| Authors: |
Robert C. Rennert, Vincent N. Nguyen, Aidin Abedi, Nadia A. Atai, Joseph N. Carey, Matthew Tenser, Arun Amar, William J. Mack, Jonathan J. Russin |
| Source: |
Frontiers in Neurology, Vol 14 (2023) |
| Publisher Information: |
Frontiers Media S.A., 2023. |
| Publication Year: |
2023 |
| Collection: |
LCC:Neurology. Diseases of the nervous system |
| Subject Terms: |
cerebral revascularization, bypass, aneurysm, neuroendovascular approach, embolization, Neurology. Diseases of the nervous system, RC346-429 |
| More Details: |
Background and purposeThe treatment of complex intracranial aneurysms can be challenging with stand-alone open or endovascular techniques, particularly after rupture. A combined open and endovascular strategy can potentially limit the risk of extensive dissections with open-only techniques, and allow for aggressive definitive endovascular treatments with minimized downstream ischemic risk.Materials and methodsRetrospective, single-institution review of consecutive patients undergoing combined open revascularization and endovascular embolization/occlusion for complex intracranial aneurysms from 1/2016 to 6/2022.ResultsTen patients (4 male [40%]; mean age 51.9 ± 8.7 years) underwent combined open revascularization and endovascular treatment of intracranial aneurysms. The majority of aneurysms, 9/10 (90%), were ruptured and 8/10 (80%) were fusiform in morphology. Aneurysms of the posterior circulation represented 8/10 (80%) of the cases (vertebral artery [VA] involving the posterior inferior cerebellar artery [PICA] origin, proximal PICA or anterior inferior cerebellar artery/PICA complex, or proximal posterior cerebral artery). Revascularization strategies included intracranial-to-intracranial (IC-IC; 7/10 [70%]) and extracranial-to-intracranial (EC-IC; 3/10 [30%]) constructs, with 100% postoperative patency. Initial endovascular procedures (consisting of aneurysm/vessel sacrifice in 9/10 patients) were performed early after surgery (0.7 ± 1.5 days). In one patient, secondary endovascular vessel sacrifice was performed after an initial sub-occlusive embolization. Treatment related strokes were diagnosed in 3/10 patients (30%), largely from involved or nearby perforators. All bypasses with follow-up were patent (median 14.0, range 4–72 months). Good outcomes (defined as a Glasgow Outcomes Scale ≥4 and modified Rankin Scale ≤2) occurred in 6/10 patients (60%).ConclusionA variety of complex aneurysms not amenable to stand-alone open or endovascular techniques can be successfully treated with combined open and endovascular approaches. Recognition and preservation of perforators is critical to treatment success. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
1664-2295 |
| Relation: |
https://www.frontiersin.org/articles/10.3389/fneur.2023.1102496/full; https://doaj.org/toc/1664-2295 |
| DOI: |
10.3389/fneur.2023.1102496 |
| Access URL: |
https://doaj.org/article/88581207dbb3439ea4d370a0adcdf6a8 |
| Accession Number: |
edsdoj.88581207dbb3439ea4d370a0adcdf6a8 |
| Database: |
Directory of Open Access Journals |
