Background Intracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis. Clinical Presentation We present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing. Conclusions ICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases.

Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial Bypass Treatment

Peschillo S.;Mancarella C.;
2017-01-01

Abstract

Background Intracranial carotid artery aneurysm can be treated via microsurgical or endovascular techniques. The optimal planning is the result of the careful patient selection through clinical, anatomic, and angiographic analysis. Clinical Presentation We present a case of ruptured internal carotid artery (ICA) aneurysm that became a complex aneurysm after failure of multi-endovascular and surgery treatment. We describe complete trapping in awake craniotomy after failure of coiling, stenting, and bypassing. Conclusions ICA aneurysms could become complex aneurysms following multi-treatment failure. Endovascular approaches to treat ICA aneurysms include coiling, stenting, flow diverter stenting, and stenting-assisted coiling technique. The role of surgery remains relevant. To avoid severe neurologic deficits, recurrence, and the need of retreatment, a multidisciplinary discussion with experienced endovascular and vascular neurosurgeons is mandatory in such complex cases.
2017
Extracranial-intracranial bypass; flow diverter stent; intracranial aneurysm; intracranial stent; subarachnoid hemorrhage; surgical clip; Aneurysm, Ruptured; Angiography, Digital Subtraction; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Cerebrovascular Circulation; Combined Modality Therapy; Computed Tomography Angiography; Female; Humans; Intracranial Aneurysm; Magnetic Resonance Angiography; Middle Aged; Stents; Subarachnoid Hemorrhage; Treatment Failure; Craniotomy; Embolization, Therapeutic; Endovascular Procedures; Vascular Grafting
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/402085
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