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

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Presentation on theme: "Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial."— Presentation transcript:

1 Clipping in Awake Surgery as End-Stage in a Complex Internal Carotid Artery Aneurysm After Failure of Multimodal Endovascular and Extracranial-Intracranial Bypass Treatment  Delia Cannizzaro, MD, Simone Peschillo, MD, PhD, Cristina Mancarella, MD, Biagia La Pira, MD, Emanuela Rastelli, MD, Emiliano Passacantilli, MD, PhD, Antonio Santoro, MD, PhD  Journal of Stroke and Cerebrovascular Diseases  Volume 26, Issue 6, Pages e114-e118 (June 2017) DOI: /j.jstrokecerebrovasdis Copyright © 2017 National Stroke Association Terms and Conditions

2 Figure 1 Computed tomography scan: subarachnoid hemorrhage of the basal cisterns (A). Angio-CT scan shows a large aneurysm of the left internal carotid artery on axial (B) and coronal (C) views. Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

3 Figure 2 Coiling of the internal carotid artery aneurysm in lateral (A) and anterior (B) projection. The patient underwent coiling procedure with a subtotal occlusion due to the large aneurysm neck: it was decided to re-treat the aneurysm with a flow diverter stent within 3 months. Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

4 Figure 3 Prestenting of the internal carotid artery aneurysm in anterior projection showed a big recurrence (A). Three-dimensional reconstruction shows where the stent was deployed (from left middle cerebral artery to left internal carotid artery aneurysm) (B). Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

5 Figure 4 A 1-month middle cerebral artery follow-up showed a steady state of aneurysm size (A). A 3-month MRA follow-up showed an increase in aneurysm size (B and C). Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

6 Figure 5 The picture shows the extra-intracranial bypass between external carotid artery and left middle cerebral artery. In (A), the venous graft is lean on the distal segment of left middle cerebral artery. In (B), handmade suture is showed. MCA, middle cerebral artery. Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

7 Figure 6 Digital subtraction angiography (anterior projection) showed the occlusion of the aneurysm and the patency and the regular course of the graft. Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

8 Figure 7 Digital subtraction angiography (anterior projection) showed a new portion of the sac with the persistence patency of the graft. Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

9 Figure 8 The midterm DSA (anterior [A] and oblique [B] projection) showed the occlusion of the aneurysm and the patency and regular course of the graft. In red, the schematic of the clip. (Color version of figure is available online.) Journal of Stroke and Cerebrovascular Diseases  , e114-e118DOI: ( /j.jstrokecerebrovasdis ) Copyright © 2017 National Stroke Association Terms and Conditions

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