Treatment of Internal Carotid Artery Aneurysms with a Covered Stent: Experience in 24 Patients with Mid-Term Follow-up Results
Isil Saatcia,
H. Saruhan Cekirgea,
M. Halil Ozturkd,
Anil Arata,
Fikret Ergungorc,
Zeki Sekercie,
Engin Senvelie,
Uygur Ere,
Sami Turkoglue,
Osman E. Ozcanb and
Tuncalp Ozgenb
a Department of Radiology, Hacettepe University Hospitals, Ankara, Turkey
b Department of Neurosurgery, Hacettepe University Hospitals, Ankara, Turkey
c Department of Neurosurgery, Numune Hospital, Ankara, Turkey
d Department of Radiology, SSK Diskapi Hospital, Ankara, Turkey
e Department of Neurosurgery, SSK Diskapi Hospital, Ankara, Turkey
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FIG 1. A, Lateral angiogram obtained before treatment shows a right ruptured dissecting ICA aneurysm.
B, 4 x 9 mm Jomed covered stent placed across the aneurysm neck with the support of a long reinforced Arrow sheath in the proximal petrous (straight arrow) and a 6-French Envoy guiding catheter in the distal petrous ICA (arrowhead). Extreme care was taken not to cover the anterior choroidal artery origin with the graft (curved arrow).
C, Post-treatment lateral view shows exclusion of the aneurysm and the reconstructed internal carotid artery.
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FIG 2. A, Giant right carotico-ophthalmic aneurysm.
B, Oblique image of stent graft placed across the aneurysm neck before its deployment. Note that the ophthalmic artery is covered with the graft but not the anterior choroidal artery.
C, Non-subtracted view of the deployed stent graft (curved arrow). Note the contrast material trapped in the aneurysm sac because of the immediate exclusion.
D, Oblique angiogram obtained after treatment reveals the reconstruction of the ICA. Note that the ophthalmic artery is not filling but the anterior choroidal artery origin is preserved.
E, Oblique control angiogram obtained 18 months later shows no stenosis.
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FIG 3. A, Oblique angiogram of the left carotid artery reveals two posttraumatic aneurysms. One is giant, extending medially, and the other is small, extending laterally. Both originate from the cavernous portion of the ICA.
B, Oblique post-treatment angiogram obtained after deployment of the stent graft reveals exclusion of the giant aneurysm but persistent endoleak into the small aneurysm (arrow).
C, Control angiogram obtained 2 years later reveals spontaneous occlusion of the endoleak and excellent reconstruction of the ICA, with no stenosis.
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FIG 4. A, Oblique posttraumatic angiogram of a left cavernous ICA aneurysm.
B, Oblique angiogram obtained after stent graft deployment shows reconstruction of the ICA with no residual aneurysm filling.
C, Oblique control angiogram obtained 6 months later reveals intimal hyperplasia (arrow) with no hemodynamic significance.
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FIG 5. A, Lateral angiogram shows a broad based, bilobulated carotico-ophthalmic ICA aneurysm for which a previous seal test for Onyx treatment failed.
B, Lateral angiogram obtained after treatment shows reconstruction of the ICA with the stent graft deployed across the aneurysm neck. Note the occlusion of the ophthalmic artery origin covered by the graft.
C, Retrograde filling of the ophthalmic artery via external carotid artery.
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