Endovascular Embolization Through Grafts for Recurrent Giant Complex Internal Carotid Artery Aneurysms after Combined Microsurgical Low-Flow with Subsequent High-Flow Revascularization and Parent Artery Occlusion
Nurimanov C. Menlibayeva K. Mammadinova I. Nurakay N. Makhambetov Y.
10 October 2024Lippincott Williams and Wilkins
Neurosurgery Practice
2024#5Issue 4
BACKGROUND AND IMPORTANCE:The case describes the management of a giant and recurrent aneurysm in a patient. The treatment involved a combination of microsurgical protective low-flow, followed by high-flow revascularization and parent artery occlusion.CLINICAL PRESENTATION:The patient presented with severe headaches and progressive visual impairment. Brain magnetic resonance imaging revealed a giant saccular intracranial aneurysm in the left internal carotid artery. The examination also revealed hypoplasia of the right anterior cerebral artery and a fetal-type left posterior cerebral artery originating from the neck of the aneurysm. Considering the location and size of the aneurysm, a combination of endovascular and microsurgical approaches was applied. A protective low-flow procedure was followed by high-flow revascularization and occlusion of the parent artery. After 12 months, the aneurysm recanalized through the graft. To address the recurrence of giant complex aneurysms, endovascular embolization was performed through the radial artery grafts. These interventions showed positive midterm outcomes for the patients giant aneurysm.CONCLUSION:In the treatment of complex giant aneurysms, it is important to consider both endovascular and microsurgical approaches as complementary, rather than mutually exclusive. Endovascular embolization using radial artery grafts may be used when dealing with retrograde recanalization and the challenges associated with accessing the aneurysm.
Cerebral revascularization , Complex giant aneurysms , Endovascular embolization , Hybrid approach , Parent artery occlusion , Recanalization
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Department of Vascular and Functional Neurosurgery, National Centre for Neurosurgery, Astana, Kazakhstan
Department of Hospital Management, National Centre for Neurosurgery, Astana, Kazakhstan
Department of Vascular and Functional Neurosurgery
Department of Hospital Management
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