Tuesday, January 19, 2016

Endovascular management of internal Carotid Artery Aneurysm



Endovascular management of Intracranial aneurysms is gaining popularity worldwide. It is especially useful in the management of Cerebral Aneurysms that are difficult to access or whose surgery has a high morbidity rate. It is also very useful in elderly patients and patients who are in a poor neurological state. 

Microcatheters placed in the carotid and vertebral arteries through the femoral route outline the aneurysm and then deliver coils which are placed into the aneurysmal sac. The size and configuration of the aneurysm determines the number and type of coils used. 

A 65 year old lady presented with repeated attacks of unawareness and loss of vision suggestive of TIA and TMB. An MRI with MR angiogram revealed an Internal Carotid artery aneurysm. A Digital Subtraction Angiogram (DSA) was done which showed the aneurysm to be arising from the ventral wall of the Cavernous Sinus segment of the ICA. Embolisation of the Aneurysm using 3D coils was performed after placing a balloon across the neck of the aneurysm to prevent distal embolus of the coil. 

The procedure was successful with the post-coiling angiogram showing complete obliteration of the aneurysm. 

The lady was discharged three days after the procedure without any symptoms or deficits.

Special points of interest
  • Aneurysms can present in many ways including TIA
  • All symptomatic aneurysms and some incidental aneurysms require treatment
  • The choice of management between surgery and endovascular management depends on many factors
  • A microcatheter placed in the carotid and vertebral arteries through the femoral route helps delineate the configuration of the aneurysm
  • The size and configuration of the aneurysm decides the type and number of coils used
  • It is essential that the Neurosurgical team be on stand by during the pro-cedure in case of any eventuality

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