Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-yea...Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.展开更多
Background and Objective: Giant cavernous carotid artery aneurysms (CCAAs) often produce a variety of neurological deficits, primarily those related to ophthalmoplegia/paresis and headache. This study was designed to ...Background and Objective: Giant cavernous carotid artery aneurysms (CCAAs) often produce a variety of neurological deficits, primarily those related to ophthalmoplegia/paresis and headache. This study was designed to evaluate the resolution of symptoms after parent artery occlusion (PAO) treatment for giant CCAAs. Methods: We retrospectively reviewed a series of 17 consecutive giant CCAAs treated with PAO treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by PAO. The following outcomes were analyzed: angiographic assessment, evolution of symptoms and outcome at clinical follow-up using modified Rankin Scale (mRS). Results: A total number of 17 giant CCAAs were treated by PAO. The initial post-procedure and follow-up angiogram revealed complete occlusion in all patients, no new lesion was detected. Periprocedural infarcts occurred in 1 patient (5.9%). Procedure-related mortality and morbidity were 0% and 5.9%, respectively. At mean 31.8 months clinical follow-up, symptoms had disappeared in 7 (41.2%) of the patients, partially improved in 5 (29.4%), remained unchanged in 4 (23.5%) and worsened in 1 (5.9%) of cases. Sixteen (94.1%) patients presented a good clinical outcome (mRS 0 - 1). Conclusion: Most patients in our series improved or remained stable after PAO. The results of this study indicate that PAO can improve the outcome of those symptomatic giant CCAAs if BOT can be tolerated.展开更多
Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Materi...Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Material And Method A 67 year-old female patient admitted for lower leg fracture at the outside university hospital. After 6 days later, she presented with left hemiparesis, verbal disturbance and visual disturbance. She transferred to our hospital and evaluated with MRI and Angiography. Angiography show stenosis with ulceration and pseudoaneurysm at the internal carotid artery. The stenosis rate was 63%. At the lesion, ophthalmic artery was poor visualized. Results The intracranial lesion was treated with angioplasty and stenting. After stenting, angiography showed good ophthalmic artery flow. Patients improved visual acuity just after stenting. Conclusions Intracranial angioplasty and stenting will be a good treatment option in a highly selected case.展开更多
We report a rare case of internal carotid artery agenesis with stenosed intercavernous anastomosis. A 59-year- old male patient presented with a new infarction in the left basal ganglia. Magnetic resonance angiography...We report a rare case of internal carotid artery agenesis with stenosed intercavernous anastomosis. A 59-year- old male patient presented with a new infarction in the left basal ganglia. Magnetic resonance angiography and cerebral angiography showed that the right internal carotid artery disappeared from the origin to the foramen lacerum segment, and there was an anastomotic artery with severe stenosis passed through the floor of the sella and in front of the cavernous sinus. The right A1 segment of the anterior cerebral artery was absent and A2 segment was supplied by the normal contralateral internal carotid artery via the anterior communicating artery.展开更多
BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-n...BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.展开更多
We present a case of extracranial internal carotid artery (ICA) aneurysm, which presented as an inflammatory submandibular swelling in the upper part of the right side of the neck. The lack of frank pulsatility and si...We present a case of extracranial internal carotid artery (ICA) aneurysm, which presented as an inflammatory submandibular swelling in the upper part of the right side of the neck. The lack of frank pulsatility and signs of inflammation though was a bit confusing, the Doppler and CT angiogram clinched the diagnosis. We were able to surgically resect and reform the ICA using the native vessel itself, which is an unusual technique, which we thought was worth presenting.展开更多
The posterior meningeal artery (PMA) usually originates from the third segment of the vertebral artery. Many variations in its origin and course have been observed;however, as far as we know, the association of true a...The posterior meningeal artery (PMA) usually originates from the third segment of the vertebral artery. Many variations in its origin and course have been observed;however, as far as we know, the association of true aneurysm of the PMA and its anomalous origin from the internal carotid artery has not been reported previously. We reported the case of a 59-year-old woman who suddenly presented a loss of consciousness without head trauma, computed tomography (CT) revelated intracerebellous hematoma associated with a subarachnoid hemorrhage of the posterior cerebral fossa. Cerebral angiography demonstrated a true aneurysm of the PMA which originated from the internal carotid artery.展开更多
Background: Aneurysms of the internal carotid artery within the petrous temporal bone are extremely rare;their true incidence is unknown. The exact cause is unclear: they may be congenital or result from trauma, infec...Background: Aneurysms of the internal carotid artery within the petrous temporal bone are extremely rare;their true incidence is unknown. The exact cause is unclear: they may be congenital or result from trauma, infection, or radiation. Aim: We report a case of massive otorrhagia and epistaxis from a ruptured aneurysm of the petrous internal carotid artery. Case Presentation: A 34-year-old man presented to our department for the first time with repeated left otorrhagia ongoing for 5 years, left sided pulsatile tinnitus and left conductive hearing loss. In his history, we noted a right hemi-corporeal deficit of sudden onset one month ago and the head-CT showed a left frontoparietal subarachnoid hemorrhage without any visualised vascular malformation. Otomicroscopy showed a pulsatile mass visible at the posterior part of the hypotympanum. There was a right-sided hemiparesis estimated at 2/5 with no disorder of the sensitivity. After hemodynamic stabilization, the patient was discharged from the hospital and treatment was scheduled in interventional radiology and neurosurgery unit. Unfortunately the patient presented at home with a cataclysmic hemorrhage by massive otorrhagia and epistaxis and arrived dead at the emergency unit. Conclusion: The treatment of a petrous carotid aneurysm must be carried out quickly considering the risk of rupture leading to a cataclysmic hemorrhage that can be rapidly life threatening.展开更多
Dear Editor,We are writing this letter to report an unexpected rare caseofcentralretinalarteryocclusion(CRAO)happened after stent-assisted coiling for internal carotid artery(ICA)aneurysm in a female patient.CRAO is a...Dear Editor,We are writing this letter to report an unexpected rare caseofcentralretinalarteryocclusion(CRAO)happened after stent-assisted coiling for internal carotid artery(ICA)aneurysm in a female patient.CRAO is a devastating ocular emergency with poor visual prognosis and no universal acceptedtreatmentatpresent.CRAOisusuallyassociated witharterialhypertension,diabetesmellitus,renaldisease.展开更多
Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass ef...Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.展开更多
Background:Blister-like aneurysms(BLAs)on the supraclinoid segment of the internal carotid artery(ICA)are an enigma of cerebrovascular disease.Neither has a definite pathogenesis been so far identified,nor have unifor...Background:Blister-like aneurysms(BLAs)on the supraclinoid segment of the internal carotid artery(ICA)are an enigma of cerebrovascular disease.Neither has a definite pathogenesis been so far identified,nor have uniform treatment guidelines been established for them.Our aim was to develop a hypothesis regarding the evolution of BLAs according to their macroscopic morphologies and to evaluate the efficacy of microsurgical clipping.Methods:The clinical data and morphological features of 15 consecutive patients with 16 BLAs on the supraclinoid ICA were retrospectively reviewed.The treatment strategies were analyzed,and functional outcomes were evaluated using the modified Rankin scale(mRS).Favorable outcomes were defined as a mRS score of 0-2.Results:Morphologically,aneurysm growth with expansion of the aneurysm neck before the surgical procedure occurred in two ruptured and one unruptured aneurysm.Daughter bleb formation was observed in two ruptured and five unruptured aneurysms.A varied degree of parent artery sclerosis was observed in nine patients.Thirteen patients were treated with direct surgical clipping,one patient was treated with clipping and wrapping,and the remaining patient was treated with an encircling clipping graft.Favorable and unfavorable outcomes were observed in 13 and two cases,respectively.Follow-up angiograms revealed 4 cases of stenosis with respective degree of mild,30%,50%,and 80%without any neurological dysfunction.Conclusions:We suggest a hypothesis that BLAs on the supraclinoid ICA may share different evolving mechanisms between ruptured and unruptured lesions.A majority of them can be reliably and safely obliterated by direct clipping technique,except for the aneurysms accompanied with severely atherosclerotic parent walls.展开更多
Multiple intracranial aneurysms account for 14%-35%of all intracranial aneurysms.Their incidence rate is significantly increased in women,patients with connective tissue disease,and patients with a family history of s...Multiple intracranial aneurysms account for 14%-35%of all intracranial aneurysms.Their incidence rate is significantly increased in women,patients with connective tissue disease,and patients with a family history of subarachnoid hemorrhage.Among them,tandem aneurysms are located on the same parent artery and in close proximity to each other.The LEO stent is a self-expanding nickel-titanium braided stent for intracranial vascularization,which is a delivery system that is easy to navigate and position precisely.This case report describes a 68-year-old female patient who was presented with the chief complaints of dizziness for more than a month upon admission to the First Affiliated Hospital,Zhejiang University,School of Medicine.The cerebral angiography established right vertebral artery occlusion,V4 segment of left vertebral artery dissection with two tandem aneurysms,and bilateral internal carotid artery cavernous sinus segment dissection aneurysm.Therefore,we opted to use the LEO stent semi-release assisted coil embolization to treat the vertebral artery V4 segment tandem aneurysms.Some problems encountered during the operation were also considered and discussed.展开更多
文摘Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.
文摘Background and Objective: Giant cavernous carotid artery aneurysms (CCAAs) often produce a variety of neurological deficits, primarily those related to ophthalmoplegia/paresis and headache. This study was designed to evaluate the resolution of symptoms after parent artery occlusion (PAO) treatment for giant CCAAs. Methods: We retrospectively reviewed a series of 17 consecutive giant CCAAs treated with PAO treatment. All patients were evaluated by balloon occlusion test (BOT) before treatment. Patients who could tolerate BOT were treated by PAO. The following outcomes were analyzed: angiographic assessment, evolution of symptoms and outcome at clinical follow-up using modified Rankin Scale (mRS). Results: A total number of 17 giant CCAAs were treated by PAO. The initial post-procedure and follow-up angiogram revealed complete occlusion in all patients, no new lesion was detected. Periprocedural infarcts occurred in 1 patient (5.9%). Procedure-related mortality and morbidity were 0% and 5.9%, respectively. At mean 31.8 months clinical follow-up, symptoms had disappeared in 7 (41.2%) of the patients, partially improved in 5 (29.4%), remained unchanged in 4 (23.5%) and worsened in 1 (5.9%) of cases. Sixteen (94.1%) patients presented a good clinical outcome (mRS 0 - 1). Conclusion: Most patients in our series improved or remained stable after PAO. The results of this study indicate that PAO can improve the outcome of those symptomatic giant CCAAs if BOT can be tolerated.
文摘Objective Intracranial internal carotid artery dissection is a rare case. The purpose of this study was to report the treatment of intracranial internal carotid dissection and the radiologic and clinical result.Material And Method A 67 year-old female patient admitted for lower leg fracture at the outside university hospital. After 6 days later, she presented with left hemiparesis, verbal disturbance and visual disturbance. She transferred to our hospital and evaluated with MRI and Angiography. Angiography show stenosis with ulceration and pseudoaneurysm at the internal carotid artery. The stenosis rate was 63%. At the lesion, ophthalmic artery was poor visualized. Results The intracranial lesion was treated with angioplasty and stenting. After stenting, angiography showed good ophthalmic artery flow. Patients improved visual acuity just after stenting. Conclusions Intracranial angioplasty and stenting will be a good treatment option in a highly selected case.
文摘We report a rare case of internal carotid artery agenesis with stenosed intercavernous anastomosis. A 59-year- old male patient presented with a new infarction in the left basal ganglia. Magnetic resonance angiography and cerebral angiography showed that the right internal carotid artery disappeared from the origin to the foramen lacerum segment, and there was an anastomotic artery with severe stenosis passed through the floor of the sella and in front of the cavernous sinus. The right A1 segment of the anterior cerebral artery was absent and A2 segment was supplied by the normal contralateral internal carotid artery via the anterior communicating artery.
文摘BACKGROUND There is no standard endovascular treatment for extracranial internal carotid artery dissecting aneurysms.In the past,stent-graft isolation and stent-assisted coil embolization were commonly used for wide-necked and fusiform aneurysms.Here,we present two cases of extracranial internal carotid artery dissecting aneurysms treated successfully using the SUPERA stent.CASE SUMMARY Case 1 was a 57-year-old male patient with sudden right limb weakness and vague speech and diagnosed with cerebral infarction in February 2019.Cervical computed tomographic angiography(CTA)revealed left internal carotid artery dissection with stenosis.CTA at 2 mo showed an eccentric wide-necked dissecting aneurysm(5 mm×5 mm×12 mm,10-mm neck)that was enlarged at 4 mo(7 mm×6 mm×12 mm,11-mm neck).The patient underwent SUPERA stent implantation.His condition was stable in July 2020.Case 2 was a 57-year-old man who suddenly felt dizzy and developed unsteady walking in November 2019.Cervical CTA suggested right internal carotid artery dissecting aneurysm(11 mm×9 mm×31 mm)complicated with severe lumen stenosis(95%).The patient underwent SUPERA stent implantation.The patient had no residual symptoms and was stable in December 2020.CONCLUSION SUPERA stent implantation might achieve good results in treating wide-necked or long fusiform internal carotid artery dissecting aneurysms.
文摘We present a case of extracranial internal carotid artery (ICA) aneurysm, which presented as an inflammatory submandibular swelling in the upper part of the right side of the neck. The lack of frank pulsatility and signs of inflammation though was a bit confusing, the Doppler and CT angiogram clinched the diagnosis. We were able to surgically resect and reform the ICA using the native vessel itself, which is an unusual technique, which we thought was worth presenting.
文摘The posterior meningeal artery (PMA) usually originates from the third segment of the vertebral artery. Many variations in its origin and course have been observed;however, as far as we know, the association of true aneurysm of the PMA and its anomalous origin from the internal carotid artery has not been reported previously. We reported the case of a 59-year-old woman who suddenly presented a loss of consciousness without head trauma, computed tomography (CT) revelated intracerebellous hematoma associated with a subarachnoid hemorrhage of the posterior cerebral fossa. Cerebral angiography demonstrated a true aneurysm of the PMA which originated from the internal carotid artery.
文摘Background: Aneurysms of the internal carotid artery within the petrous temporal bone are extremely rare;their true incidence is unknown. The exact cause is unclear: they may be congenital or result from trauma, infection, or radiation. Aim: We report a case of massive otorrhagia and epistaxis from a ruptured aneurysm of the petrous internal carotid artery. Case Presentation: A 34-year-old man presented to our department for the first time with repeated left otorrhagia ongoing for 5 years, left sided pulsatile tinnitus and left conductive hearing loss. In his history, we noted a right hemi-corporeal deficit of sudden onset one month ago and the head-CT showed a left frontoparietal subarachnoid hemorrhage without any visualised vascular malformation. Otomicroscopy showed a pulsatile mass visible at the posterior part of the hypotympanum. There was a right-sided hemiparesis estimated at 2/5 with no disorder of the sensitivity. After hemodynamic stabilization, the patient was discharged from the hospital and treatment was scheduled in interventional radiology and neurosurgery unit. Unfortunately the patient presented at home with a cataclysmic hemorrhage by massive otorrhagia and epistaxis and arrived dead at the emergency unit. Conclusion: The treatment of a petrous carotid aneurysm must be carried out quickly considering the risk of rupture leading to a cataclysmic hemorrhage that can be rapidly life threatening.
文摘Dear Editor,We are writing this letter to report an unexpected rare caseofcentralretinalarteryocclusion(CRAO)happened after stent-assisted coiling for internal carotid artery(ICA)aneurysm in a female patient.CRAO is a devastating ocular emergency with poor visual prognosis and no universal acceptedtreatmentatpresent.CRAOisusuallyassociated witharterialhypertension,diabetesmellitus,renaldisease.
文摘Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.
文摘Background:Blister-like aneurysms(BLAs)on the supraclinoid segment of the internal carotid artery(ICA)are an enigma of cerebrovascular disease.Neither has a definite pathogenesis been so far identified,nor have uniform treatment guidelines been established for them.Our aim was to develop a hypothesis regarding the evolution of BLAs according to their macroscopic morphologies and to evaluate the efficacy of microsurgical clipping.Methods:The clinical data and morphological features of 15 consecutive patients with 16 BLAs on the supraclinoid ICA were retrospectively reviewed.The treatment strategies were analyzed,and functional outcomes were evaluated using the modified Rankin scale(mRS).Favorable outcomes were defined as a mRS score of 0-2.Results:Morphologically,aneurysm growth with expansion of the aneurysm neck before the surgical procedure occurred in two ruptured and one unruptured aneurysm.Daughter bleb formation was observed in two ruptured and five unruptured aneurysms.A varied degree of parent artery sclerosis was observed in nine patients.Thirteen patients were treated with direct surgical clipping,one patient was treated with clipping and wrapping,and the remaining patient was treated with an encircling clipping graft.Favorable and unfavorable outcomes were observed in 13 and two cases,respectively.Follow-up angiograms revealed 4 cases of stenosis with respective degree of mild,30%,50%,and 80%without any neurological dysfunction.Conclusions:We suggest a hypothesis that BLAs on the supraclinoid ICA may share different evolving mechanisms between ruptured and unruptured lesions.A majority of them can be reliably and safely obliterated by direct clipping technique,except for the aneurysms accompanied with severely atherosclerotic parent walls.
文摘Multiple intracranial aneurysms account for 14%-35%of all intracranial aneurysms.Their incidence rate is significantly increased in women,patients with connective tissue disease,and patients with a family history of subarachnoid hemorrhage.Among them,tandem aneurysms are located on the same parent artery and in close proximity to each other.The LEO stent is a self-expanding nickel-titanium braided stent for intracranial vascularization,which is a delivery system that is easy to navigate and position precisely.This case report describes a 68-year-old female patient who was presented with the chief complaints of dizziness for more than a month upon admission to the First Affiliated Hospital,Zhejiang University,School of Medicine.The cerebral angiography established right vertebral artery occlusion,V4 segment of left vertebral artery dissection with two tandem aneurysms,and bilateral internal carotid artery cavernous sinus segment dissection aneurysm.Therefore,we opted to use the LEO stent semi-release assisted coil embolization to treat the vertebral artery V4 segment tandem aneurysms.Some problems encountered during the operation were also considered and discussed.
