Article Figures & Data
Figures
- Fig 1.
A, Lateral angiogram obtained before treatment shows a right ruptured dissecting ICA aneurysm.
B, 4 × 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.
- 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.
- 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.
- 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.
- 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.
Tables
Patient demographics, aneurysm location and size, clinical data, post-procedural clinical and angiographic follow-up
Patient No. Age (yr) Sex Aneurysm Location Size (mm) Mass Effect Trauma Control Angiography Mass Effect Early Outcome* Mass Effect Late Outcome* 1 55 M R cav 33 × 28 6n Palsy + 6 month Full recovery Stable 2 22 M R cav 34 × 29 Headache + 1 year Improved Full recovery 3 48 F R petrocav 27 × 31 Headache + NA Improved NA 4 49 M L cav† 15 × 20 6n and 3n Palsy − NA Full recovery NA 5α 18 M L cav 16 × 24 None + 6 month NA NA 6α 23 M L cav† 39 × 33 2n Palsy +(β) 2 year Full recovery Stable L cav 6 × 6 NA NA 7 54 M R cav 20 × 17 Headache − 6 month Improved Full recovery 8α 43 F R cav† 22 × 15 6n Palsy + 6 month No change Full recovery 6 months 9 32 M L cav 14 × 21 None +(β) 6 month NA NA 10 25 M L petrocav† 5 × 7 None +(β) 1 year NA NA 11 35 M R cav 21 × 17 Headache + 1 year Improved Full recovery 12α 34 M R caroticooph 37 × 25 Total ophthalmoplegia + 18 month Full recovery Stable 13α 59 F L caroticooph 14 × 17 None (SAH) − 6 month NA NA 14α 43 M L cav† 27 × 20 Total ophthalmoplegia + 18 month Partial recovery Full recovery 6 months 15 18 M L petrocav 12 × 14 None +(β) 6 month NA NA 16 22 M R petrocav 9 × 6 None +(β) 6 month NA NA 17α 34 M L cav 28 × 34 3n Palsy − 1 year Partial recovery Full recovery 6 months 18 17 F L cav 18 × 14 6n Palsy + 1 year Full recovery Stable 19 23 M L cav 16 × 11 None − NA NA NA 20α 27 F L caroticooph 9 × 7 None − 6 month NA NA 21 29 M L cav 4 × 3 None +(β) 6 month NA NA 22 36 F L petrous 24 × 28 Headache + 6 month Full recovery Stable 23 24 F R caroticooph 3 × 4 None (SAH) − 1 year NA NA 24 34 F R cavernous 22 × 27 3n Palsy + 6 month Partial recovery Full recovery Note.—α indicates patients in whom ophthalmic artery was covered with the stent graft; M, male; F, female; R, right; L, left; cav, cavernous internal carotid artery; petrocav, petrous and cavernous portion of the internal carotid artery; caroticooph, carotico-ophthalmic segment of the internal carotid artery; 6n, sixth nerve; 3n, third nerve; 2n, second nerve; SAH, subarachnoid hemorrhage; β, patients who had nasal bleeding; NA, not applicable because the time interval since treatment was <6 months and no control angiography had yet been performed.
* Control Angiography, latest angiography performed; Mass Effect Early Outcome, evaluation of mass effect symptom at end of second week; Mass Effect Late Outcome, evaluation during clinical follow-up (during third month unless otherwise indicated).
† Aneurysms were partially thrombosed.
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