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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 829-834. doi: 10.19723/j.issn.1671-167X.2019.05.007

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Management of severe internal carotid stenosis with unruptured intracranial aneurysm

Hai-yan ZHAO1,Dong-sheng FAN1,Jin-tao HAN2,△()   

  1. 1. Department of Neurology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2017-10-10 Online:2019-10-18 Published:2019-10-23
  • Contact: Jin-tao HAN E-mail:bmucystal@163.com

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Abstract:

Objective: To investigate the safety and feasibility of endovascular treatment for severe internal carotid artery stenosis (≥70%) with unruptured intracranial aneurysms. Methods: We retrospectively reviewed 213 cases with severe stenosis or occlusion of internal carotid artery, and those patients had been treated at Peking University Third Hospital, between January 2012 and July 2015. In the stu-dy, 14 (6.6%) cases were coexistence with unruptured intracranial aneurysms. The medical records, imaging data, treatment and prognosis were analyzed. Results: There were 15 aneurysms (11 after the stenosis, 1 before the stenosis, and 3 in the other drainage basin) in those 14 patients with severe stenosis or occlusion of internal carotid artery. One of the 14 patients underwent carotid endarterectomy, and the 11 patients were successfully implanted with an internal carotid stent (residual stenosis 0-30%, mean 6.4%). Two patients with internal carotid artery stenosis remained untreated. One of them had complete occlusion of the initial segment of the internal carotid artery and was not possible to be treated, and the other patient refused to treat with internal carotid stenosis. The sizes of aneurysms were 1.0-7.0 mm, with an average of (2.8±1.5) mm. Three cases were treated with stenosis and aneurysms treated at the same time, and stent assisted coil embolization was performed in all the aneurysms, including 1 case that treated aneurysm before the stenosis. One patient refused surgical treatment of unruptured aneurysm, and no treatment was given to 10 patients who had small unruptured aneurysms (<5.0 mm). No perioperative complications were observed during the perioperative period. Three cases were lost with the follow-up, and the other 11 patients were followed up for 15-55 months, with a median of 37 months, and had good prognosis. Conclusion: Our results suggest that patient coexistance with severe internal carotid stenosis and unruptured intracranial aneurysms should be treated individually according to the location and size of aneurysms. Moreover, the presence of a small intracranial aneurysm (<5.0 mm) does not seem to increase the risk of endovascular stenosis in patients with severe internal carotid stenosis.

Key words: Intracranial aneurysm, Carotid stenosis, Stents, Embolism

CLC Number: 

  • R743

Table 1

Characteristics of patients and treatment of carotid stenosis and aneurysms (n=14)"

Patient no. Age (year)/
Gender		 Clinical
presentation		 Location of carotid lesion,
stenosis ratio		 Aneurysm/mm Carotid
treatment		 Residual stenosis
ratio		 Aneurysm
treatment
1 50/F Hemiplegia R C1, 90% R C5, 3 mm R CAS 10% Aneurysm
embolism
after CAS
2 61/F Dizziness R C1, 70%+L C1,
70%+L C4, 80%		 R C6, 3 mm R CAS+L CAS 10% None
3 83/F Dizziness R C1, 90% R C4, 3 mm R CEA 0 None
4 67/F Aphasia R C1, 90% L C7, 2 mm R CAS 0 None
5 67/F Dizziness L C1, 90% R C7, 2 mm L CAS 0 None
6 65/M Hemiplegia L C1, 95%+L C3/C4,
50%-70%+R C1,100%		 L C4, 4 mm L CAS 0 None
7 77/M Dizziness R C1,80% R C4, 4 mm R CAS 0 None
8 65/M Dizziness R C1,90% R C4, 1.4 mm+
R C4, 1.3 mm		 None None None
9 60/M Dizziness, amaurosis R C1,90% L C7, 3 mm L CAS 0 None
10 75/M Dizziness L C1,80%+R C1,95% L C4, 2 mm R CAS 0 None
11 50/M Dizziness R C1,100% L C4, 1 mm None None None
12 71/M Dizziness R C4,80% R C4, 3 mm R CAS 20% Aneurysm
embolism
before CAS
13 73/M Hemiplegia L C4,90% L C4, 2 mm L CAS 30% None
14 66/M Dizziness,
hemiplegia		 R C6,70% R C6, 7 mm R CAS 0 Aneurysm
embolism
after CAS

Figure 1

Right internal carotid artery C1 segment stenosis combined C5 segmnet aneurysm A and B showed carotid angioplasty and stenting; C and D showed intracranial aneurysm embolismed."

Figure 2

Right internal carotid artery C6 segment stenosis combined distal C6 segmnet aneurysm A showed right internal carotid artery C6 segment stenosis combined distal aneurysm pre-operation in 3-D view; B and C showed C6 segment angioplasty and stent-assisted coiling post operation in frontal and lateral view; E and F showed frontal and lateral view in 6-month follow-up."

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