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Carotid occlusion as a treatment modality for complex wide neck aneurysms
EANS Academy. El Ghanam A. 09/25/19; 275610; EP01051
Amin El Ghanam
Amin El Ghanam

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Abstract
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Background: The carotid aneurysms are associated with a higher mortality rate after rupture and patients can present significant morbidities during the subsequent treatment. Neurosurgical management of both intra cranial and extra cranial aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefited in the last two decades from tremendous improvements in the endovascular technology.
Methods: Two cases will be discussed representing intra and extra cranial carotid aneurysms . The first case was an African male 25 years old complaining from a right hemiparesis and dysarthria . MRI Brain with diffusion revealed a typical picture of cerebral ischemia . The cerebral angiography explained this ischemia by a giant aneurysm at the left common carotid bifurcation disturbing the cerebral blood flow . The second case was a male 75 years old complaining from headache & amnesia . MRI Brain revealed a giant right ICA aneurysm .
Results: The management of the two cases depends on the results of occlusion of the carotids in both cases with good permeability consequences . The first case was managed by occluding the left common carotid near its bifurcation with detachable balloons ,but it was preceded by coiling for the left ICA to prevent its competitive effect.A remarkable improvement of the anterior circulation at the left side was noticed . In the second case ,we occluded the right ICA by some coils & injecting EVOH (onyx). Finally, we maintained the revascularization through a good working anterior communicating artery.
Conclusion: Carotid occlusion is a safe &practical endovascular treatment for giant complex aneurysms .
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