Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms

Results in 87 cases

R. T. Higashida, V. V. Halbach, C. Dowd, S. L. Barnwell, B. Dormandy, J. Bell, G. B. Hieshima

Research output: Contribution to journalArticle

175 Citations (Scopus)

Abstract

Interventional neurovascular techniques for treating patients with intracranial aneurysms are now being performed in selected cases. In certain anatomical locations that are difficult to reach surgically, such as the cavernous portion of the internal carotid artery (ICA), this technique may be especially useful. The procedure is performed from a transfemoral approach, using local anesthesia, thus permitting continuous neurological monitoring. Between 1981 and 1989, 87 patients diagnosed as having an intracavernous aneurysm were treated with endovascular detachable balloon embolization techniques. The patients ranged in age from 11 to 84 years. The presenting symptom was mass effect in 69 cases (79.3%), rupture of a preexisting aneurysm resulting in a carotid-cavernous sinus fistula in eight cases (9.2%), trauma resulting in a cavernous pseudoaneurysm in seven cases (8.0%), and hemorrhage in three cases (3.4%). Therapeutic occlusion of the ICA across or just proximal to the aneurysm neck was performed in 68 patients (78.2%). Since 1984, with the development of a permanent solidifying agent (2-hydroxyethyl methacrylate) to fill the balloon, it is now feasible in some cases to guide the balloon directly into the aneurysm and preserve the parent artery; this was achieved in 19 cases (22%). Follow-up examination has demonstrated complete thrombosis with partial or total alleviation of symptoms in all patients with therapeutic occlusion of the parent vessel. Of the 19 patients with preservation of the parent artery, follow-up studies have demonstrated total exclusion in 12 cases (63%) and subtotal occlusion of greater than 85% in seven cases (37%), with clinical improvement in all cases. Complications from therapy included transient cerebral ischemia during or after therapy requiring volume expansion in seven cases, embolic symptoms requiring antiplatelet medication in two cases, and stroke in four cases; there were no deaths. Detachable balloon embolization therapy, particularly for large and giant symptomatic aneurysms of the cavernous ICA, can be an effective mode of treatment.

Original languageEnglish (US)
Pages (from-to)857-863
Number of pages7
JournalJournal of Neurosurgery
Volume72
Issue number6
StatePublished - 1990
Externally publishedYes

Fingerprint

Balloon Occlusion
Carotid Arteries
Aneurysm
Therapeutic Occlusion
Internal Carotid Artery
Carotid-Cavernous Sinus Fistula
Therapeutics
Arteries
False Aneurysm
Transient Ischemic Attack
Intracranial Aneurysm
Local Anesthesia
Rupture
Thrombosis
Stroke
Hemorrhage
Wounds and Injuries

Keywords

  • aneurysm
  • balloon occlusion
  • Cavernous internal carotid artery
  • detachable balloon
  • endovascular therapy
  • interventional radiology

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Higashida, R. T., Halbach, V. V., Dowd, C., Barnwell, S. L., Dormandy, B., Bell, J., & Hieshima, G. B. (1990). Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: Results in 87 cases. Journal of Neurosurgery, 72(6), 857-863.

Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms : Results in 87 cases. / Higashida, R. T.; Halbach, V. V.; Dowd, C.; Barnwell, S. L.; Dormandy, B.; Bell, J.; Hieshima, G. B.

In: Journal of Neurosurgery, Vol. 72, No. 6, 1990, p. 857-863.

Research output: Contribution to journalArticle

Higashida, RT, Halbach, VV, Dowd, C, Barnwell, SL, Dormandy, B, Bell, J & Hieshima, GB 1990, 'Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: Results in 87 cases', Journal of Neurosurgery, vol. 72, no. 6, pp. 857-863.
Higashida RT, Halbach VV, Dowd C, Barnwell SL, Dormandy B, Bell J et al. Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms: Results in 87 cases. Journal of Neurosurgery. 1990;72(6):857-863.
Higashida, R. T. ; Halbach, V. V. ; Dowd, C. ; Barnwell, S. L. ; Dormandy, B. ; Bell, J. ; Hieshima, G. B. / Endovascular detachable balloon embolization therapy of cavernous carotid artery aneurysms : Results in 87 cases. In: Journal of Neurosurgery. 1990 ; Vol. 72, No. 6. pp. 857-863.
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abstract = "Interventional neurovascular techniques for treating patients with intracranial aneurysms are now being performed in selected cases. In certain anatomical locations that are difficult to reach surgically, such as the cavernous portion of the internal carotid artery (ICA), this technique may be especially useful. The procedure is performed from a transfemoral approach, using local anesthesia, thus permitting continuous neurological monitoring. Between 1981 and 1989, 87 patients diagnosed as having an intracavernous aneurysm were treated with endovascular detachable balloon embolization techniques. The patients ranged in age from 11 to 84 years. The presenting symptom was mass effect in 69 cases (79.3{\%}), rupture of a preexisting aneurysm resulting in a carotid-cavernous sinus fistula in eight cases (9.2{\%}), trauma resulting in a cavernous pseudoaneurysm in seven cases (8.0{\%}), and hemorrhage in three cases (3.4{\%}). Therapeutic occlusion of the ICA across or just proximal to the aneurysm neck was performed in 68 patients (78.2{\%}). Since 1984, with the development of a permanent solidifying agent (2-hydroxyethyl methacrylate) to fill the balloon, it is now feasible in some cases to guide the balloon directly into the aneurysm and preserve the parent artery; this was achieved in 19 cases (22{\%}). Follow-up examination has demonstrated complete thrombosis with partial or total alleviation of symptoms in all patients with therapeutic occlusion of the parent vessel. Of the 19 patients with preservation of the parent artery, follow-up studies have demonstrated total exclusion in 12 cases (63{\%}) and subtotal occlusion of greater than 85{\%} in seven cases (37{\%}), with clinical improvement in all cases. Complications from therapy included transient cerebral ischemia during or after therapy requiring volume expansion in seven cases, embolic symptoms requiring antiplatelet medication in two cases, and stroke in four cases; there were no deaths. Detachable balloon embolization therapy, particularly for large and giant symptomatic aneurysms of the cavernous ICA, can be an effective mode of treatment.",
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