Angioscopy-assisted aneurysm clipping

Giuseppe Lanzino, László Miskolczi, Lee R. Guterman, L. Nelson Hopkins

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE: To test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel complex. METHODS: A carotid bifurcation aneurysm was surgically created in a dog at the lingual artery origin. A balloon catheter was inflated proximal to the aneurysm to block proximal blood flow and allow endoluminal visualization. A flexible angioscope connected to a video monitoring system and to a high-intensity light source was then advanced within the catheter lumen and positioned immediately distal to the catheter tip. The aneurysm neck was clipped, and the clip was repositioned several times along the neck, with or without distal parent vessel compromise. Each time, the endovascular image on the monitor was interpreted by an observer blinded to the position of the clip. Clip position and image interpretation were communicated independently to a third person, who analyzed the correlation between them. RESULTS: Angioscopy allowed clear visualization of the extent of aneurysm neck occlusion (complete, incomplete, residual 'dog ear') after clip application, as well as the presence or absence of distal parent vessel compromise. Aneurysm neck configuration, size, presence of thrombus, and suture line definition were depicted. Critical structures external to the aneurysm-parent vessel complex were transilluminated by the high-intensity lamp. CONCLUSION: Although acknowledged as the treatment of choice for intracranial aneurysms, surgical exclusion can be accompanied by significant morbidity related to perforator occlusion, parent artery compromise, and/or persistent residual aneurysm. The availability of a device allowing visualization of an aneurysm from an endoluminal perspective theoretically could reduce the incidence of these complications. Angioscopy has the potential to become a useful adjunct during intracranial aneurysm clipping because it provides real-time endoluminal viewing of the aneurysm-distal parent vessel complex, which is sometimes obscured to the surgeon.

Original languageEnglish (US)
Pages (from-to)609-613
Number of pages5
JournalNeurosurgery
Volume45
Issue number3
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Angioscopy
Aneurysm
Surgical Instruments
Intracranial Aneurysm
Catheters
Angioscopes
Arteries
Dogs
Tongue
Sutures
Ear
Thrombosis
Neck

Keywords

  • Angioscopy
  • Intracranial aneurysms
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Lanzino, G., Miskolczi, L., Guterman, L. R., & Hopkins, L. N. (1999). Angioscopy-assisted aneurysm clipping. Neurosurgery, 45(3), 609-613. https://doi.org/10.1097/00006123-199909000-00032

Angioscopy-assisted aneurysm clipping. / Lanzino, Giuseppe; Miskolczi, László; Guterman, Lee R.; Hopkins, L. Nelson.

In: Neurosurgery, Vol. 45, No. 3, 1999, p. 609-613.

Research output: Contribution to journalArticle

Lanzino, G, Miskolczi, L, Guterman, LR & Hopkins, LN 1999, 'Angioscopy-assisted aneurysm clipping', Neurosurgery, vol. 45, no. 3, pp. 609-613. https://doi.org/10.1097/00006123-199909000-00032
Lanzino G, Miskolczi L, Guterman LR, Hopkins LN. Angioscopy-assisted aneurysm clipping. Neurosurgery. 1999;45(3):609-613. https://doi.org/10.1097/00006123-199909000-00032
Lanzino, Giuseppe ; Miskolczi, László ; Guterman, Lee R. ; Hopkins, L. Nelson. / Angioscopy-assisted aneurysm clipping. In: Neurosurgery. 1999 ; Vol. 45, No. 3. pp. 609-613.
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AB - OBJECTIVE: To test the concept that endovascular angioscopy can assist surgical intracranial aneurysm clipping by providing an endoluminal view of the aneurysm-parent vessel complex. METHODS: A carotid bifurcation aneurysm was surgically created in a dog at the lingual artery origin. A balloon catheter was inflated proximal to the aneurysm to block proximal blood flow and allow endoluminal visualization. A flexible angioscope connected to a video monitoring system and to a high-intensity light source was then advanced within the catheter lumen and positioned immediately distal to the catheter tip. The aneurysm neck was clipped, and the clip was repositioned several times along the neck, with or without distal parent vessel compromise. Each time, the endovascular image on the monitor was interpreted by an observer blinded to the position of the clip. Clip position and image interpretation were communicated independently to a third person, who analyzed the correlation between them. RESULTS: Angioscopy allowed clear visualization of the extent of aneurysm neck occlusion (complete, incomplete, residual 'dog ear') after clip application, as well as the presence or absence of distal parent vessel compromise. Aneurysm neck configuration, size, presence of thrombus, and suture line definition were depicted. Critical structures external to the aneurysm-parent vessel complex were transilluminated by the high-intensity lamp. CONCLUSION: Although acknowledged as the treatment of choice for intracranial aneurysms, surgical exclusion can be accompanied by significant morbidity related to perforator occlusion, parent artery compromise, and/or persistent residual aneurysm. The availability of a device allowing visualization of an aneurysm from an endoluminal perspective theoretically could reduce the incidence of these complications. Angioscopy has the potential to become a useful adjunct during intracranial aneurysm clipping because it provides real-time endoluminal viewing of the aneurysm-distal parent vessel complex, which is sometimes obscured to the surgeon.

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