Unruptured internal carotid artery bifurcation aneurysms: general features and overall results after modern treatment

Biagia La Pira, Waleed Brinjikji, Anthony M. Burrows, Harry J. Cloft, Roanna L. Vine, Giuseppe Lanzino

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Internal carotid artery bifurcation aneurysms (ICAbifAs) present unique challenges to endovascular and surgical operators, and little is known about their natural history. We reviewed our institution’s experience with ICAbifAs studying outcomes of surgical and endovascular management and natural history. Methods: Consecutive patients with unruptured ICAbifAs evaluated and/or treated over an 8-year interval were studied. Baseline demographics, neurovascular risk factors, aneurysm location and size, clinical presentation, treatment recommendations, and outcomes were prospectively collected and retrospectively analyzed. Continuous variables were compared with Student’s t test and categorical variables with Chi-square tests. Results: Fifty-nine patients with 61 unruptured ICAbifAs were included. Seven aneurysms were treated surgically (11.5 %), 22 underwent endovascular treatment (36 %), and 32 were managed conservatively (52.5 %). In the surgical group, short- and long-term complete aneurysm occlusion rates were 100 % with no cases of perioperative or long-term permanent morbidity or treatment-related mortality. In the endovascular group, two patients (11.7 %) with giant aneurysms had perioperative thromboembolic events with transient morbidity. There was one case of aneurysm rupture at follow-up in a giant aneurysm treated with partial coil embolization. Complete/near-complete occlusion rates were 63 %. There was one case of aneurysm rupture after 114 aneurysm-years of follow-up in the conservative management group (0.89 %/year), but no ruptures were observed in small aneurysms selected for conservative management. Conclusions: Unruptured small ICAbifAs have a benign natural history. In patients selected for treatment, excellent results can be achieved in the vast majority of patients with judicious use of endovascular and surgical therapy.

Original languageEnglish (US)
Pages (from-to)2053-2059
Number of pages7
JournalActa Neurochirurgica
Volume158
Issue number11
DOIs
StatePublished - Nov 1 2016

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Internal Carotid Artery
Aneurysm
Therapeutics
Natural History
Rupture
Morbidity
Chi-Square Distribution

Keywords

  • Endovascular coil embolization
  • Internal carotid artery bifurcation aneurysm
  • Natural history
  • Surgical clipping

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Unruptured internal carotid artery bifurcation aneurysms : general features and overall results after modern treatment. / La Pira, Biagia; Brinjikji, Waleed; Burrows, Anthony M.; Cloft, Harry J.; Vine, Roanna L.; Lanzino, Giuseppe.

In: Acta Neurochirurgica, Vol. 158, No. 11, 01.11.2016, p. 2053-2059.

Research output: Contribution to journalArticle

La Pira, Biagia ; Brinjikji, Waleed ; Burrows, Anthony M. ; Cloft, Harry J. ; Vine, Roanna L. ; Lanzino, Giuseppe. / Unruptured internal carotid artery bifurcation aneurysms : general features and overall results after modern treatment. In: Acta Neurochirurgica. 2016 ; Vol. 158, No. 11. pp. 2053-2059.
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abstract = "Background: Internal carotid artery bifurcation aneurysms (ICAbifAs) present unique challenges to endovascular and surgical operators, and little is known about their natural history. We reviewed our institution’s experience with ICAbifAs studying outcomes of surgical and endovascular management and natural history. Methods: Consecutive patients with unruptured ICAbifAs evaluated and/or treated over an 8-year interval were studied. Baseline demographics, neurovascular risk factors, aneurysm location and size, clinical presentation, treatment recommendations, and outcomes were prospectively collected and retrospectively analyzed. Continuous variables were compared with Student’s t test and categorical variables with Chi-square tests. Results: Fifty-nine patients with 61 unruptured ICAbifAs were included. Seven aneurysms were treated surgically (11.5 {\%}), 22 underwent endovascular treatment (36 {\%}), and 32 were managed conservatively (52.5 {\%}). In the surgical group, short- and long-term complete aneurysm occlusion rates were 100 {\%} with no cases of perioperative or long-term permanent morbidity or treatment-related mortality. In the endovascular group, two patients (11.7 {\%}) with giant aneurysms had perioperative thromboembolic events with transient morbidity. There was one case of aneurysm rupture at follow-up in a giant aneurysm treated with partial coil embolization. Complete/near-complete occlusion rates were 63 {\%}. There was one case of aneurysm rupture after 114 aneurysm-years of follow-up in the conservative management group (0.89 {\%}/year), but no ruptures were observed in small aneurysms selected for conservative management. Conclusions: Unruptured small ICAbifAs have a benign natural history. In patients selected for treatment, excellent results can be achieved in the vast majority of patients with judicious use of endovascular and surgical therapy.",
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