Management of carotid artery stenosis in patients with coexistent unruptured intracranial aneurysms

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OBJECTIVE

Concomitant unruptured intracranial aneurysms (UIAs) are present in patients with carotid artery stenosis not infrequently and result in unique management challenges. Thus, we investigated the risk of rupture of an aneurysm after revascularization of a carotid artery in a contemporary consecutive series of patients seen at our institution.

METHODS

Data from patients who underwent a carotid revascularization in the presence of at least one concomitant UIA at our institution from 1991 to 2018 were retrospectively reviewed. Patients were evaluated for the incidence of aneurysm rupture within 30 days (early period) and after 30 days (late period) of carotid revascularization, as well as for the incidence of periprocedural complications from the treatment of carotid stenosis and/or UIA.

RESULTS

Our study included 53 patients with 63 concomitant UIAs. There was no rupture within 30 days of carotid revascularization. The overall risk of rupture was 0.87% per patient-year. Treatment (coiling or clipping) of a concomitant UIA, if pursued, could be performed successfully after carotid revascularization.

CONCLUSIONS

Carotid artery revascularization in the setting of a concomitant UIA can be performed safely without an increased 30-day or late-term risk of rupture. If indicated, treatment of the UIA can take place after the patient recovers from the carotid procedure.

ABBREVIATIONS CAS = carotid artery stenting; CEA = carotid endarterectomy; CN = cranial nerve; SAH = subarachnoid hemorrhage; UIA = unruptured intracranial aneurysm.
Article Information

Contributor Notes

Correspondence Giuseppe Lanzino: Mayo Clinic, Rochester, MN. lanzino.giuseppe@mayo.edu.INCLUDE WHEN CITING Published online January 18, 2019; DOI: 10.3171/2018.9.JNS182155.

T.T. and T.J.S. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Ballotta EDa Giau GManara RBaracchini C: Extracranial severe carotid stenosis and incidental intracranial aneurysms. Ann Vasc Surg 20:582006

    • Search Google Scholar
    • Export Citation
  • 2

    Borkon MJHoang HRockman CMussa FCayne NSRiles T: Concomitant unruptured intracranial aneurysms and carotid artery stenosis: an institutional review of patients undergoing carotid revascularization. Ann Vasc Surg 28:1021072014

    • Search Google Scholar
    • Export Citation
  • 3

    Cho YDJung KHRoh JKKang HSHan MHLim JW: Characteristics of intracranial aneurysms associated with extracranial carotid artery disease in South Korea. Clin Neurol Neurosurg 115:167716812013

    • Search Google Scholar
    • Export Citation
  • 4

    Gallego León JIConcepción Aramendía LBallenilla Marco FVázquez Suárez JC: Concomitant endovascular treatment of concomitant extracranial carotid stenosis and intracranial aneurysm. Our experience. Interv Neuroradiol 15:53592009

    • Search Google Scholar
    • Export Citation
  • 5

    Héman LMJongen LMvan der Worp HBRinkel GJHendrikse J: Incidental intracranial aneurysms in patients with internal carotid artery stenosis: a CT angiography study and a metaanalysis. Stroke 40:134113462009

    • Search Google Scholar
    • Export Citation
  • 6

    Kappelle LJEliasziw MFox AJBarnett HJ: Small, unruptured intracranial aneurysms and management of symptomatic carotid artery stenosis. Neurology 55:3073092000

    • Search Google Scholar
    • Export Citation
  • 7

    Khan UAThapar AShalhoub JDavies AH: Risk of intracerebral aneurysm rupture during carotid revascularization. J Vasc Surg 56:173917472012

    • Search Google Scholar
    • Export Citation
  • 8

    Ladowski JSWebster MWYonas HOSteed DL: Carotid endarterectomy in patients with asymptomatic intracranial aneurysm. Ann Surg 200:70731984

    • Search Google Scholar
    • Export Citation
  • 9

    Shakur SFAmin-Hanjani SBednarski CDu XAletich VACharbel FT: Intracranial blood flow changes after extracranial carotid artery stenting. Neurosurgery 76:3303362015

    • Search Google Scholar
    • Export Citation
  • 10

    Shakur SFHrbac TAlaraj ADu XAletich VACharbel FT: Effects of extracranial carotid stenosis on intracranial blood flow. Stroke 45:342734292014

    • Search Google Scholar
    • Export Citation
  • 11

    Stern JWhelan MBrisman RCorrell JW: Management of extracranial carotid stenosis and intracranial aneurysms. J Neurosurg 51:1471501979

    • Search Google Scholar
    • Export Citation
  • 12

    Suh BYYun WSKwun WH: Carotid artery revascularization in patients with concomitant carotid artery stenosis and asymptomatic unruptured intracranial artery aneurysm. Ann Vasc Surg 25:6516552011

    • Search Google Scholar
    • Export Citation
  • 13

    Yang WRong XBraileanu MJiang BGarzon-Muvdi TCaplan JM: Is carotid revascularization safe for patients with concomitant carotid stenosis and intracranial aneurysms? World Neurosurg 93:11182016

    • Search Google Scholar
    • Export Citation
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