De Novo Large Fusiform Posterior Circulation Intracranial Aneurysm Presenting With Subarachnoid Hemorrhage 7 Years After Therapeutic Internal Carotid Artery Occlusion
- 1 September 2012
- journal article
- case report
- Published by Ovid Technologies (Wolters Kluwer Health) in Neurosurgery
- Vol. 71 (3), E764-E771
- https://doi.org/10.1227/neu.0b013e31825fd169
Abstract
Although the use of proximal artery occlusion, or hunterian ligation, for the treatment of intracranial aneurysms has decreased greatly over the past decades, this approach still finds use for certain giant and complex aneurysms. The main risks of artery sacrifice are ischemic complications but also, although rare, de novo aneurysm formation. We present here a case of de novo formation of a large fusiform basilar artery aneurysm 7 years after internal carotid artery occlusion. A 17-year-old male patient with a history of a giant right cavernous aneurysm treated 7 years earlier with right-sided endovascular internal carotid artery occlusion presented to our institution with a thunderclap headache. At the time of initial evaluation, the patient was neurologically intact and imaging revealed a 22 × 10-mm fusiform aneurysm of the distal basilar artery with mass effect on the adjacent pons as well as a small amount of subarachnoid and intraventricular blood. Complete occlusion of the right internal carotid artery was demonstrated with retrograde filling of the right middle cerebral artery from the enlarged right posterior communicating artery. The patient was subsequently treated with hunterian occlusion of the basilar artery below anterior inferior cerebellar arteries. A superficial temporal artery to middle cerebral artery bypass was performed on the right side before this occlusion. Further studies on the epidemiology of de novo aneurysms after carotid artery occlusion are warranted. Patients at higher risk of the development of intracranial aneurysms should be followed aggressively after hunterian ligation, and the possibility of an extracranial-intracranial bypass should be discussed.Keywords
This publication has 48 references indexed in Scilit:
- De Novo Aneurysm Formation after Carotid Artery Occlusion for Cerebral AneurysmsJournal of Neurological Surgery Part B: Skull Base, 2010
- MOLECULAR ALTERATIONS ASSOCIATED WITH ANEURYSMAL REMODELING ARE LOCALIZED IN THE HIGH HEMODYNAMIC STRESS REGION OF A CREATED CAROTID BIFURCATIONNeurosurgery, 2009
- Development of 'De novo' Aneurysm after Therapeutic Carotid OcclusionJournal of Korean Neurosurgical Society, 2009
- Congenital absence of the right common carotid artery, internal carotid artery and external carotid artery associated with anterior communicating artery aneurysm: a rare caseNeurological Sciences, 2008
- Aneurysm Growth Occurs at Region of Low Wall Shear StressStroke, 2008
- Nascent Aneurysm Formation at the Basilar Terminus Induced by HemodynamicsStroke, 2008
- De novo aneurysm formation and aneurysm growth following therapeutic carotid occlusion for intracranial internal carotid artery (ICA) aneurysmsActa Neurochirurgica, 1993
- Serial development of ‘de novo’ aneurysms after carotid ligation: Case reportSurgical Neurology, 1992
- Rebleeding of an angiographically healed aneurysmSurgical Neurology, 1983
- Contralateral intracranial aneurysm formation as a late complication of carotid ligationSurgical Neurology, 1982