Treatment Results of Endovascular Surgery based on Projection of Paraclinoid Internal Carotid Artery Aneurysms

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  • Ito Hidemichi
    Department of Neurosurgery, St. Marianna University School of Medicine
  • Morishima Hiroyuki
    Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
  • Onodera Hidetaka
    Department of Neurosurgery, St. Marianna University School of Medicine
  • Wakui Daisuke
    Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama City Seibu Hospital
  • Tanaka Yuichiro
    Department of Neurosurgery, St. Marianna University School of Medicine
  • Hashimoto Takuo
    Department of Neurosurgery, St. Marianna University School of Medicine

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  • 傍突起部内頚動脈瘤の発育方向とコイル塞栓術の治療結果

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Object: In order to predict the technical difficulties of coil embolization for paraclinoid aneurysms (PC-an), we retrospectively analized our clinical experience. Method: We analyzed 34 patients with 35 PC-an treated with endovascular techniques between 2001 and 2010. These aneurysms were classified into 4 groups on the basis of their projections visualized on angiograms as follows: ventral, 17 ; medial, 7 ; dorsal, 8 and lateral, 3. The size of the aneurysms and the angle of carotid siphon were measured on angiograms for each group. The levels of those aneurysm necks were classified as supraclinoid, clinoid and infraclinoid according to their relation to the anterior clinoid process. Angiographic outcome, volume embolization ratio (VER), number of microcatheters and microguidewires used and duration of endovascular procedure were evaluated for each group. Clinical outcomes were assessed using the Glasgow Outcome Scale (GOS). Result: The mean size of the aneurysms in the ventral, medial, dorsal and lateral groups was 4.1, 5.6, 6.7 and 8.4 mm, respectively. The mean angle of carotid siphon was more acute in the dorsal and lateral groups. The neck level was supraclinoid in 10, clinoid in 14 and infraclinoid in 11. The percentage of dorsal and lateral groups was larger in the supraclinoid level. Endovascular treatment was successfully performed in 91.4% cases with treatment complications including 3 ischemic events. The number of patients with clinical outcomes classified according to the GOS was as follows: good recovery, 31 ; moderately disabled, 2 ; severely disabled, 1 ; vegetative state, 0 and dead, 1. Complete obliteration was achieved in 70.6%, 57.1%, 32.5% and 0% patients in the ventral, medial, dorsal and lateral groups, respectively, and the corresponding VER was 37.6%, 32.3%, 24.8% and 16.4%. The number of microcatheters and microguidewires used was higher in the dorsal and lateral groups than that used in the other 2 groups. The duration of the procedures was also longer in the dorsal and lateral groups. Conclusion: Endovascular treatment is a safe and effective therapeutic alternative for PC-an. However, in dorsal and lateral PC-an, this treatment entails additional difficulties of handling microcatheters and microguidewires because of their anatomical specificity. Therefore, endovascular treatment for these aneurysms is occasionally associated with lower rates of complete obliteration and lower VER than those of ventral and medial PC-an.

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