title: De novo aneurysm formation and aneurysm growth following therapeutic carotid occlusion for intracranial internal carotid artery (ICA) aneurysms.
abstract: We herein report the long term results of 27 intracranial internal carotid artery (ICA) aneurysms treated by indirect surgery such as a trapping of the aneurysm or carotid ligation either with or without EC-IC bypass. These patients were then followed for a mean period of 10 years. Seventy-four percent of the aneurysms were categorized as either being giant or large. Late complications were observed in 7 patients. A rupture of newly formed aneurysms at the anterior communicating artery occurred in 2 cases 8 or 9 years after either trapping or performing a ICA ligation, respectively. In these patients, previous angiography could not reveal any abnormalities at the anterior communicating artery. A rupture of a contralateral ICA aneurysm was seen in a patient whose ipsilateral ICA was ligated for a ICA aneurysm 22 years previously. An enlargement of the contralateral giant cavernous ICA aneurysm became symptomatic 6 years after a partial ligation of the ICA combined with an EC-IC bypass for a giant cavernous carotid artery aneurysm on the other side. Two cases of sudden death occurred in a young patient and an elderly patient with a small anterior communicating artery aneurysm, 9 and 19 years respectively, after trapping of the ICA aneurysms, although the cause could not be definitely ascertained. Rebleeding occurred in one patient who died 8 years after a carotid ligation and a partial clipping of the ICA aneurysm. Haemodynamic stress may therefore play a major role in inducing new aneurysms or growing aneurysms.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Fujiwara
authors.forename: K
authors.initials: K
authors.lastname: Fujii
authors.forename: M
authors.initials: M
authors.lastname: Fukui
mesh_terms: D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery; D002404:Catheterization; D002548:Cerebral Revascularization; D003399:Craniotomy; D005260:Female; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000175:diagnosis / Q000601:surgery*; D008026:Ligation; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation