title: Bilateral Cavernous Carotid Aneurysms: The Growth Potential of a Contralateral Aneurysm after Therapeutic Unilateral Internal Carotid Artery Occlusion.
abstract: BACKGROUND
  Although the introduction of flow-diverter stents has been recognized as a major revolution in the treatment of cavernous carotid aneurysms (CCAs), therapeutic internal carotid artery occlusion (TICAO) remains a reliable procedure for alleviating symptoms caused by CCAs. However, TICAO has the potential risk of the enlargement of coexisting aneurysms that are frequently detected in CCA patients. The purpose of this study is to assess the occurrence of the enlargement of aneurysms coexisting with CCAs after TICAO.
  
  
  METHODS
  We reviewed medical charts of CCA patients who were managed using unilateral TICAO. Coexisting aneurysms were identified using angiograms obtained before TICAO, and imaging data in long follow-up periods were retrospectively examined to determine the extent of the enlargement after TICAO.
  
  
  RESULTS
  Of 12 patients with CCAs, 10 had 12 coexisting aneurysms; 5 of the coexisting aneurysms (41.7%) showed enlargement during a mean follow-up period of 8.1 years, and all enlarged aneurysms were smaller of the bilateral CCAs; the larger CCA had been managed by TICAO. Five of 6 (83.3%) patients with bilateral CCAs showed enlargement of the contralateral aneurysm after TICAO. Two contralateral CCAs showed marked enlargement after TICAO and were subsequently treated with stent-assisted coil embolization.
  
  
  CONCLUSIONS
  Contralateral, smaller aneurysms frequently enlarge after unilateral TICAO in patients with bilateral CCAs. The findings emphasize the importance of long-term observation after TICAO and appropriate interventions against enlarging contralateral aneurysms.
authors.affiliation: Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan. Electronic address: nishino@bri.niigata-u.ac.jp.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nishino
authors.affiliation: Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hasegawa
authors.affiliation: Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000473:pathology*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Therapeutic carotid occlusion; cavernous carotid aneurysm; enlargement; stent-assisted coil embolization