title: Is Carotid Revascularization Safe for Patients with Concomitant Carotid Stenosis and Intracranial Aneurysms?
abstract: OBJECTIVE
  The safety of carotid revascularization in patients with concomitant extracranial carotid stenosis and cerebral aneurysm is rarely reported. We examine the risk of subarachnoid hemorrhage, aneurysm growth, ipsilateral transient ischemic attack, or stroke after revascularization in patients with both carotid stenosis and cerebral aneurysms.
  
  
  METHODS
  A retrospective cohort study of patients with concomitant diagnosis of aneurysm and carotid stenosis evaluated in the neurosurgical department at our institution from 1990 to 2013 was carried out. Patients with both revascularized and nonrevascularized carotid stenosis were included. Demographic and angiographic characteristics, medical history, and treatment outcomes were collected. Comparison was made between the following 2 groups: revascularized carotid stenosis with stent or carotid endarterectomy versus nonrevascularized carotid stenosis.
  
  
  RESULTS
  The study cohort consisted of 39 patients with 48 stenotic cervical internal carotid arteries and 51 cerebral aneurysms. Twenty patients (51.3%) underwent carotid endarterectomy/stenting, and 19 (48.7%) were managed medically. Patient characteristics were similar across the 2 groups except for increased severity of carotid stenosis (P < 0.001) and more posterior circulation aneurysms (P = 0.045) in the revascularized group. Ipsilateral stenosis and aneurysm was observed in 9 cases (40.9%) in the revascularized group and in 11 cases (42.3%) in the nonrevascularized group. During average follow-up of 1.62 years, no aneurysm rupture was observed. One ipsilateral stroke occurred in the revascularized group during follow-up, corresponding to an annual risk of 2.0%. One aneurysm enlargement occurred per group, with both located in the posterior circulation.
  
  
  CONCLUSIONS
  Our study suggests that revascularization procedures for carotid stenosis should be considered safe and effective in patients with concomitant extracranial carotid occlusive disease and cerebral aneurysms.
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Wuyang
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Rong
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Braileanu
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: Garzon-Muvdi
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Caplan
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Colby
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Coon
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.affiliation: Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: jhuang24@jhmi.edu.
authors.forename: Judy
authors.initials: J
authors.lastname: Huang
mesh_terms: D016893:Carotid Stenosis / Q000401:mortality* / Q000601:surgery*; D002548:Cerebral Revascularization / Q000401:mortality* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D004691:Endarterectomy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Aneurysm; Carotid endarterectomy; Stroke; Subarachnoid hemorrhage