title: Parent vessel occlusion for treatment of cerebral aneurysms: Is there still an indication? A series of 17 patients.
abstract: OBJECTIVE
  Flow diversion has allowed cerebrovascular neurosurgeons and neurointerventionalists to treat complex, large aneurysms, previously treated with trapping, bypass, and/or parent vessel sacrifice. However, a minority of aneurysms remain that cannot be treated endovascularly, and microsurgical treatment is too dangerous. However, balloon test occlusion (macro and micro), micro WADA testing, ICG, intra-angiography and intra-operative monitoring are all available to clinically test the hypothesis that vessel sacrifice is safe. We describe a dual-institution series of aneurysms successfully treated with parent vessel occlusion (PVO).
  
  
  METHODS
  Prospectively collected databases of all endovascular and open cerebrovascular cases performed at Maine Medical Center and Vanderbilt University Medical Center from 2011 to 2013 were screened for patients treated with primary vessel sacrifice. A total of 817 patients were screened and 17 patients were identified who underwent parent vessel sacrifice as primary treatment.
  
  
  RESULTS
  All 17 patients primarily treated with PVO are described below. Nine patients presented with SAH, and 3/17 involved anterior circulation. Complete occlusion was achieved in 15/17 patients. In the remaining 2 patients, significant reduction in the aneurysm occurred. Modified Rankin Score (mRS) of 0, signifying complete independence, was achieved for 16/17 patients. One patient died due to an extracranial process.
  
  
  CONCLUSIONS
  Parent vessel sacrifice remains a viable and durable solution in select ruptured and unruptured intracranial aneurysms. Many adjuncts are available to aid in the decision making. In this small series, patients naturally divided into vertebral dissecting aneurysms, giant aneurysms and small distal aneurysms. Outcomes were favorable in this highly selected group.
authors.affiliation: Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA. Electronic address: nishant.ganesh.kumar@vanderbilt.edu.
authors.forename: Nishant
authors.initials: N
authors.lastname: Ganesh Kumar
authors.affiliation: Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA.
authors.forename: Travis R
authors.initials: TR
authors.lastname: Ladner
authors.affiliation: Dartmouth Hitchcock Medical Center, Department of Neurosurgery, Hanover, New Hampshire, USA.
authors.forename: Imad S
authors.initials: IS
authors.lastname: Kahn
authors.affiliation: Vanderbilt University Medical Center, Department of Neurosurgery, Nashville, Tenessee, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.affiliation: Maine Medical Center, Neuroscience Institute, Portland, Maine, USA; Maine Medical Center, Department of Radiology, Portland, ME, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Baker
authors.affiliation: Maine Medical Center, Neuroscience Institute, Portland, Maine, USA.
authors.forename: Marybess
authors.initials: M
authors.lastname: Skaletsky
authors.affiliation: Maine Medical Center, Neuroscience Institute, Portland, Maine, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cushing
authors.affiliation: Maine Medical Center, Neuroscience Institute, Portland, Maine, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Sanborn
authors.affiliation: Mt. Sinai Medical Center, Department of Neurosurgery, New York, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.affiliation: Maine Medical Center, Neuroscience Institute, Portland, Maine, USA; Maine Medical Center, Department of Surgery, Portland, ME, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D060205:Therapeutic Occlusion / Q000379:methods*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy
keywords: Aneurysm; Balloon test occlusion; Giant aneurysm; Parent vessel occlusion