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Concomitant Intracranial Aneurysm and Carotid Artery Stenosis: A Therapeutic Dilemma

Sankar D. Navaneethan, MD, MPH, Vijay Shri Kannan, MD, Ayodele Osowo, MD, Rakesh Shrivastava, MD, Sonal Singh, MD
Volume: 99 Issue: 7 July, 2006

Abstract:

Concurrent occurrence of carotid artery stenosis and intracerebral aneurysm is uncommon and poses a therapeutic dilemma. We report a patient with bilateral carotid artery stenosis and a 2.5 cm left middle cerebral artery aneurysm who simultaneously underwent a successful stent-assisted coiling for his intracerebral aneurysm and left carotid artery angioplasty with stenting during the same setting.


Key Points


* Occurrence of simultaneous intracerebral aneurysm and carotid artery stenosis is uncommon.


* Decision to correct both in the same setting or individually depends on the size of the intracranial aneurysm, the source of the transient ischemic attack, and the presence of locally available expertise.

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References:

1. Kappelle LJ, Eliasziw M, Fox AJ, et al. Small unruptured intracranial aneurysm and management of symptomatic carotid artery stenosis: North American symptomatic carotid endarterectomy trial group.Neurology 2000;55:307–309.
 
2. Pappada G, Fiori L, Marina R, et al. Incidence of asymptomatic of asymptomatic berry aneurysms among patients undergoing carotid endarterectomy. J Neurosurg PubMed
 
3. Kann BR, Matsumotot T, Kerstein MD. Safety of carotid endarterectomy associated with small intracranial aneurysms. South Med J 1997;90:1213–1216.
 
4. Carvi Y, Nievas MN, Haas E, Hollerhage HG. Unruptured large intracranial aneurysms in patients with transient cerebral ischemic episodes. Neurosurg Rev 2003;26:215–220.
 
5. Dippel WJ, Vermeulen M, Braakman R, Habbema JD. Transient ischemic attacks, carotid stenosis and incidental aneurysm: a decision analysis. Neurosurgery 1994;34:449–458.
 
6. Molyneux AJ, Kerr RS, Yu LM, et al, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 2005;366:809–817.
 
7. Terada T, Tsuura M, Matsumoto H, et al. Endovascular treatment of unruptured cerebral aneurysms.Acta Neurochir Suppl 2005;94:87–91.
 

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