[Ischemic complications following parent artery occlusion with detachable balloons in the treatment of large carotid aneurysms: effectiveness of 99mTc-HMPAO SPECT and importance of postoperative management]

Abstract

Three patients with large carotid aneurysms were treated by parent artery occlusion with detachable balloons. Of these, 2 had intracavernous carotid artery aneurysms and one had a carotid-ophthalmic aneurysm. All patients underwent a formal balloon occlusion test and tolerated it well. One patient with a carotid-ophthalmic aneurysm, however, developed postoperative ischemic effects. This case was that of a 55 year-old female with right visual disturbance. Her middle cerebral artery flow had been compromised during test occlusion under induced hypotension. Although initially intact after balloon occlusion, she was found to be hemiplegic 24 hours later. She subsequently developed multiple small infarcts which were shown on MRI and which corresponded exactly to the previously demonstrated region of decreased flow during testing. This ischemic complication is possibly due to hypoperfusion, but embolism from the thrombosed aneurysm can not be denied. To prevent these complications, an extracranial-intracranial artery anastomosis prior to parent artery occlusion should be considered if the preoperative 99mTc-HMPAO SPECT shows a compromised cerebral blood flow. In addition to this, postoperative anticoagulant therapy should be given even if test occlusion was well tolerated clinically.