Stent-assisted coil embolization for cavernous carotid artery aneurysms

Abstract

Internal carotid artery (ICA) occlusion with or without a bypass surgery is the traditional treatment for cavernous sinus (CS) aneurysms with cranial nerve (CN) dysfunction. Coil embolization without stents frequently requires retreatment because of the large size of CS aneurysms. We report the mid-term results of six unruptured CS aneurysms treated with stent-assisted coil embolization (SACE). The mean age of the patients was 72 years. The mean size of the aneurysms was 19.8 mm (range: 13-26 mm). Before treatment, four patients presented with CN dysfunction and two patients had no symptoms. SACE was performed under local or general anesthesia in three patients each. Mean packing density was 29.1% and tight packing was achieved. There were no neurological complications. CN dysfunction was cured in three patients (75%) and partly resolved in one patient (25%). Transient new CN dysfunction was observed in two patients (33%). Clinical and imaging follow-up ranged from 6 to 26 months (median: 16 months). Recanalization was observed in three patients (50%; neck remnant in two patients and dome filling in one patient), but no retreatment has yet been required. No recurrence of CN dysfunction has occurred yet. In summary, SACE increases packing density and may reduce requirement of retreatment with an acceptable cure rate of CN dysfunction. SACE may be a superior treatment for coiling without stents and be an alternative treatment of ICA occlusion for selected patients, such as older patients and those who require a high-flow bypass surgery or cannot receive general anesthesia.

Fig. 1

An 81-year-old woman presented with trigeminal neuralgia and diplopia due to abducens nerve palsy. A: An angiogram shows a 26-mm cavernous carotid artery aneurysm. B: After stent-assisted coil embolization, an angiogram shows a neck remnant of the aneurysm. Cranial nerve dysfunction was resolved in 2 months. C: A follow-up angiogram at 6 months after treatment shows an increased neck remnant (arrow).

Fig. 2

A 64-year-old woman presented with trigeminal neuralgia. A: An angiogram shows a 17-mm cavernous carotid artery aneurysm. B: Flat-panel detector computed tomography (XperCT; Philips Healthcare, Best, the Netherlands) shows that a microcatheter is placed in the aneurysm and that an Enterprise stent (Cordis Neurovascular, Miami, Florida, USA) covers the wide neck orifice of the aneurysm. C: After stent-assisted coil embolization, an angiogram shows complete occlusion of the aneurysm. Trigeminal neuralgia was resolved in 1 month. D: A follow-up angiogram at 6 months after the operation shows no recanalization.