Is Carotid Revascularization Safe for Patients with Concomitant Carotid Stenosis and Intracranial Aneurysms?

Wuyang Yang, Xiaoming Rong, Maria Braileanu, Bowen Jiang, Tomas Garzon-Muvdi, Justin M. Caplan, Geoffrey P. Colby, Alexander L. Coon, Rafael J. Tamargo, Judy Huang

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)11-18
Number of pages8
JournalWorld Neurosurgery
Volume93
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Carotid Stenosis
Intracranial Aneurysm
Aneurysm
Carotid Endarterectomy
Cohort Studies
Stroke
Transient Ischemic Attack
Internal Carotid Artery
Subarachnoid Hemorrhage
Stents
Rupture
Pathologic Constriction
Retrospective Studies
Demography
Safety
Growth

Keywords

  • Aneurysm
  • Carotid endarterectomy
  • Stroke
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Is Carotid Revascularization Safe for Patients with Concomitant Carotid Stenosis and Intracranial Aneurysms? / Yang, Wuyang; Rong, Xiaoming; Braileanu, Maria; Jiang, Bowen; Garzon-Muvdi, Tomas; Caplan, Justin M.; Colby, Geoffrey P.; Coon, Alexander L.; Tamargo, Rafael J.; Huang, Judy.

In: World Neurosurgery, Vol. 93, 01.09.2016, p. 11-18.

Research output: Contribution to journalArticle

Yang, W, Rong, X, Braileanu, M, Jiang, B, Garzon-Muvdi, T, Caplan, JM, Colby, GP, Coon, AL, Tamargo, RJ & Huang, J 2016, 'Is Carotid Revascularization Safe for Patients with Concomitant Carotid Stenosis and Intracranial Aneurysms?', World Neurosurgery, vol. 93, pp. 11-18. https://doi.org/10.1016/j.wneu.2016.05.060
Yang, Wuyang ; Rong, Xiaoming ; Braileanu, Maria ; Jiang, Bowen ; Garzon-Muvdi, Tomas ; Caplan, Justin M. ; Colby, Geoffrey P. ; Coon, Alexander L. ; Tamargo, Rafael J. ; Huang, Judy. / Is Carotid Revascularization Safe for Patients with Concomitant Carotid Stenosis and Intracranial Aneurysms?. In: World Neurosurgery. 2016 ; Vol. 93. pp. 11-18.
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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.",
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AU - Yang, Wuyang

AU - Rong, Xiaoming

AU - Braileanu, Maria

AU - Jiang, Bowen

AU - Garzon-Muvdi, Tomas

AU - Caplan, Justin M.

AU - Colby, Geoffrey P.

AU - Coon, Alexander L.

AU - Tamargo, Rafael J.

AU - Huang, Judy

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N2 - 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.

AB - 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.

KW - Aneurysm

KW - Carotid endarterectomy

KW - Stroke

KW - Subarachnoid hemorrhage

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