SEQUENTIAL SUCCESSFUL SURGICAL-MANAGEMENT OF EXTRACRANIAL INTERNAL CAROTID STENOSIS AND IPSILATERAL INTRACRANIAL ANEURYSM - CASE-REPORTS

The coexistence of extracranial internal carotid stenosis and ipsilate ral intracranial aneurysm is a rare event whose management is controve rsial. Theoretically, the correction of a significant stenosis of the extracranial internal carotid may lead to an increase in the downstrea m pressure in the intracranial carotid and may, consequently, increase the risk of rupture of the ipsilateral aneurysm. Moreover, dramatic i ncrease of blood pressure is not uncommon after carotid endarterectomy and may promote aneurysmal rupture. Intracranial surgical correction of a hypoperfused aneurysm down to an extracranial carotid stenosis sh ould carry an increased risk of inadequate cerebral flow during the pr ocedure, and unspecific postoperative stimulation of platelets aggrega tion and coagulation may complete obstruction of a subtotal carotid st enosis. The authors describe successful treatment of 2 patients by a t wo-stage surgical procedure. In a first step, the intracerebral aneury sms were controlled and electively excluded by clipping. In a second s tep, carotid endarterectomies were performed some days later without a ny neurologic complications. Postoperative recoveries were uneventful, and six months after these surgical procedures, clinical examination of both patients did not reveal any worsening of the preoperative neur ologic status.