TREATMENT OF ANEURYSMS OF THE INTERNAL CAROTID-ARTERY BY INTRAVASCULAR BALLOON OCCLUSION - LONG-TERM FOLLOW-UP OF 58 PATIENTS

LONG-TERM EVALUATION OF patients with aneurysms of the internal caroti d artery (ICA) treated by intravascular balloon occlusion has not been reported. From 1977 to 1992, 58 patients (age 14 to 81 years) with IC A aneurysms were treated at our institution by this technique. The ane urysms included 40 intracavernous carotid, 5 petrous carotid, 3 cervic al carotid, and 10 ophthalmic segment aneurysms. Presenting symptoms w ere caused by mass effect in 45 patients, transient ischemia or cerebr al infarction as a result of emboli in 6, subarachnoid hemorrhage in 4 , and epistaxis in 3. Preoperative temporary balloon occlusion of the ICA combined with cerebral blood flow monitoring and induced hypotensi on were used to determine tolerance for occlusion. Two patients not to lerating test occlusion required an extracranial-intracranial bypass p rocedure, and another patient underwent extracranial-intracranial bypa ss prior to test occlusion because of contralateral ICA stenosis. In 5 5 patients, aneurysms were excluded from the circulation by either occ luding the proximal ICA or trapping the aneurysm neck. In three patien ts, the aneurysm was directly obliterated with intravascular balloons with preservation of the parent ICA. Three patients died during treatm ent, one from subarachnoid hemorrhage and two from cerebral infarction . Mean follow-up was 76 months (range, 6 months to 15 years). Six pati ents who developed transient ischemia caused by emboli responded to vo lume expansion and anticoagulation treatment. Two patients developed a delayed infarction, and one patient developed aneurysm enlargement th at required surgical clipping and obliteration. Two patients suffered a delayed subarachnoid hemorrhage, one from a de novo aneurysm arising from the anterior communicating artery and another from a contralater al A1-A2 junction aneurysm that had enlarged after treatment for the I CA aneurysm. In long-term follow-up, intravascular balloon occlusion w as a relatively safe, effective treatment for eliminating ICA aneurysm s that posed a low risk for early or delayed ischemia or infarction. I ntravascular balloon occlusion is the treatment of choice for extradur al aneurysms and some distal carotid aneurysms.