Delayed thrombus propagation after parent artery clipping for giant fusiform aneurysms of the circle of Willis

• Published in: Surgical neurology Vol. 51; no. 1; pp. 89 - 93
• Main Authors: Miyamoto, Susumu, Nagata, Izumi, Yamada, Keisuke, Ueno, Yasushi, Nakahara, Ichiro, Toda, Hiroki, Hattori, Itaro, Kikuchi, Haruhiko
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 1999
• Subjects: Adult; balloon occlusion test; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Brain Ischemia - physiopathology; Cerebral Angiography; Cerebrovascular Circulation; Circle of Willis - diagnostic imaging; Circle of Willis - pathology; Circle of Willis - surgery; Female; fusiform aneurysm; Giant aneurysm; Hemiplegia - diagnostic imaging; Hemiplegia - etiology; Hemiplegia - physiopathology; Humans; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - pathology; Intracranial Aneurysm - physiopathology; Intracranial Aneurysm - surgery; Male; revascularization; Thrombosis - complications; Thrombosis - diagnostic imaging; Thrombosis - etiology; Thrombosis - physiopathology; Time Factors; Tomography, X-Ray Computed; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - methods; Giant aneurysm; revascularization; fusiform aneurysm; balloon occlusion test
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/S0090-3019(97)00347-9

BACKGROUND Obliteration of a giant fusiform aneurysm without significant therapeutic morbidity is extremely difficult. Ischemic complications have been often reported. METHODS Two patients with giant fusiform aneurysms of the circle of Willis are presented. Both patients underwent proximal parent artery clipping after a bypass procedure. Balloon occlusion tests confirmed both patients’ ability to tolerate flow reduction after proximal clipping. RESULTS Although both patients awoke from anesthesia without neurologic deficit, they developed contralateral hemiparesis several hours after the operation as a result of a small infarct in the basal ganglia. These ischemic events might be attributed to the delayed thrombosis involving the orifice of the distal perforating arteries. CONCLUSIONS In the treatment for giant fusiform aneurysms of the circle of Willis, special attention should be paid not only to flow reduction, but also to delayed thrombus propagation that may not be predicted by preoperative balloon occlusion testing.