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Brief report
Tandem cervical carotid stenting for stenosis with flow diversion embolisation for the treatment of intracranial aneurysms
  1. Jessica K Campos1,
  2. Li-Mei Lin2,
  3. Narlin B Beaty1,
  4. Matthew T Bender1,
  5. Bowen Jiang1,
  6. David A Zarrin1,
  7. Alexander L Coon1
  1. 1 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2 Department of Neurosurgery, University of California, Irvine, Orange, California, USA
  1. Correspondence to Dr Alexander L Coon; dralexandercoon{at}gmail.com

Abstract

Background An estimated 2%–3% of the population harbour an intracranial aneurysm. Concomitant atherosclerotic cervical carotid disease is not uncommon. The management of these two entities remains a challenge within the field.

Case presentation We report a single case of concomitant carotid stenosis and two ipsilateral unruptured intracranial aneurysms treated with a single-staged cervical carotid stenting and cerebral aneurysm embolisation with the Pipeline embolisation device.

Discussion No consensus currently exists to guide endovascular treatment of intracranial aneurysms associated with asymptomatic ipsilateral stenosis. Here, we present a case of asymptomatic moderate carotid stenosis with two ipsilateral intracranial aneurysms and suggest carotid artery stenting takes procedural priority over aneurysm embolisation in single-stage treatment. The rationale for the sequence of neurointerventions is based on the tracking a robust distal access system beyond a stenotic proximal carotid lesion and stabilisation of the ulcerated plaque to avoid thromboembolic complications associated with plaque irritation during aneurysm embolisation. Additional cases and longer follow-up will be needed to further assess the efficacy of this technique.

  • stenosis
  • aneurysm
  • flow diverter
  • stent

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2018-000187

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    Footnotes

    • Contributors JKC, L-ML and NBB drafted the manuscript and critically revised the manuscript for important intellectual content. MTB, BJ and DAZ assisted with the data collection and analysis. ALC performed treatment procedures and critically revised the important intellectual content. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests ALC is a consultant for InNeuroCo, a consultant and proctor for Medtronic Neurovascular, MicroVention-Terumo and Stryker Neurovascular. L-ML is a proctor for Medtronic Neurovascular. The other authors have no conflict of interest. No author received financial support in conjunction with the generation of this submission.

    • Ethics approval Johns Hopkins Institutional Review Board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional unpublished data from this study.

    • Patient consent for publication Not required.