Sequential Successful Surgical Management of Extracranial Internal Carotid Stenosis and Ipsilateral Intracranial Aneurysm

Abstract

The coexistence of extracranial internal carotid stenosis and ipsilateral intracranial aneurysm is a rare event whose management is controversial. Theoretically, the correc tion of a significant stenosis of the extracranial internal carotid may lead to an increase in the downstream pressure in the intracranial carotid and may, consequently, increase the risk of rupture of the ipsilateral aneurysm. Moreover, dramatic increase of blood pressure is not uncommon after carotid endarterectomy and may promote aneurysmal rupture. Intracranial surgical correction of a hypoperfused aneurysm down to an extracra nial carotid stenosis should carry an increased risk of inadequate cerebral flow during the procedure, and unspecific postoperative stimulation of platelets aggregation and coagu lation may complete obstruction of a subtotal carotid stenosis. The authors describe successful treatment of 2 patients by a two-stage surgical procedure. In a first step, the intracerebral aneurysms were controlled and electively excluded by clipping. In a second step, carotid endarterectomies were performed some days later without any 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 neurologic status.