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Basilar Apex Aneurysms in the Setting of Carotid Artery Stenosis

Author(s):

Mihael D. Rosenbaum, Daniel M. Heiferman, Osama A. Raslan , Brendan Martin , Jose F. Dominguez , Paula M. de la Peña , William W. Ashley , Jordan D. Rosenblum and Anand V Germanwala *   Pages 1 - 7 ( 7 )

Abstract:


Background: Intracranial aneurysms (IAs) are life-threatening lesions known within the literature to be found incidentally during routine angiographic workup for carotid artery stenosis (CAS). As IAs are associated with vascular shear stress, it is reasonable to expect that altered flow demands within the anterior circulation, such as with CAS, increase compensatory flow demands via the Circle of Willis (COW) and may induce similar stress at the basilar apex.

Objective: We present a series of nine unruptured basilar apex aneurysms (BAA) with CAS and a comparative radiographic analysis to BAA without CAS.

Methods: Twenty-three patients with BAA were retrospectively identified using records from 2011 to 2016. CAS by North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, morphology of BAA, competency of COW, and anatomic relationships within the posterior circulation were examined independently by a neuroradiologist using angiographic imaging.

Results: Nine (39%) of the twenty-three BAA patients had CAS, with six having stenosis ≥50%. Four (67%) of the patients with ≥50% CAS demonstrated aneurysm flow angles contralateral to the side with highest CAS. Additionally, the angle between the basilar artery (BA) trajectory and aneurysm neck was observed to be smaller in patients with ≥50% CAS (61 vs 74 degrees). No significant differences in COW patency, posterior circulation morphology, and degree of stenosis were observed.

Conclusion: Changes in the cervical carotid arteries may lead to blood flow alterations in the posterior circulation that increase the propensity for BAA formation. Posterior circulation imaging can be considered in CAS patients to screen for BAA.

Keywords:

Basilar artery, intracranial aneurysm, posterior circulation, carotid artery stenosis.

Affiliation:

Departments of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, Departments of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, Department of Radiology, University of California-Davis Medical Center, Sacramento, CA, Department of Research, National Council of State Boards of Nursing, Chicago, IL, Department of Neurological Surgery, New York Medical College, Valhalla, NY, Departments of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL, Department of Neurosurgery, The Sandra and Malcolm Berman Brain and Spine Institute, Sinai Hospital and LifeBridge Health System, Baltimore, MD, Departments of Radiology, Loyola University Stritch School of Medicine, Maywood, IL, Departments of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, IL



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