Treatment of Internal Carotid Artery (ICA) Aneurysm in Germany

An internal carotid artery aneurysm is a bulging in the area of ​​the corresponding blood vessel. This is a dangerous disease, since, if the aneurysm ruptures, it can lead to a subarachnoid hemorrhage, and if blood clots form, there is a risk of an ischemic stroke. Large aneurysms cause symptoms by compressing brain tissue. Timely treatment can prevent complications and eliminate neurological symptoms. You can undergo treatment of internal carotid artery aneurysm in Germany. This country gives preference to minimally invasive endovascular treatment, which is successfully used even for complex aneurysms.

Content

1. Surgical treatment
2. Endovascular treatment
3. Minimally invasive treatment of complex aneurysms

Surgical treatment

In Germany, open surgical treatment for ICA aneurysms is used less and less frequently, as doctors resort to endovascular interventions, if possible. However, in some cases, surgery is indispensable. Surgical treatment is often used for multiple, large, and complicated aneurysms. An "open repair" of the blood vessel provides patients with reliable long-term results.

Microsurgical treatment options include:

• a ligation of the internal carotid artery;
• an imposition of an extra-intracranial anastomosis (the formation of an additional blood flow bypass between the intracranial and extracranial parts of the artery);
• aneurysm clipping (clamping its neck with a clip to eliminate it from the bloodstream);
• a trapping procedure, (a type of clipping) in which the clips are applied not on the aneurysm, but at a distance from it, so that blood no longer enters this part of the blood vessel.

A direct aneurysm clipping with a resection of the aneurysmal sac, can be used for a gigantic size of neoplasm, which has a large volume, compresses the adjacent tissues, and causes severe neurological symptoms.

Sometimes, the problematic site of ​​the blood vessel can simply be closed without affecting cerebral blood flow. This is possible in cases with adequate collateral (bypass) circulation. To check whether the remaining arteries are able to deliver enough blood to the brain, doctors perform preoperative diagnostics using CT, MRI, PET scans, and, during surgery, a balloon occlusion test (atrial occlusion of the internal carotid artery with a balloon) can be performed. If the collateral blood flow is insufficient, it is necessary to form anastomoses, which are additional blood vessels that connect two healthy sections of the carotid artery.

Endovascular treatment

To make the intervention less traumatic and safer and to reduce the period of hospitalization and rehabilitation, doctors in Germany perform endovascular procedures. These allow the specialists to eliminate the aneurysm from the bloodstream by performing the intervention from inside the blood vessels.

The main treatment options are as follows:

• a transluminal embolisation (closure of the aneurysm lumen) with coils, with or without balloon assistance;
• an intravascular stent implantation;
• a flow-diverting stent placement at the level of the aneurysm neck, in some cases in combination with a microcoil embolization.

Surgical and endovascular techniques can be combined. These operations are called hybrid surgeries and they are performed in specialized German centers in patients with poor collateral blood flow. The doctors perform the aneurysm embolization in combination with the formation of extra-intracranial anastomosis.

Minimally invasive treatment of complex aneurysms

The specialists in Germany successfully use endovascular techniques even for complex internal carotid artery aneurysms, which account for up to 5% of cases. These cases are the most dangerous: if left untreated, the risk of death within 2 years reaches 60%.

The treatment of complex aneurysms involves the use of stents. These are "tubes" that are placed at the level of the neck of the aneurysm. Stents carry blood, bypassing the aneurysmal sac, thus, eliminating the aneurysm from the bloodstream.

Stents require the use of antiplatelet agents (drugs that prevent blood clotting), and drugs of this group are contraindicated in patients with bleeding from an aneurysm. In such cases in Germany, a balloon-assisted coil embolization is used. The essence of this operation is to place a microcatheter into the aneurysm cavity, with the simultaneous placement of the balloon at the level of the neck. The balloon becomes inflated when the microcoils are inserted into the aneurysmal sac. Inflating the balloon prevents both the displacement of the coils and blood clots from entering the lumen of the carrier blood vessel. In cases with insufficient collateral blood flow, doctors periodically deflate the balloon to fill the cerebral blood vessels with blood and avoid any damage due to oxygen starvation of the nerve cells.

If you have been diagnosed with an internal carotid artery aneurysm, you can undergo your treatment in one of the German hospitals. You can visit the Booking Health website to see the prices for treatment. When making an appointment for your treatment through our service, the cost of medical services is reduced due to the lack of additional coefficients for foreign patients. The specialists of the Booking Health company will select the best clinics in Germany for you and arrange your trip.

Authors: 

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Farrukh Ahmed. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Medical News Today

The Lancet