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Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
Endovascular therapeutic occlusion of major cerebral arteries in children
Kittiphop Somboonnithiphol1,2, Soliman Oushy1, Alfred P See1
1Cerebrovascular Surgery and Interventions Center, Boston Children's Hospital, Boston, MA, USA.
Insights
Therapeutic cerebral artery occlusion in children is safe and effective for cerebrovascular conditions. Long-term follow-up is recommended to monitor for potential de novo aneurysm formation.
Area of Science:
- Pediatric Neurology
- Interventional Neuroradiology
- Cerebrovascular Diseases
Background:
- Therapeutic occlusion of major cerebral arteries is a necessary intervention for pediatric head and neck cerebrovascular conditions.
- This procedure carries risks including stroke and new intracranial aneurysm formation.
Purpose of the Study:
- To evaluate the long-term clinical and radiographic outcomes of therapeutic cerebral artery occlusion in pediatric patients.
Main Methods:
- Retrospective review of pediatric patients undergoing endovascular therapeutic occlusion (January 2002 - June 2023).
- Analysis of clinical presentation, radiographic findings, management, and follow-up data.
Main Results:
- Eighteen children (mean age 8.8 years) treated for aneurysms, dissections, arteriovenous shunts, or neoplasms.
- Complete occlusion achieved in 89.9%; 5 perioperative ischemic strokes occurred, all resolved.
- No new infarcts, transient ischemic attacks, de novo aneurysms, or mortality observed during mean follow-up of 6.9 years.
Conclusions:
- Therapeutic cerebral artery occlusion is a safe and effective pediatric treatment.
- Long-term surveillance is advised due to the theoretical risk of de novo aneurysm formation.
Abstract:
BackgroundTherapeutic occlusion of major cerebral arteries is sometimes required in pediatric cerebrovascular conditions of the head and neck. However, this procedure carries a considerable risk of stroke and de novo intracranial aneurysm formation. This study aims to assess the long-term clinical and radiographic outcomes of therapeutic cerebral artery occlusion in a pediatric cohort.MethodsA retrospective review was conducted on pediatric patients who underwent endovascular therapeutic occlusion between January 2002 and June 2023. Clinical presentation, radiographic findings, management strategies, and follow-up data were analyzed.ResultsEighteen children (male-to-female ratio: 2:1, mean age: 8.8 years) were included. Most cases (83%) were symptomatic at presentation. The diagnoses included aneurysm (44.4%), arterial dissection (22.2%), arteriovenous shunting (22.2%), and craniocervical neoplasm (11.1%). Eight patients underwent carotid circulation occlusion, and 10 underwent vertebrobasilar system occlusions; the majority (77.7%) were performed electively. Detachable coils were the primary devices used. Complete occlusion was observed in 89.9% of cases on immediate control angiography, and repeat embolization was performed in 2 cases. Perioperative ischemic strokes were observed in five cases: three asymptomatic and two with mild symptoms that completely resolved on follow-up. No new infarcts, transient ischemic attacks, de novo intracranial aneurysms, or mortality were observed over a mean clinical and radiographic follow-up duration of 6.9 years and 4 years, respectively.ConclusionsTherapeutic occlusion of major cerebral arteries appears to be a safe and effective treatment in pediatric patients. Nevertheless, long-term follow-up is recommended due to the theoretical risk of de novo aneurysm formation over their lifespan.
