Abstract
The authors describe the efficacy and safety of carotid ligation designed especially for surgical treatment of a giant aneurysm of the internal carotid artery (ICA) in clinical and experimental studies. To determine the safety of ICA ligation, the balloon Matas test was administered for the ipsilateral ICA in nine patients with ICA aneurysms, seven of whom had giant aneurysms. Neither ischemic symptoms nor EEG changes developed during testing of the giant ICA aneurysms. Further, angiograms demonstrated that the contrast material filled poorly into the intracranial arteries distal to the aneurysm. In four of the seven giant aneurysms. ICA ligation effected good results with no complications.
Using five models of an experimental giant aneurysm made of a canine descending aortic segment, the intra-arterial pressures of the common carotid artery was measured at the proximal and distal portions of the aneurysm with the transcatheter technique. Significant reductions of the arterial blood pressure and pulse pressure at the distal portion of the giant aneurysm model were noted.
The data suggest that reductions of the mean pressure and pulse pressure in the distal ICA of the giant ICA aneurysm promote the development of collateral circulation. Thus, in many cases of giant aneurysm, ICA ligation would tend to preclude hemodynamic ischemia. When the neck of a giant aneurysm is difficult to clip, carotid ligation may be a safe alternative surgical treatment that yields good results.
