Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries


  • Volodymyr P. Komarnytskyi Department of Neurosurgical Pathology of Head and Neck Vessels, Romodanov Neurosurgery Institute, Kyiv, Ukraine
  • Mikhaylo Y. Orlov Department of Neurosurgical Pathology of Head and Neck Vessels, Romodanov Neurosurgery Institute, Kyiv, Ukraine



angiospasm, ischemic complications, ruptures of arterial aneurysms, occlusive-stenotic lesions, cerebral arteries, surgical treatment


Objective – to determine the effect of occlusive-stenotic lesions of cerebral arteries on angiospasm and ischemic complications in patients with ruptured arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries.

Materials and methods. A retrospective study of the medical histories of 1,147 patients with cerebral artery aneurysms from 2006 to 2022 was conducted. 63 patients were included in the study group because they met the following criteria: surgical treatment; rupture of saccular aneurysms (SAs); the presence of occlusive-stenotic lesions was proven using instrumental examination methods. Patients of the control group had to meet the following criteria: surgical treatment; rupture of SAs; the absence of occlusive-stenotic lesions was proven by means of instrumental examination methods; the gender and age distribution had to match the study group. Of the 126 patients included in this study, there were 76 men (60.32%) and 50 women (39.68%). The age of the patients varied from 31 to 77 years. The average age of patients- 55.9±0.76 years; men – 54.3±0.94 years, women – 58.3±1.19 years.

Results. A percentage predominance of patients with high cerebral blood flow velocity (>200 cm/s, which is equal to the velocity with severe grade III vasospasm of the cerebral arteries) in the study group (32.56%) compared with the control group (24.24%) was revealed.

Conclusions. The predominance of men among patients of the study group (60.32%) was established. The average age of men with occlusive-stenotic lesions was younger than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is the largest in the 2nd subgroup of the study group where the severity of stenosis is 50-75% (men - 48.3 years; women - 62 years). Ruptures of arterial aneurysms of the middle cerebral artery occur more often in the presence of stenoses (study group - 25.4%, control group - 12.7%). The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis for life and health was in men with a ruptured arterial aneurysm against the background of a 50-75% stenotic lesion and severe vasospasm of the cerebral arteries.


1. Tallarita T, Sorenson TJ, Rinaldo L, Oderich GS, Bower TC, Meyer FB, Lanzino G. Management of carotid artery stenosis in patients with coexistent unruptured intracranial aneurysms. J Neurosurg. 2019 Jan 18:1-4. [CrossRef] [PubMed]

2. Porter RW, Lawton MT, Hamilton MG, Spetzler RF. Concurrent aneurysm rupture and thrombosis of high grade internal carotid artery stenosis: report of two cases. Surg Neurol. 1997 Jun;47(6):532-9; discussion 539-40. [CrossRef] [PubMed]

3. Werner C, Mathkour M, Scullen T, Mccormack E, Dumont AS, Amenta PS. Multiple flow-related intracranial aneurysms in the setting of contralateral carotid occlusion: Coincidence or association? Brain Circ. 2020 Jun 26;6(2):87-95. [CrossRef] [PubMed] [PubMed Central]

4. Hiramatsu R, Ohnishi H, Yagi R, Kuroiwa T, Wanibuchi M, Miyachi S. A Patient with a Large Aneurysm Complicated by Stenosis of the Internal Carotid Artery Distal to the Aneurysm in Whom Treatment Using a Pipeline Flex Was Performed. J Neuroendovasc Ther. 2020;14(11):501-507. [CrossRef] [PubMed] [PubMed Central]

5. Zhao HY, Fan DS, Han JT. [Management of severe internal carotid stenosis with unruptured intracranial aneurysm]. Beijing Da Xue Xue Bao Yi Xue Ban. 2019 Oct 18;51(5):829-834. Chinese. [CrossRef] [PubMed] [PubMed Central]

6. Cvetic V, Dragas M, Colic M, Vukasinovic I, Radmili O, Ilic N, Koncar I, Bascarevic V, Ristanovic N, Davidovic L. Simultaneous Endovascular Treatment of Tandem Internal Carotid Lesions: Case Report and Review of Literature. Vasc Endovascular Surg. 2016 Jul;50(5):359-62. [CrossRef] [PubMed]

7. Wajima D, Nakagawa I, Wada T, Nakase H. A Trial for an Evaluation of Perianeurysmal Arterial Pressure Change during Carotid Artery Stenting in Patients with Concomitant Severe Extracranial Carotid Artery Stenosis and Ipsilateral Intracranial Aneurysm. Turk Neurosurg. 2019;29(5):785-788. [CrossRef] [PubMed]

8. Kaçar E, Nas ÖF, Erdoğan C, Hakyemez B. Single-stage endovascular treatment in patients with severe extracranial large vessel stenosis and concomitant ipsilateral unruptured intracranial aneurysm. Diagn Interv Radiol. 2015 Nov-Dec;21(6):476-82. [CrossRef] [PubMed] [PubMed Central]

9. Ni H, Zhong Z, Zhu J, Jiang H, Hu J, Lin D, Bian L. Single-Stage Endovascular Treatment of Severe Cranial Artery Stenosis Coexisted With Ipsilateral Distal Tandem Intracranial Aneurysm. Front Neurol. 2022 May 18;13:865540. [CrossRef] [PubMed] [PubMed Central]

10. Campos JK, Lin LM, Beaty NB, Bender MT, Jiang B, Zarrin DA, Coon AL. Tandem cervical carotid stenting for stenosis with flow diversion embolisation for the treatment of intracranial aneurysms. Stroke Vasc Neurol. 2018 Dec 17;4(1):43-47. [CrossRef] [PubMed] [PubMed Central]

11. Cherednychenko Y, Engelhorn T, Miroshnychenko A, Zorin M, Dzyak L, Tsurkalenko O, Cherednychenko N. Endovascular treatment of patient with multiple extracranial large vessel stenosis and coexistent unruptured wide-neck intracranial aneurysm using a WEB device and Szabo-technique. Radiol Case Rep. 2020 Oct 5;15(12):2522-2529. [CrossRef] [PubMed] [PubMed Central]

12. Karsonovich T, Gordhan A. Endovascular management of symptomatic cerebral aneurysm thromboembolism due to pre-aneurysmal arterial stenosis. SAGE Open Med Case Rep. 2017 Sep 4;5:2050313X17730263. [CrossRef] [PubMed] [PubMed Central]

13. Kaya B, Erdi F, Keskin F, Kalkan E, Koç O. Endovascular management of a collateral network aneurysm in a patient with spontaneous internal carotid artery occlusion. Interv Neuroradiol. 2015 Apr;21(2):175-7. [CrossRef] [PubMed] [PubMed Central]

14. Crichton AB, Rajagopalan S. Co-existing Arterial Pathology: Stenosis and Aneurysm in Carotid Territory: To worry? Eur J Vasc Endovasc Surg. 2017 Aug;54(2):201. [CrossRef] [PubMed]

15. Yee S, Portalatin M, Sridhar M, Perrone J, Adunbarin A, Guerrero M, Danks JM, Zuberi J, Sori AJ. Fatal Subarachnoid Hemorrhage From Ruptured Intracerebral Aneurysm After Carotid Endarterectomy. J Med Cases. 2020 Jan;11(1):12-15. [CrossRef] [PubMed] [PubMed Central]

16. Georgieva VB, Krastev ED, Byulbyuleva SK. Extracranial-Intracranial High-Flow Bypass for Giant Ruptured Paraclinoid Aneurysm with Concomitant Bilateral Internal Carotid Artery Stenotic Dissection. World Neurosurg. 2018 Sep;117:265-270. [CrossRef] [PubMed]

17. Sirko A, Dzyak L, Romanukha D, Pilipenko G, Cherednychenko Y. Surgery for Triple Pathology of Giant Vestibular Schwannoma Associated with Carotid Artery Stenosis and Intracranial Aneurysm: Case Report. J Neurol Surg Rep. 2018 Apr;79(2):e65-e69. [CrossRef] [PubMed] [PubMed Central]

18. Hurford R, Taveira I, Kuker W, Rothwell PM; Oxford Vascular Study Phenotyped Cohort. Prevalence, predictors and prognosis of incidental intracranial aneurysms in patients with suspected TIA and minor stroke: a population-based study and systematic review. J Neurol Neurosurg Psychiatry. 2021 May;92(5):542-548. [CrossRef] [PubMed] [PubMed Central]

19. Borkon MJ, Hoang H, Rockman C, Mussa F, Cayne NS, Riles T, Jafar JJ, Veith FJ, Adelman MA, Maldonado TS. Concomitant unruptured intracranial aneurysms and carotid artery stenosis: an institutional review of patients undergoing carotid revascularization. Ann Vasc Surg. 2014 Jan;28(1):102-7. [CrossRef] [PubMed]

20. Shakur SF, Alaraj A, Mendoza-Elias N, Osama M, Charbel FT. Hemodynamic characteristics associated with cerebral aneurysm formation in patients with carotid occlusion. J Neurosurg. 2018 May 4;130(3):917-922. [CrossRef] [PubMed]

21. Jou LD, Shaltoni HM, Morsi H, Mawad ME. Hemodynamic relationship between intracranial aneurysm and carotid stenosis: review of clinical cases and numerical analyses. Neurol Res. 2010 Dec;32(10):1083-9. [CrossRef] [PubMed]

22. Tanaka R, Takahashi S, Okano S, Okayama A, Suzuki N, Kure S, Azuma H. Evolution into moyamoya disease in an infant with internal carotid artery aneurysms. eNeurologicalSci. 2017 Jan 31;6:80-82. [CrossRef] [PubMed] [PubMed Central]

23. Tsimeiko OA, Abbaszade EZ, Moroz VV, Skorohoda II, Shahin N. [Vasospasm in patients with anterior circulation aneurysm rupture complicated with intracerebral and intraventricular haemorrhage]. Ukrainian Medical Journal. 2011 Apr 21;2 (82)-III/IV:98-101. Russian.



How to Cite

Komarnytskyi, V. P., & Orlov, M. Y. (2024). Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries. Ukrainian Neurosurgical Journal, 30(2), 36–42.



Original articles