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      <h1 class="highwire-cite-title" id="page-title">Parent Artery Occlusion: A Well-Established Technique</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">C.M. Benson</span>, <span class="highwire-citation-author" data-delta="1">D.M. Pelz</span> and <span class="highwire-citation-author" data-delta="2">S.P. Lownie</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">June 2015,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">36 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(6) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E53; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4353 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-13932--6583572583" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">C.M. Benson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Medical Imaging and Clinical Neurological Sciences
University Hospital
London, Ontario, Canada</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.M.%2BBenson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Benson%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AC.M.%2BBenson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">D.M. Pelz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Medical Imaging and Clinical Neurological Sciences
University Hospital
London, Ontario, Canada</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.M.%2BPelz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pelz%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AD.M.%2BPelz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">S.P. Lownie </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Departments of Medical Imaging and Clinical Neurological Sciences
University Hospital
London, Ontario, Canada</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.P.%2BLownie%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lownie%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.P.%2BLownie%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p>In their recent publication “Parent Artery Occlusion in Large, Giant, or Fusiform Aneurysms of the Carotid Siphon: Clinical and Imaging Results,” Labeyrie et al<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> retrospectively reviewed 56 patients treated with aneurysm trapping by using detachable platinum coils. The authors make 2 controversial statements, neither of which is referenced, and with which we take issue:
</p><ol class="list-ord " id="list-1"><li id="list-item-1"><p id="p-2">“Proximal occlusion without trapping (surgical or endovascular) has a lower rate of aneurysmal retraction and <em>should not be performed</em> for carotid aneurysms.”</p></li><li id="list-item-2"><p id="p-3">“Endovascular parent artery occlusion <em>with trapping</em> of the aneurysm has long been considered the reference treatment for large, giant, or fusiform aneurysms of the carotid siphon.” [Italics added for emphasis.]</p></li></ol><p id="p-4">Several large series of giant aneurysms treated with parent artery occlusion have, in fact, demonstrated the safety and efficacy of this treatment alone. Even in the setting of initial retrograde filling, these aneurysms often progress to complete thrombosis. In 1994, Drake et al<sup><a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a></sup> published a series of 160 anterior circulation giant aneurysms treated with Hunterian proximal occlusion. Eighty of 82 petrous and cavernous aneurysms were obliterated with proximal occlusion, only 4 of which required trapping. In 1987, Fox et al<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> reported 58 patients with anterior circulation giant aneurysms, with all 37 aneurysms below the ophthalmic segment and 10 of 21 supraclinoid aneurysms obliterated with proximal occlusion alone without the need for trapping. We have been unable to find evidence in the literature demonstrating the inferiority of proximal occlusion as a first-line procedure. Furthermore, the addition of distal occlusion may have contributed to the authors' increased rate of ischemic events in 27% of patients, because the origins of perforating vessels will, by definition, be occluded across any trapped segment. We would argue that proximal occlusion of the parent artery without trapping remains a viable time-honored treatment option for giant saccular and fusiform carotid aneurysms.</p><div class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-36.6.E53.1" data-doi="10.3174/ajnr.A4064"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Labeyrie</span>  <span class="cit-name-given-names">MA</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lenck</span>  <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bresson</span>  <span class="cit-name-given-names">D</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Parent artery occlusion in large, giant, or fusiform aneurysms of the carotid siphon: clinical and imaging results</span>. <abbr class="cit-jnl-abbrev">AJNR Am J Neuroradiol</abbr> <span class="cit-pub-date">2015</span>;<span class="cit-vol">36</span>:<span class="cit-fpage">140</span>–<span class="cit-lpage">45</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiYWpuciI7czo1OiJyZXNpZCI7czo4OiIzNi8xLzE0MCI7czo0OiJhdG9tIjtzOjE5OiIvYWpuci8zNi82L0U1My5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-36.6.E53.2" data-doi="10.3171/jns.1994.81.5.0656"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Drake</span>  <span class="cit-name-given-names">CG</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Peerless</span>  <span class="cit-name-given-names">SJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ferguson</span>  <span class="cit-name-given-names">GG</span></span></li></ol><cite>. <span class="cit-article-title">Hunterian proximal arterial occlusion for giant aneurysms of the carotid circulation</span>. <abbr class="cit-jnl-abbrev">J Neurosurg</abbr> <span class="cit-pub-date">1994</span>;<span class="cit-vol">81</span>:<span class="cit-fpage">656</span>–<span class="cit-lpage">65</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3171/jns.1994.81.5.0656&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=7931611&amp;link_type=MED&amp;atom=%2Fajnr%2F36%2F6%2FE53.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-36.6.E53.3" data-doi="10.3171/jns.1987.66.1.0040"><div class="cit-metadata"><ol class="cit-auth-list"><li>
</li><li><span class="cit-auth"><span class="cit-name-surname">Fox</span>  <span class="cit-name-given-names">AJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Vinuela</span>  <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Pelz</span>  <span class="cit-name-given-names">DM</span></span>, <span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Use of detachable balloons for proximal artery occlusion in the treatment of unclippable cerebral aneurysms</span>. <abbr class="cit-jnl-abbrev">J Neurosurg</abbr> <span class="cit-pub-date">1987</span>;<span class="cit-vol">66</span>:<span class="cit-fpage">40</span>–<span class="cit-lpage">46</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.3171/jns.1987.66.1.0040&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=3783258&amp;link_type=MED&amp;atom=%2Fajnr%2F36%2F6%2FE53.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2015 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 36</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 6 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Jun 2015 </div></div>
      
      
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