Extracranial–intracranial bypass in the treatment of complex or giant internal carotid artery aneurysms

Lee, Chien‐Hui; Chiu, Ted H.; Tsai, Sheng-Tzung; Kuo, Wei-Chih

doi:10.1016/j.tcmj.2015.06.004

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Tearing of the aneurysm neck during direct clipping without assistance of bypass was noted. Poor recovery rates have been noted after emergency bypass in patients with complex ICA aneurysms [ 7 ]. Good preparation for STA-MCA bypass before aneurysm treatment can prevent ischemic stroke when major vessel sacrifice or prolonged ischemic time during surgery is inevitable [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

2018

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Objectives:Direct microsurgical clipping for complex middle cerebral artery (MCA) aneurysms may require a long ischemic time. Sacrifice of the parent artery with trapping or endovascular coiling also may lead to ischemic stroke. We described our institutional experience with the treatment of complex MCA aneurysms using extracranial-intracranial (EC-IC) (superficial temporal artery [STA]-MCA) bypass.Materials and Methods:We retrospectively reviewed patients who had treatment of IC aneurysms with the assistance of STA-MCA bypass from July 2002 to December 2016. Six patients with complex MCA aneurysms were identified, and we reviewed their clinical characteristics.Results:There were three men and three women with age ranging from 27 to 59 (mean 49) years old. Image studies showed subarachnoid hemorrhage in three cases. All patients underwent STA-MCA anastomosis, and the follow-up period ranged from 2 to 116 months (mean 51.5 months). Two of the six MCA aneurysms were fusiform, two aneurysms had bizarre configurations, one was a dissecting saccular aneurysm, and one had a blister configuration. Three patients received direct vessel trapping, two patients received aneurysm clipping, and one received aneurysm coiling. The postoperative bypass patency rate was 100%. The modified Rankin scale showed good outcomes in the six patients.Conclusions:EC-IC bypass plays an important role as a salvage procedure in the treatment of complex MCA aneurysms which have a fusiform, bizarre, or blister configuration.

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Section: Discussionmentioning

confidence: 99%

“…All bypasses were done by end-to-side anastomosis of the STA to the MCA (frontal and temporal M3 branches of the MCA). The details of the surgical procedures have been described previously [ 7 ]. A 5-cm length of the frontal branch of the STA was dissected.…”

Section: Aterials and Methodsmentioning

confidence: 99%

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

2018

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“…В Україні досвід використання високопотокових ЕІКА та ІІКА у хірургії СЦА є незначним і представлений поодинокими спостереженнями в усних доповідях на професійних конференціях. Впровадження та застосування техніки мікроанастомозу надає додаткові опції та розширює можливості хірургічного лікування СЦА [16,17].…”

Section: оригінальні статтіunclassified

Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms

Мoрoз¹,

Harmatina

Скорохода

et al. 2022

Ukr. ìnterv. nejroradìol. hìr.

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The aim of surgical treatment of any cerebral aneurysm is to achieve its total exclusion from the bloodstream. Although the progress in the development and implementation of microsurgical and the latest endovascular technologies, in many cases, the treatment of complex cerebral aneurysms is not an easy task. Unsatisfactory results of the exclusion of complicated cerebral aneurysms are due to many factors, for instance: gigantic size, fusiform or dolichoectatic configuration of the cerebral aneurysm, the presence of atherosclerotic changes, anatomical features of the departure of functionally important arteries directly from the cerebral aneurysm. Such cerebral aneurysms are quite problematic both for microsurgical remodeling clipping and for endovascular exclusion. At the current stage, the introduction and use of the microanastomosis technique provides additional options and expands the possibilities of surgical treatment of complex cerebral aneurysms.Objective ‒ to analyze the possibilities and results of surgical treatment of complicated cerebral aneurysms using the technique of surgical revascularization (bypass surgery).Materials and methods. An analysis of the results of the examination and surgical treatment of 16 patients with complicated cerebral aneurysms for the period from 2016 to 2020, who were treated and operated on in the emergency vascular neurosurgery department with the X-ray operating department Romodanov Institute of Neurosurgery of NAMS of Ukraine. All patients diagnosed with complicated cerebral aneurysms had gigantic sizes. All cases of surgical intervention included placement of extra-intracranial microanastomosis or intra-intracranial anastomosis, sometimes a combination of it, to ensure normal blood supply to the vessel of complicated cerebral aneurysm that were planned to be devascularized. In 14 observations, one-time anastomosis and exclusion of complicated cerebral aneurysms were performed. In 2 observations, the first stage was an anastomosis without exclusion of the complicated cerebral aneurysms due to insufficient vascularization of the distal arterial branch for deconstructive exclusion of aneurysm.Results. Satisfactory results of surgical treatment (grade 1 and 2 of Modified Rankin Scale (MRS)) in the general group of patients were observed in 13 (81 %) patients with complicated cerebral aneurysms. Unsatisfactory results of surgical treatment occurred in 3 (19 %) observations. Profound disability (MRS grade 5) as a result of surgical treatment was recorded in 1 (6 %) patient. Cases that ended fatally occurred in 2 (13 %) observations of the total group of patients. In the group of patients with surgical revascularization and excluded complicated cerebral aneurysms, satisfactory results were observed in 13 (92.9 %) patients. Fatal results of surgical treatment were recorded in 2 patients with a hemorrhagic course of complicated cerebral aneurysms, in which surgical revascularization was performed as first stage and scheduled removal of complicated cerebral aneurysms was planned.Conclusions. The introduction and use of the microanastomosis technique expands the possibilities of surgical treatment of complicated cerebral aneurysms. Revascularization surgical interventions are highly effective in the prevention of ischemic complications when complicated cerebral aneurysms are excluded. Recommendations (indications) for revascularization should be considered in impossibility and high risks of ischemic complications during remodeling clipping or endovascular exclusion of complicated cerebral aneurysms.

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“…In such cases, EC-IC bypass with further parent artery occlusion sometimes is the only treatment option. Recent reports demonstrated safety, high occlusion rates and long term bypass patency [40]. Furthermore, described bypasses are used as rescue tool in situations of parent artery occlusion and cerebral blood flow insufficiency [41].…”

Section: Discumentioning

confidence: 99%

Treatment of Complex Internal Carotid Aneurysms

Kaliyev¹,

Bekmukhambetov²,

Medetov³

et al. 2019

OF THE NATIONAL ACADEMY OF SCIENCES OF THE REPUBLIC OF KAZAKHST

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Abzhanov Arkhat, prof. (Boston, USA), Abelev S.K., prof. (Moscow, Russia), Aitkhozhina N.А., prof., academician (Kazakhstan) Akshulakov S.K., prof., academician (Kazakhstan) Alchinbayev М.K., prof., academician (Kazakhstan) Batpenov N.D., prof., corr. member (Kazakhstan) Berezin V.Ye., prof., corr. member. (Kazakhstan) Bersimbayev R.I., prof., academician (Kazakhstan) Berkinbaev S.F., prof. (Kazakhstan) Bisenbayev А.K., prof., academician (Kazakhstan) Bishimbayeva N.K., prof., academician (Kazakhstan) Botabekova Т.K., prof., corr. member. (Kazakhstan) Bosch Ernesto, prof. (Spain) Davletov Kairat, PhD, associate professor, executive Secretary Dzhansugurova L.B., Cand. biol., prof. (Kazakhstan) Ellenbogen Adrian, prof. (Tel-Aviv, Israel), Zhambakin K.Zh., prof., academician (Kazakhstan), deputy editor-in-chief Ishchenko Alexander, prof. (Villejuif, France) Isayeva R.B., prof. (Kazakhstan) Kaydarova D.R., prof., academician (Kazakhstan) Kokhmetova A., prof., corr. member (Kazakhstan) Kuzdenbayeva R.S., prof., academician (Kazakhstan) Lokshin V.N., prof., corr. member (Kazakhstan) Los D.А., prof. (Moscow, Russia) Lunenfeld Bruno, prof. (Israel) Makashev E.K., prof., corr. member (Kazakhstan) Mitalipov Sh.M. (America) Muminov Т.А., prof., academician (Kazakhstan) Ogar N.P., prof., corr. member (Kazakhstan) Omarov R.T., cand. biol., prof. (Kazakhstan) Prodeus A.P., prof. (Russia) Purton Saul, prof. (London, UK) Rakhypbekov Т.K., prof., corr. member. (Kazakhstan) Saparbayev Мurat, prof. (Paris, France) Sarbassov Dos, prof. (Houston, USA) Turysbekov E.K., cand. biol., assoc. prof. (Kazakhstan) Sharmanov A.T., prof. (USA) News of the National Academy of Sciences of the Republic of Kazakhstan. Series of biology and medicine.

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Extracranial–intracranial bypass in the treatment of complex or giant internal carotid artery aneurysms

Cited by 8 publications

References 26 publications

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

Surgical revascularization (bypass surgery) in the treatment of complicated cerebral aneurysms

Treatment of Complex Internal Carotid Aneurysms

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