High-flow bypass surgery using a radial artery graft for an extracranial internal carotid artery aneurysm: Case reports and literature review

Abstract

Background: Extracranial carotid artery aneurysms are rare. Surgery may be difficult when vessels are tortuous and on a high cervical level. We report two patients whose tortuous extracranial internal carotid artery (ICA) aneurysm located on a high cervical level was successfully treated by ICA ligation and a high-flow bypass using a radial artery (RA) graft between the external carotid- and the middle cerebral artery. Case Description: (Case 1) A 47-year-old man suffered a recurrent cerebral infarct despite medical treatment. His right extracranial ICA aneurysm measured 33 mm; it was tortuous and located at a high cervical level. We ligated the ICA after placing a high-flow bypass using an RA graft. The aneurysm was not repaired. (Case 2) A 59-year-old woman noticed pulsatile swelling on her left neck. It was due to an extracranial ICA aneurysm that was large (36 mm), tortuous, and located at a high cervical level. We performed ICA ligation after placing a high-flow bypass using an RA graft without direct aneurysmal repair. Six months after the operation she noted a pulsatile bulge on the left oropharynx. We confirmed recurrence of an aneurysm from retrograde blood flow and performed internal trapping by occluding the distal portion of the ICA aneurysm using an intravascular procedure. Conclusion: ICA ligation after placing a high-flow bypass with an RA-graft is a technically demanding, but safe procedure to address extracranial ICA aneurysms that are tortuous and located at a high cervical level.

External carotid artery-to-petrous internal carotid artery radial artery graft bypass for a giant high cervical aneurysm

“…The absence of uni ed treatment guidelines for EICAs underscores their rarity. Nonetheless, surgical intervention is generally regarded as the preferred option, encompassing approaches such as simple carotid ligation, aneurysm repair, aneurysm resection with anastomosis/vascular reconstruction, and endovascular treatment [10,11] . Historical perspectives reveal the evolution of treatment methodologies.…”

“…Open surgical repair remains the contemporary gold standard for EICAs [11] , encompassing aneurysm resection with end-to-end anastomosis, aneurysm repair, and patch angioplasty. Pioneering procedures by Professors Dimtza and Beall in the 1950s and 1960s laid the foundation for addressing extracranial internal carotid aneurysms [14,15] .…”

“…In 1978, Professor Fisch introduced the infratemporal fossa approach, maximizing exposure but at the expense of potential complications, including hearing loss and neurologic damage [10,17,[19][20][21] . Despite these drawbacks, open surgical repair remains the prevailing standard for EICAs [11] .…”

“…Cerebrovascular bypass emerges as a favorable option for EICAs, particularly in cases where open surgery or endovascular intervention presents challenges. High cervical segment aneurysms carry inherent risks, including unpredictable embolism, distal control di culty, peripheral structure injury, and cranial nerve damage [11] . To address these concerns, high-ow bypass techniques, such as carotidradial/ saphenous vein-middle cerebral artery bypass, offer a promising avenue for restoring normal blood ow and isolating the aneurysm [26][27][28] .…”

Neurologic deficits and surgical treatment in a horse affected with internal carotid artery tortuous elongation

“…In humans, until 1950, the treatment of choice was ligation, but nowadays, it is used only when reconstruction is not possible. Surgical treatment consists of open resection of the aneurysm and curved part with or without arterial replacement with interposition of a graft or stent (El‐Sabrout & Cooley, 2000; Koge et al, 2018; Koketsu et al, 2021; Larson et al, 1995; Lin et al, 2000; Stilo et al, 2017). The latest deemed due to its anatomic location, not to be an option in the equine.…”