Indications for A3-A3 Bypass in Patients with Anterior Cerebral Artery Territory Aneurysms

Abstract

A3-A3 side-to-side bypass (A3-A3 bypass) is commonly used for revascularization of the anterior cerebral artery territory; however, it is indicated in few patients. This study investigated the indications for A3-A3 bypass based on our clinical experience and a literature review. The study included 5 patients (3 men and 2 women) who underwent A3-A3 bypass between April 2012 and November 2017. The patients were in their 20s (n = 2), 40s (n = 1), and 50s (n = 2). The diagnoses included unruptured anterior communicating artery aneurysm treated with trapping (n = 1), recurrent enlargement of the anterior communicating artery after clipping (n = 1), anterior cerebral artery dissection (n = 1), anterior cerebral artery stenosis with cerebral infarction (n = 1), and traumatic distal anterior cerebral artery aneurysm (n = 1). A3-A3 bypass was completed and patency was confirmed in all patients. The requirements for A3-A3 bypass performance include suturing skills for anastomosis, appropriate selection of donor and recipient vessels, and comprehensive preoperative assessment. The indications for A3-A3 bypass are various. When performing a craniotomy for anterior communicating artery aneurysms and distal anterior cerebral artery aneurysms, the A3-A3 bypass can be used as a rescue technique. Therefore, stroke surgeons should master the essential skills. Training in suturing skills is an important part of preparation for the procedure.