Treatment of Giant and Large Internal Carotid Artery Aneurysms With a High-Flow Replacement Bypass Using the Excimer Laser-Assisted Nonocclusive Anastomosis Technique

Abstract

This study shows that the excimer laser-assisted nonocclusive anastomosis high-flow replacement bypass, which provides maximum brain protection because of its nonocclusive character, is a reliable and effective method to treat these otherwise untreatable patients.

Optimization of the excimer laser assisted non‐occlusive anastomosis (ELANA) flap retrieval rate

“…1 , Utrecht, the Netherlands) it is not permitted and not possible to vary laser energy when using the technique in patients. At the standard 10 mJ, the flap retrieval rate was shown to be suboptimal, which was already expected based on previous retrospective clinical series [4][5] [12]. It was particularly worrisome that 26.7% of the flaps were missed in the 10 mJ, 1 laser episode, 0 N subgroup.…”

“…The technique is mainly used in neurosurgical bypass procedures to treat intracranial aneurysms, hemodynamic insufficiency causing ischemia of the brain or intracranial tumors [4][5][6][7]. ELANA anastomosis construction is usually performed on large proximal intracranial cerebral arteries like the internal carotid artery (ICA) or the middle cerebral artery (MCA).…”

Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms

“…Partial trapping strategies consist of either Bproximal inflow^or Bdistal outflow^occlusion. The rationale behind Binflow^and Boutflow^occlusion is to obtain a reduction/ change of flow within the aneurysm, with a subsequent a-m antero-medullary segment of the PICA, ELANA Excimer laser-assisted non-occlusive anastomosis, l-m latero-medullary segment of the PICA, MCA middle cerebral artery, M1-M5 segments of the MCA, ICA internal carotid artery, PICA posterior inferior cerebellar artery, t-m tonsillo-medullary segment of the PICA decrease in hemodynamic stress [1,2,9,10,23,30]. The concept is to manipulate the flow in order to induce hemodynamic change and favor intra-aneurysmal thrombosis and reduce the risk of rupture [10].…”

“…The rationale of proximal inflow occlusion is therefore to (1) reduce the flow through the aneurysm sufficiently to promote its thrombosis by occluding the inflow; (2) to ensure retrograde perfusion of any perforators [10,13]. The purpose of the bypass is to both supply the downstream arterial territory and provide retrograde blood flow for the perforators [10,26,30].…”

High flow extracranial-to-intracranial brain bypass surgery

“…The reported long-term graft patency ranges from 73% to 100% after salvage (Table 3). [19][20][21]31,42,55,60,[62][63][64][65][66][67] in our experience, the surgical outcome for 152 intracranial vein bypass procedures using vein bypasses has been good with an acceptable complication rate. The senior author (M.K.M.)…”