Results of early high-flow bypass and trapping for ruptured blood blister-like aneurysms of the internal carotid artery.

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Results of early high-flow bypass and trapping for ruptured blood blister-like aneurysms of the internal carotid artery.

World Neurosurg. 2017 Jun 12;:

Authors: Kikkawa Y, Ikeda T, Takeda R, Nakajima H, Ogura T, Ooigawa H, Kurita H

Abstract
OBJECTIVE: The aim of this study is to clarify the efficacy and safety of early surgery using trapping of the affected internal carotid artery (ICA) and high-flow bypass between second portion of the middle cerebral artery and cervical external carotid artery with radial artery graft for ruptured blood blister-like aneurysms (BBAs) arising from anterior wall of the ICA.
METHODS: Medical chart of consecutive 16 patients (M:F=7:9, mean 59 years) with subarachnoid hemorrhage (WFNS grade I:2, II:5, III:2, IV:4, V:3) due to ruptured BBA surgically treated between July 2010 and October 2015 were retrospectively reviewed. Eleven patients underwent acute surgery within 24 hours after the onset, whereas surgery was performed between 3 and 17 days after the onset due to referral delay or associated vasospasm in 5 patients. All patients underwent same surgical procedure.
RESULTS: Elimination of the BBA and patency of the bypass were achieved in all patients. Postoperatively, 2 patients showed small infarction in the Heubner's artery area, and the other 2 suffered symptomatic vasospasm, but no patient suffered infarction in the posterior communicating/anterior choroidal artery territories. Identically, no patient showed ischemic optic neuropathy. At the last follow up (mean 36 months), favorable clinical outcome (GR or MD in Glasgow outcome scale) was achieved in 14 (88%) of the patients without re-bleeding nor re-filling of the aneurysms.
CONCLUSIONS: Early surgical repair of BBAs by trapping of the affected ICA with high-flow bypass is safe and effective treatment with satisfactory mid-term outcome.

PMID: 28619499 [PubMed - as supplied by publisher]

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