Artikel
Extra-intracranial high-flow bypasses for symptomatic internal carotid artery aneurysms
Extra-intrakranielle High-Flow-Bypässe als Therapieoption symptomatischer Arteria-cerebri-interna-Aneurysmen
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Autoren
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J. Rohlfs
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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U. Sure
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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O. Sürücü
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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L. Benes
- Klinik für Neurochirurgie, Philipps-Universität Marburg
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R.G. Moosdorf
- Klinik für Herz- und thorakale Gefäßchirurgie, Philipps-Universität Marburg
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H. Bertalanffy
- Klinik für Neurochirurgie, Philipps-Universität Marburg
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: A review of the literature shows that the treatment of patients with symptomatic unclippable and uncoilable carotid artery aneurysms is uncommon. In patients with insufficient cross flow, in which occlusion of the internal carotid artery (ICA) alone is not possible, additional placement of a high-flow bypass may be necessary. We report on our experience with 5 patients, who underwent such a treatment in order to exclude a large or giant ICA-aneurysm from the blood circulation.
Methods: Four patients had large infraclinoidal ICA aneurysms and one individual, a giant supraophthalmic ICA aneurysm. Angiography furnished evidence of an insufficient cross flow of the communicating arteries in all patients. In three cases, a radial artery graft and in the remaining two a saphenous vein graft were implanted. The grafts were either interposed between the external carotid artery and the medial cerebral artery (four patients) or between the proximal and distal ICA (one patient).
Results: Four of the five grafts remained patent over time. At follow-up (mean: 53,8 months), 4 patients showed a complete resolution of the preoperative ocular symptoms and neurological deficits. One patient had deteriorated during the late postoperative course.
Conclusions: High-flow bypass surgery is a reasonable and efficient treatment option for patients with large symptomatic ICA aneurysms, in whom direct clipping or interventional neuroradiological vascular remodelling is not possible. However, considering the risk of severe complications, the indication for high-flow bypass surgery and ICA-occlusion should be accurately evaluated and strictly established.
