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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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STA-MCA bypass followed by parent artery occlusion is an effective flow replacement strategy for giant and complex ICA aneurysms – the multimodal Vienna experience

Multimodale Kombination aus Standard STA-MCA Bypass und therapeutischem Gefäßverschluss als effektive Revaskularisationsstrategie von komplexen und riesigen ACI Aneurysmen – die Wiener Serie

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  • presenting/speaker Philippe Dodier - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Josa M. Frischer - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Wei-Te Wang - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Dorian Hirschmann - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Arthur Hosmann - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Gerhard Bavinzski - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich
  • Karl Rössler - Medizinische Universität Wien, Universitätsklinik für Neurochirurgie, Wien, Österreich

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV012

doi: 10.3205/21dgnc012, urn:nbn:de:0183-21dgnc0123

Published: June 4, 2021

© 2021 Dodier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Treatment of giant and complex ICA aneurysms remains a major neurosurgical challenge. The aim of this study was to investigate the safety and efficacy of our low-flow replacement strategy in patients not amenable to conventional therapeutic options.

Methods: Between 1998 and 2017, 382 patients harboring unruptured ICA aneurysms were treated at our department. Only patients with an a priori planned combined strategy, including standard bypass and parent artery occlusion, were included. Thus, our cohort comprised 47 giant/complex ICA aneurysms in 41 patients. Clinical and radiological outcome was assessed according to the modified Rankin scale, the bypass patency rate and the Raymond classification. Our median follow-up time was 3.9 years.

Results: Intraoperative patency was confirmed in 100% of completed, predominantly double-barrel, procedures. Endovascular (n=37) or microsurgical (n=1) parent artery occlusion was executed as planned in 38 patients, in most cases immediately after positive balloon occlusion test (BOT). Long-term patency rate in patients with completed bypass surgery and successful PAO was 99% (66/67 bypass grafts in 36/37 patients) at last follow-up, which underscores the importance of flow demand of a maturing bypass. A satisfactory aneurysm occlusion rate of 94% became evident at last follow-up. We observed a procedure-related mortality of 0% while 97% of patients presented with excellent or good outcome (mRS 0-2) at last follow-up. Thus, a statistically significant improvement compared to the preoperative clinical status was evident (p< 0.001). An improvement of cranial nerve compression syndromes was also observed in 83% of patients.

Conclusion: Our results suggest that combined STA-MCA bypass surgery followed by PAO presents a safe and effective alternative to high-flow arterial or venous graft interponates and to flow diversion in selected symptomatic giant/complex ICA aneurysms.