Clinical evaluation of high-flow bypass surgery from the external carotid artery to the middle cerebral artery via the radial artery for treating large or giant internal carotid artery aneurysms with insufficient collateral circulation
Objective To investigate the clinical efficacy of external carotid artery(ECA)-radial artery(RA)-middle cerebral artery(MCA)M2 segment bypass combined with aneurysm isolation surgery in patients with large/giant internal carotid artery aneurysms.Methods This retrospective single-center study enrolled 8 patients diagnosed with large/giant internal carotid artery aneurysms(10 cases of aneurysms in total and 2 cases of tandem aneurysms)who underwent ECA-RA-M2 bypass combined with aneurysm isolation surgery at the Department of Neurosurgery,Tianjin Huanhu Hospital between January 2016 and June 2021.Of the 8 patients,2 were ruptured aneurysms.Preoperative evaluation confirmed positivity in the balloon occlusion test(BOT)and/or stage Ⅱ2 brain perfusion weighted imaging(PWI).Immediate postoperative embolization degree was assessed using the O'Kelly-Marotta(OKM)grading system.Intraoperative and postoperative complications were documented.Clinical symptoms were observed and outcomes were evaluated using the modified Rankin Scale(mRS)and Karnofsky Performance Status(KPS)scale.Results Among the 8 patients,the postoperative complete occlusion/OKM grading of D1 and near-total occlusion/OKM C1 was observed in 6 patients and 1 patient,respectively.During the perioperative period,2 patients experienced ischemic stroke.The follow-up duration[M(Q1,Q3)]of 8 patients was 69.9(55.0,85.3)months.By the end of the follow-up period,6/8 of patients exhibited relief or recovery from preoperative clinical symptoms.Ischemic stroke occurred in 1 patient.At the last follow-up,the mRS score was 0 in 5 patients,1 in 2,4 in 1.There was no statistically significant difference in mRS scores before and after surgery(Z=-1.19,P=0.236).The KPS scores of 8 patients were 92.5±13.9 points.Imaging follow-up time[M(Q1,Q3)]was 35.8(5.8,68.8)months,with aneurysm shrinkage demonstrated in 1 patient and complete or near-total occlusion in the remaining 7 patients.Conclusion ECA-RA-M2 bypass combined with aneurysm isolation remains an essential therapeutic modality for addressing large/giant internal carotid artery aneurysms characterized by inadequate blood flow compensation.
Intracranial aneurysmInternal carotid arteryCerebral revascularizationTreat-ment outcomeLarge or giantSurgery-related complications
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