“Y”形双腔旁路治疗动脉瘤.docVIP

The Y-shaped double-barrel bypass in the treatment of large and giant anterior communicating artery aneurysms Keywords: anterior communicating artery aneurysm; vascular disorders; surgical revascularization; double-barrel bypass; giant intracranial aneurysm. Abbreviations used in this paper: ACoA = anterior communicating artery; EC = extracranial; IC = intracranial; ICA = internal carotid artery; ICG = indocyanine green; MCA = middle cerebral artery; mRS = modified Rankin Scale; STA = superficial temporal artery. Abstract Large and giant anterior communicating artery (ACoA) aneurysms usually show partial thrombosis and incorporate both the A1 and A2 segments and crucial perforating vessels. Therefore, direct clip placement or endovascular strategies often fail, leaving cerebral bypass surgery as a relevant therapeutic option. The authors present 3 cases in which a giant or large ACoA aneurysm was successfully occluded using a new technique that applies a double-barrel radial artery bypass. A radial artery graft is modified into a Y-shaped double-barrel conduit. After both pterional and parasagittal craniotomies are carried out, the graft is tunneled between both sites and anastomosed in an end-to-side fashion proximally to either a superficial temporal artery (STA) or M2 branch and distally to bilateral A3 branches. Aneurysm occlusion is then conducted through the pterional or parasagittal craniotomy. In one case, a 42-year-old patient in whom an endovascular approach had failed, the authors performed an STA-A3-A3 bypass and proximal aneurysm occlusion. In two others, a 49-year-old man in whom coiling had failed and a 56-year-old man in whom a giant ACoA aneurysm was partially thrombosed, the authors performed an M2-A3-A3 double-barrel bypass followed by either proximal or distal aneurysm occlusion. Complete aneurysm occlusion with excellent bypass perfusion was documented in the first two cases. In the third case, the authors observed good bypass perfusi