Abstract
Objective: to demonstrate the first experience of high-flow extra-intracranial (EC-IC) bypasses performance for treatment of patients with giant aneurysms (GA) of internal carotid artery (ICA). Material and methods: we performed high-flow EC-IC bypasses at 4 female patients with GA of ICA: two patients had GA of cavernous ICA with tumor-like (mass effect) signs, 1 patient - complex GA of ICA bifurcation with combined (apoplectiform and tumor-like) clinical manifestation and 1 patient with left ophthalmic GA also with combined clinical manifestation (embolic and apoplectiform). Results: We used radial artery as an autoshunt in all cases. Patient with left ophthalmic GA underwent urgent performance of EC-IC bypass between M2 segment of left middle cerebral artery (MCA) and left external carotid artery (ECA) because if intraoperative thrombosis of supraclinoid ICA after clipping and resection of aneurysm. The other three patients underwent routinely operation with performance of EC-IC high-flow bypass between M2 segment of right MCA and right ECA with following right ICA sacrifice with the usage of moderate hypothermia and barbiturates as well as EEG-monitoring. The bypass patency confirmed by intraoperative Doppler sonography, digital subtraction angiography in postoperative period and by ultrasound examination of subcutaneous bypass region. One patient underwent the bypass thrombosis without any neurological deficit in one week after operation because of collateral blood flow improving but this patient died in 3 week after operation because of pulmonary artery thromboembolia. One patient suffered from bypass thrombosis on next day after operation with following massive ischemia stroke causing death. Two patients were discharged in satisfactory condition with patent bypasses. Conclusion: The performance of high-flow EC-IC bypass is one of the current treatment options for patients with GA of ICA. It is necessary to perform the routine surgery under the conditions of specially equipped operative theatre with the usage of EEG-monitoring, barbiturates and moderate hypothermia. It is possible to perform the urgent high-flow EC-IC bypass in case of intraoperative ICA thrombosis
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