High-flow bypass using saphenous vein grafts with trapping of ruptured blood blister-like aneurysms of the internal carotid artery: patient series.

Taichi Ishiguro,Koji Yamaguchi,Go Matsuoka,Takayuki Funatsu,Yoshihiro Omura,Tatsuya Ishikawa,Takakazu Kawamata,Daiki Ottomo

doi:10.3171/case21439

Taichi Ishiguro, Koji Yamaguchi + Show 6 more

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https://doi.org/10.3171/case21439

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Abstract

BACKGROUNDTrapping an aneurysm after the establishment of an extracranial to intracranial high-flow bypass is considered the optimal surgical strategy for ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA). For high-flow bypass surgeries, a radial artery graft is generally preferred over a saphenous vein graft (SVG). However, SVGs can be advantageous in acute-phase surgeries because of their greater length, easy manipulability, ability to act as high-flow conduits, and reduced risk of vasospasms. In this study, the authors presented five cases of ruptured BBAs treated with high-flow bypass using an SVG followed by BBA trapping, and they reported on surgical outcomes and operative nuances that may help avoid potential pitfalls.OBSERVATIONSAfter the surgeries, there were no ischemic or hemorrhagic complications, including symptomatic vasospasms. In three of the five cases, postoperative modified Rankin scale scores were between 0 and 2 at the 3-month follow-up. In one case, the SVG spontaneously occluded after surgery while the protective superficial temporal artery (STA) to middle cerebral artery (MCA) bypass became dominant, and the patient experienced no ischemic symptoms.LESSONSHigh-flow bypass using an SVG with a protective STA-MCA bypass followed by BBA trapping is a safe and effective treatment strategy.

Highlights

Trapping an aneurysm after the establishment of an extracranial to intracranial high-flow bypass is considered the optimal surgical strategy for ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA)
Case 2 A 34-year-old man presented with a sudden headache and was subsequently diagnosed with a World Federation of Neurosurgical Societies (WFNS) grade 1 subarachnoid hemorrhage (SAH) due to a BBA located on the lateral wall of the left ICA on the proximal side of the posterior communicating (PCOM) (Fig. 3A–D). He was treated by establishing an ECASVG-middle cerebral artery (MCA) bypass with a protective superficial temporal artery (STA)-MCA double-barrel bypass and BBA trapping while preserving the PCOM (Fig. 3E–G)
Observations This study presents a treatment protocol for ruptured BBA using an saphenous vein graft (SVG) and protective STA-MCA bypass

Summary

BACKGROUND

Trapping an aneurysm after the establishment of an extracranial to intracranial high-flow bypass is considered the optimal surgical strategy for ruptured blood blister–like aneurysms (BBAs) of the internal carotid artery (ICA). Postoperative 3D CT angiography showed no recurrence of the BBA and good patency of both the high-flow and STA-MCA bypasses (Fig. 2H) Case 2 A 34-year-old man presented with a sudden headache and was subsequently diagnosed with a WFNS grade 1 SAH due to a BBA located on the lateral wall of the left ICA on the proximal side of the PCOM (Fig. 3A–D) He was treated by establishing an ECASVG-MCA bypass with a protective STA-MCA double-barrel bypass and BBA trapping while preserving the PCOM (Fig. 3E–G). His postoperative course included no complications or cerebral ischemia due to vasospasms. Long-term follow-up angiography indicated that the SVG was patent in all cases except the one spontaneously occluded case mentioned above

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