クリッピング困難な内頚動脈瘤に対するバイパス併用手術

Abstract

The treatment of complex internal carotid artery (ICA) aneurysms is still a controversial issue. This study aimed to evaluate the safety and efficacy of a surgical strategy using the bypass procedure in such patients. We retrospectively reviewed the clinical and radiological records of 50 consecutive patients with 52 complex ICA aneurysms who underwent bypass surgery. In this study, we divided the ICA into 3 segments based on the origin of the ophthalmic artery (OpthA) and posterior communicating artery (PComA). All patients with an aneurysm located in the portion proximal to the OpthA (segment 1) were treated with bypass and proximal ICA occlusion, and only 1 patient (5.2%) experienced an ischemic complication. Among patients with an aneurysm located between the OpthA and PComA (segment 2), 14 were treated with bypass and trapping, and 10 were treated with clipping under bypass. Among these, 3 (12.5%) had an ischemic complication and 1 (4.2%) had a hemorrhagic complication. Among patients with an aneurysm located distal to the PComA (segment 3), clipping under temporary bypass was performed in 2, clipping with bypass and proximal occlusion in 4, trapping in 2, and bypass and proximal occlusion in 1. However, 4 of 9 (44.4%) patients had an ischemic complication. Finally, 41 of 50 (82.0%) patients showed a favorable outcome (modified Rankin scale 0-2) in this series. In conclusion, the results of our surgical strategy using a bypass procedure were acceptable; however, ischemic complications were a persistent problem in aneurysms located distal to the PComA.