Excimer laser-assisted bypass in aneurysm treatment: short-term outcomes.
OBJECTIVE
If clip application or coil placement for treatment of intracranial aneurysms is not feasible, the parent vessel can be occluded to induce thrombosis of the aneurysm. The Excimer laser-assisted anastomosis technique allows the construction of a high-flow bypass in patients who cannot tolerate such an occlusion. The authors assessed the complications of this procedure and clinical outcomes after the construction of high-flow bypasses in patients with intracranial aneurysms.


METHODS
Data were retrospectively collected on patient and aneurysm characteristics, procedural complications, and functional outcomes in 77 patients in whom a high-flow bypass was constructed. Logistic regression analysis was used to quantify the relationships between patient and aneurysm characteristics on the one hand and outcome measures on the other. Fifty-one patients harbored a giant aneurysm, 24 patients suffered from a ruptured aneurysm, and 35 patients from an unruptured symptomatic aneurysm. In 22 patients (29%; 95% confidence interval [CI] 19-40%) a permanent deficit developed from an operative complication. At a median follow-up period of 2.5 months, 25 patients (32%; 95% CI 22-44%) were dependent or had died; in 10 of these patients (13% of all patients; 95% CI 6-23%) operative complications were the single cause of this poor outcome. Univariate analysis demonstrated that a poor clinical condition before treatment (odds ratio [OR] 4.7; 95% CI 1.7-13.3) and a history of cardiovascular disease (OR 4.1; 95% CI 1-16.2) increased the risk of poor outcome. Multivariate analysis demonstrated that only the clinical condition before treatment was significantly related to outcome (OR 4; 95% CI 1.3-11.9).


CONCLUSIONS
In patients with an intracranial aneurysm that cannot be treated by clip application or coil placement, and in whom occlusion of the parent artery cannot be tolerated, the construction of a high-flow bypass should be considered. This procedure carries a considerable risk of complications, but this should be weighed against the disabling or life-threatening effects of compression, the high risk of rupture, and the substantial chance of poor outcome after the rupture of such aneurysms.
Brilstra
Eva H
EH
University Department of Neurology, University of Utrecht, The Netherlands. E_Brilstra@neuro.azu.nl
Rinkel
Gabriel J E
GJ
Klijn
Catharina J M
CJ
van der Zwan
Albert
A
Algra
Ale
A
Lo
Rob T H
RT
Tulleken
Cornelis A F
CA
D000328:Adult; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000209:etiology; D019917:Blood Vessel Prosthesis Implantation; D002545:Brain Ischemia / Q000209:etiology; D002536:Cerebral Arteries; D002548:Cerebral Revascularization / Q000009:adverse effects; D002560:Cerebrovascular Circulation; D003250:Constriction; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000503:physiopathology / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome