title: Double-insurance bypass for internal carotid artery aneurysm surgery.
abstract: OBJECTIVE
  The aim of this article is to present the usefulness of a double-bypass method in the surgical treatment of complex internal carotid artery (ICA) aneurysms. For patients with clippable but complex aneurysms of the ICA having poor collateral circulation, bypass surgery is needed before temporary occlusion of the ICA. We propose a double bypass for safety.
  
  
  METHODS
  The superficial temporal artery was anastomosed to the distal cortical branch of the middle cerebral artery (MCA), followed by anastomosis between the radial artery and the inferior trunk of the MCA. For patients with clippable ICA aneurysms, the radial artery was temporarily anastomosed to the inferior trunk of the MCA by raising the ipsilateral forearm to the head after the radial artery was harvested. After the aneurysm had been clipped, the anastomosed radial artery was cut close to the anastomosed site and repositioned back to the original arm.
  
  
  RESULTS
  This double-bypass procedure was performed in two patients, and no ischemic complications related to revascularization were observed. Temporary occlusion times of the MCA for superficial temporal artery-to-MCA anastomosis and radial artery-to-MCA anastomosis were 30 and 46 minutes in one patient and 28 and 55 minutes in another.
  
  
  CONCLUSIONS
  This surgical procedure, which we called "double-insurance bypass," can reduce the risk of ischemic complications associated with revascularization of the ICA.
authors.affiliation: Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan. khongo@hsp.md.shinshu-u.ac.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hongo
authors.forename: Tetsuyoshi
authors.initials: T
authors.lastname: Horiuchi
authors.forename: Junpei
authors.initials: J
authors.lastname: Nitta
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tada
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography