Treatment of giant and large internal carotid artery aneurysms with a high-flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique.
OBJECTIVE
To define the clinical value of the high-flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique in the treatment of patients with a noncoilable, nonclippable giant or large intracranial aneurysm of the internal carotid artery (ICA).


METHODS
We studied 34 patients with a giant intracranial aneurysm of the ICA proximal to its bifurcation who were treated with an extracranial-intercranial high-flow replacement bypass in our hospital between 1999 and 2004. We retrospectively collected data for patient characteristics, operative aspects, complications, and functional health scores using the modified Rankin scale. Long-term data were updated by questionnaire and telephone survey. Mean long-term follow-up period was 3.3 years (range, 0.6-5.6 yr).


RESULTS
We were able to construct a patent bypass in 33 out of 34 patients (97%). In six patients (17%), we needed two bypass attempts. In one patient (3%), the bypass was technically impossible. After bypass construction, we occluded the ICA during or after surgery in 32 patients (94%), causing aneurysm thrombosis in all of these patients. A fatal complication occurred in two patients (6%) before we could occlude the ICA. A nonfatal complication occurred in seven patients (21%). In the long term, 25 patients (74%) had a favorable outcome and 27 patients (79%) were independent (modified Rankin scale, <3).


CONCLUSIONS
This study shows that the excimer laser-assisted nonocclusive anastomosis high-flow replacement bypass, which provides maximum brain protection because of its nonocclusive character, is a reliable and effective method to treat these otherwise untreatable patients.
van Doormaal
Tristan P C
TP
Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. T.vandoormaal@gmail.com
van der Zwan
Albert
A
Verweij
Bon H
BH
Langer
David J
DJ
Tulleken
Cornelis A F
CA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012501:Saphenous Vein / Q000637:transplantation*; D016896:Treatment Outcome