title: Treatment of giant and large internal carotid artery aneurysms with a high-flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique.
abstract: 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.
authors.affiliation: Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands. T.vandoormaal@gmail.com
authors.forename: Tristan P C
authors.initials: TP
authors.lastname: van Doormaal
authors.forename: Albert
authors.initials: A
authors.lastname: van der Zwan
authors.forename: Bon H
authors.initials: BH
authors.lastname: Verweij
authors.forename: David J
authors.initials: DJ
authors.lastname: Langer
authors.forename: Cornelis A F
authors.initials: CA
authors.lastname: Tulleken