Parent artery occlusion with bypass surgery for the treatment of internal carotid artery aneurysms: clinical and hemodynamic results.
OBJECTIVE
Parent artery occlusion with/without bypass surgery is one of the treatment choices for the internal carotid artery (ICA) aneurysm difficult to treat by clipping or coiling. There have been few reports regarding postoperative cerebral blood flow (CBF) changes after surgery. This study evaluated the present bypass selection strategy based on balloon test occlusion (BTO) in terms of clinical and hemodynamic outcomes.


METHODS
Twenty-one consecutive patients with ICA aneurysms underwent parent artery occlusion. High flow bypass (n=9), superficial temporal artery-middle cerebral artery bypass (n=10), or no bypass (n=2) was performed depending on the changes in clinical symptoms and CBF during BTO. Quantitative CBF measurement with acetazolamide challenge was performed in the chronic stage.


RESULTS
Overall outcome at discharge was good recovery 18, moderate disability 2, and severe disability 1. Two patients suffered symptomatic embolic or perforator infarction associated with the surgical manipulations. Preoperative cranial nerve pareses improved completely or partially in all patients except one. CBF in the chronic stage (n=18) demonstrated no significant difference between the surgical and non-surgical cerebral hemispheres. No cerebral ischemic event was observed during the follow-up period (mean 2.9 years).


CONCLUSIONS
The present surgical strategy based on preoperative BTO provides a reliable tool to achieve acceptable clinical and hemodynamic outcomes in patients with complex ICA aneurysms to be treated by parent artery occlusion.
Shimizu
Hiroaki
H
Department of Neurosurgery, Tohoku University Graduate School of Medicine, Japan. hshim@nsg.med.tohoku.ac.jp
Matsumoto
Yasushi
Y
Tominaga
Teiji
T
D000086:Acetazolamide / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000601:surgery*; D000792:Angiography; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002404:Catheterization; D002560:Cerebrovascular Circulation / Q000502:physiology; D003545:Cysteine / Q000031:analogs & derivatives; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D004232:Diuretics; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C059659:technetium Tc 99m bicisate; D003545:Cysteine; D000086:Acetazolamide