title: Universal extracranial-intracranial graft bypass for large or giant internal carotid aneurysms: techniques and results in 38 consecutive patients.
abstract: OBJECTIVE
  To present indications, surgical techniques, and outcomes of extracranial-intracranial (EC-IC) graft bypass.
  
  
  METHODS
  Between January 1996 and June 2011, 38 patients with large or giant internal carotid artery (ICA) aneurysms were treated using graft bypass, employing the radial artery (RA) or the saphenous vein (SV) as a graft. Preoperative balloon test occlusions were not performed in any of the cases. In 17 patients, the external carotid artery (ECA)-RA-M2 segment of the middle cerebral artery bypass was used for treatment, and ECA-SV-M2 bypass was used in 21 patients.
  
  
  RESULTS
  All aneurysms were completely trapped, and there were no subarachnoid hemorrhages or recanalizations of aneurysms during the follow-up period (8-170 months). Of the 38 bypasses, 36 (94.7%) remained patent, and there were no permanent neurologic deficits. Hyperperfusion syndrome was not experienced in this series. There were 2 temporary neurologic deficits. In 1 case using the RA, graft vasospasm occurred, and kinking occurred in 1 case using the SV. Another patient with a SV graft had to undergo an emergent revision of the graft 8 hours after the initial operation. One patient with a SV graft underwent a second operation to control an epidural abscess.
  
  
  CONCLUSIONS
  Universal EC-IC graft bypass is a safe and effective method for treating large or giant ICA aneurysms.
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan; Department of Neurosurgery and Stroke Unit, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan. Electronic address: yi44ta@gmail.com.
authors: Yohei
authors: Y
authors: Ishishita
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Rokuya
authors: R
authors: Tanikawa
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Kosumo
authors: K
authors: Noda
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Hisashi
authors: H
authors: Kubota
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Naoto
authors: N
authors: Izumi
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Makoto
authors: M
authors: Katsuno
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Nakao
authors: N
authors: Ota
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Takanori
authors: T
authors: Miyazaki
authors: Abashiri Neurosurgical Rehabilitation Hospital, Hokkaido, Japan.
authors: Masaaki
authors: M
authors: Hashimoto
authors: Department of Neurosurgery and Stroke Unit, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan.
authors: Toshikazu
authors: T
authors: Kimura
authors: Department of Neurosurgery and Stroke Unit, NTT Medical Center Tokyo, Shinagawa, Tokyo, Japan.
authors: Akio
authors: A
authors: Morita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D001794:Blood Pressure / Q000502:physiology; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery*; D002548:Cerebral Revascularization / Q000379:methods*; D002648:Child; D003399:Craniotomy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D023261:Glasgow Outcome Scale; D006083:Graft Occlusion, Vascular; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D013699:Temporal Arteries / Q000601:surgery; D016896:Treatment Outcome
keywords: Cerebral revascularization; Extracranial-intracranial bypass; Giant aneurysm; Internal carotid aneurysm