title: Prevention of Retrograde Blood Flow Into Large or Giant Internal Carotid Artery Aneurysms by Endovascular Coil Embolization with High-Flow Bypass: Surgical Technique and Long-Term Results.
abstract: BACKGROUND
  Recanalization has been reported in large or giant aneurysms of the internal carotid artery (ICA) addressed by high-flow bypass and endovascular treatment. Aneurysmal recanalization may be attributable to retrograde blood flow into the aneurysm through the ICA branches, such as the ophthalmic artery or the meningohypophyseal trunk, or through the surgically created bypass. We modified the endovascular treatment of aneurysms to prevent retrograde flow and evaluated the long-term efficacy of our method.
  
  
  METHODS
  We used a hybrid operative/endovascular technique to treat 5 patients with large or giant aneurysms arising from the C2-C4 segment of the ICA who presented with visual symptoms due to the mass effect of the aneurysm. To prevent retrograde flow into the aneurysm our modified endovascular treatment involves coil embolization of the aneurysmal orifice and the ICA, including the origin of the ophthalmic artery and meningohypophyseal trunk, and placement of a high-flow bypass using a radial artery graft.
  
  
  RESULTS
  During the 5- to 12-year follow-up period, 4 aneurysms disappeared, and the other decreased in size. There were no subarachnoid hemorrhages. All bypass grafts remained patent. Visual preservation was achieved in 2 patients; 1 patient manifested visual improvement. Although 2 patients experienced transient neurological deficits we encountered no permanent complications in this series. The final modified Rankin scale of the 5 patients was 0 or 1.
  
  
  CONCLUSIONS
  Prevention of retrograde flow into the aneurysm by coil embolization with high-flow bypass is a safe and effective method. It prevents the recanalization of large or giant ICA aneurysms.
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors: Norio
authors: N
authors: Nakajima
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan. Electronic address: nagahiro.shinji@tokushima-u.ac.jp.
authors: Shinji
authors: S
authors: Nagahiro
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors: Junichiro
authors: J
authors: Satomi
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors: Yoshiteru
authors: Y
authors: Tada
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors: Kohei
authors: K
authors: Nakajima
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors: Shu
authors: S
authors: Sogabe
authors: Department of Neurosurgery, Institute of Health Biosciences, Tokushima University, Tokushima, Japan.
authors: Mami
authors: M
authors: Hanaoka
authors: Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan.
authors: Shunji
authors: S
authors: Matsubara
authors: Department of Neurosurgery, Kawasaki Medical School, Okayama, Japan.
authors: Masaaki
authors: M
authors: Uno
authors: Department of Neurosurgery, Tokushima Red Cross Hospital, Tokushima, Japan.
authors: Koichi
authors: K
authors: Satoh
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001783:Blood Flow Velocity; D020215:Carotid Artery, Internal, Dissection / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D002560:Cerebrovascular Circulation; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Coil embolization; Giant aneurysm; High-flow bypass; Internal carotid artery; Retrograde blood flow