title: Retrograde suction decompression of a large internal carotid aneurysm using a balloon guide catheter combined with a blood-returning circuit and STA-MCA bypass: a technical note.
abstract: It is difficult to treat large internal carotid aneurysms with simple surgical clipping. Here, we present a retrograde suction decompression (RSD) procedure for large internal carotid aneurysms using a balloon guide catheter combined with a blood-returning circuit and a superficial temporal artery to middle cerebral artery (STA-MCA) bypass.All patients underwent an STA-MCA bypass before the temporary occlusion of the internal carotid artery (ICA). A 6-French sheath was inserted into the common carotid artery (CCA), and a 6-French Patrive balloon catheter was placed into the ICA 5 cm past the bifurcation. Aneurysm exposure was obtained; temporary clips were placed on the proximal M1, A1, and posterior communicating (Pcom) segments; and an extension tube was then connected to the balloon catheter. A three-way stopcock was placed, and aspiration was performed through the device to collapse the aneurysm. The aspirated blood was returned to a venous line with an added heparin to prevent anemia after aspiration. During the decompression, the blood flow to the cortical area was supplied through the STA-MCA bypass. After the aneurysm collapse, the surgeon carefully dissected the perforating artery from the aneurysm dome or neck, and permanent clips were then placed on the aneurysm neck. Our procedure has several advantages, such as STA-MCA bypass without external carotid artery occlusion for preventing ischemic complications of the cortical area, anemia may be avoided because of the return of the aspirated blood, and a hybrid operation room is not required to perform this method.
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan. s00-078@nms.ac.jp.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Matano
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Mizunari
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Shushi
authors.initials: S
authors.lastname: Kominami
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Fujiki
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Kubota
authors.affiliation: Department of Neurosurgery, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Murai
authors.affiliation: Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Akio
authors.initials: A
authors.lastname: Morita
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D002548:Cerebral Revascularization / Q000295:instrumentation / Q000379:methods; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013396:Suction; D017792:Surgical Stapling; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Aneurysm; Balloon catheter; Suction decompression