Extracranial–Intracranial High-Flow Bypass for Giant Ruptured Paraclinoid Aneurysm with Concomitant Bilateral Internal Carotid Artery Stenotic Dissection

Georgieva, Vania Bozhidarova; Krastev, Emil Dimitrov; Byulbyuleva, Stefka Kostadinova

doi:10.1016/j.wneu.2018.06.101

World Neurosurgery

2018

DOI: 10.1016/j.wneu.2018.06.101

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Extracranial–Intracranial High-Flow Bypass for Giant Ruptured Paraclinoid Aneurysm with Concomitant Bilateral Internal Carotid Artery Stenotic Dissection

Vania Bozhidarova Georgieva

Emil Dimitrov Krastev

Stefka Kostadinova Byulbyuleva

Abstract: Dealing only with the ruptured paraclinoid aneurysm, without taking care of the underlying cerebral ischemia owing to concomitant extracranial ICA dissection, could be an insufficient approach for treatment. In the presented case of a giant ruptured paraclinoid aneurysm and coexistence of severe bilateral ICA dissecting stenosis, trapping with matching the bypass flow was the proper solution for managing simultaneously with the aneurysm and the cerebral ischemia from the left side. Anticoagulants and antiplate… Show more

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Cited by 4 publications

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Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

Ito,

Maruichi,

Nakayama

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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Background There are some cases where a radial artery (RA) graft is needed for a high-flow extracranial to intracranial (EC-IC) bypass as the external carotid artery (ECA) cannot be utilized as a donor artery. In this report, we describe two cases of extracranial vertebral artery (VA) to middle cerebral artery (MCA) high-flow bypass using an RA graft with an artificial vessel as an alternative bypass technique. Methods The patient was placed supine with a head rotation of 80 degrees. After frontotemporal craniotomy, another C-shaped skin incision was made at the retroauricular region and the V3 portion of the VA was exposed at the suboccipital triangle. Prior to attempting the high-flow bypass, the superficial temporal artery (STA) was anastomosed to the M4 portion of the MCA as an insurance bypass. The RA graft was anastomosed to the V3 portion of the VA that traveled under the periosteum at the supra-auricular region through an artificial vessel. After RA-M2 anastomosis, an alternative EC-IC bypass, the V3-RA-M2 bypass, was achieved. Results Postoperative angiography demonstrated successful graft patency and no perioperative complications were observed in both cases. Conclusions In the cases where a high-flow bypass is required, the V3 portion of the VA is a suitable alternative proximal anastomosis site when the ECA is not a candidate donor. Furthermore, an artificial vessel shows satisfactory protection against graft complications.

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Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

Ito,

Maruichi,

Nakayama

et al. 2023

J Neurol Surg A Cent Eur Neurosurg

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Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries

Komarnytskyi,

Orlov

2024

Ukr Neurosurg J

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Objective – to determine the effect of occlusive-stenotic lesions of cerebral arteries on angiospasm and ischemic complications in patients with ruptured arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries. Materials and methods. A retrospective study of the medical histories of 1,147 patients with cerebral artery aneurysms from 2006 to 2022 was conducted. 63 patients were included in the study group because they met the following criteria: surgical treatment; rupture of saccular aneurysms (SAs); the presence of occlusive-stenotic lesions was proven using instrumental examination methods. Patients of the control group had to meet the following criteria: surgical treatment; rupture of SAs; the absence of occlusive-stenotic lesions was proven by means of instrumental examination methods; the gender and age distribution had to match the study group. Of the 126 patients included in this study, there were 76 men (60.32%) and 50 women (39.68%). The age of the patients varied from 31 to 77 years. The average age of patients- 55.9±0.76 years; men – 54.3±0.94 years, women – 58.3±1.19 years. Results. A percentage predominance of patients with high cerebral blood flow velocity (>200 cm/s, which is equal to the velocity with severe grade III vasospasm of the cerebral arteries) in the study group (32.56%) compared with the control group (24.24%) was revealed. Conclusions. The predominance of men among patients of the study group (60.32%) was established. The average age of men with occlusive-stenotic lesions was younger than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is the largest in the 2nd subgroup of the study group where the severity of stenosis is 50-75% (men - 48.3 years; women - 62 years). Ruptures of arterial aneurysms of the middle cerebral artery occur more often in the presence of stenoses (study group - 25.4%, control group - 12.7%). The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis for life and health was in men with a ruptured arterial aneurysm against the background of a 50-75% stenotic lesion and severe vasospasm of the cerebral arteries.

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Ruptures of arterial aneurysms of the brain and stenosis of the carotid basin: clinic, diagnosis

Komarnytskyi,

Orlov

2024

Ukr. ìnterv. nejroradìol. hìr.

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Objective – to investigate the clinical and morphological characteristics of the manifestations of the rupture of arterial aneurysms of the brain in patients with occlusive-stenotic lesions of the cerebral arteries.Materials and methods. 1147 case histories of patients with aneurysmal disease of the cerebral arteries who underwent comprehensive examination and treatment in the Department of Neurosurgical Pathology of Head and Neck Vessels with X-ray Surgical Department «Romodanov Institute of Neurosurgery NAMS of Ukraine» since 2006 until 2022. The medical histories of 126 patients who were included in this study and divided into two groups were studied in detail. The criteria for inclusion in the main group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm the presence (proven using instrumental examination methods) of occlusive-stenotic lesions.The criteria for inclusion in the control group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm; absence (proven by means of instrumental examination methods) of occlusive-stenotic lesions; the gender and age distribution had to match the main group.Among the patients included in this study, there were 76 men (60.32 %) and 50 women (39.68 %). The age of the patients varied from 31 to 77 years. The average age of patients ‒ 55.9 ± 0.76 years. Results. The Hunt‒Hess severity of patients was approximately the same between the main and control groups. When evaluated by the World Federation of Neurologican Surgeons (WFNS) and Glasgow Coma scale (GCS), more patients in the control group had a lighter score. Aneurysms of the anterior cerebral-anterior connecting artery complex prevailed in both groups. A higher frequency of arterial aneurysms of the middle cerebral artery was revealed among patients of the main group (main group ‒ 27.0 %, comparison group 15.8 %). The higher number of multiple aneurysms in the main group (the main group ‒ 25.4 %, the controlgroup ‒ 12.7 %) and the smaller number of miliary aneurysms and the larger number of large aneurysms in the main group may indicate the predominance of congenital etiological factors common to both pathologies in the development of the disease until the rupture of the arterial aneurysm.Conclusions. Gender differences were established with a predominance of men among patients of the main group (60.32 %). The average age of men with occlusive-stenotic lesions was lower than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is especially pronounced in the subgroup of the main group where the severity of stenosis is 50‒75 % (men ‒ 48.3 years; women ‒ 62.0 years).The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis is in men with a ruptured arterial aneurysm and a 50‒75 % stenotic lesion.

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Extracranial–Intracranial High-Flow Bypass for Giant Ruptured Paraclinoid Aneurysm with Concomitant Bilateral Internal Carotid Artery Stenotic Dissection

Cited by 4 publications

References 38 publications

Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

Alternative Bypass Technique Using Radial Artery Graft between V3 Segment of Vertebral Artery and Middle Cerebral Artery: Technical Note

Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries

Ruptures of arterial aneurysms of the brain and stenosis of the carotid basin: clinic, diagnosis

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