Acerbi Francesco, Mazzapicchi Elio, Falco Jacopo, Vetrano Ignazio Gaspare, Restelli Francesco, Faragò Giuseppe, La Corte Emanuele, Bonomo Giulio, Bersano Anna, Canavero Isabella, Gemma Marco, Broggi Morgan, Schiariti Marco, Ziliani Vanessa, Raccuia Gabriella, Mangiafico Salvatore, Ganci Giuseppe, Ciceri Elisa, Ferroli Paolo
Neurosurgical Unit II, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
Experimental Microsurgical Laboratory, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
Brain Sci. 2022 Oct 3;12(10):1339. doi: 10.3390/brainsci12101339.
Despite the increasing popularity of flow diverters (FDs) as an endovascular option for intracranial aneurysms, the treatment of complex aneurysms still represents a challenge. Combined strategies using a flow-preservation bypass could be considered in selected cases. In this study, we retrospectively reviewed our series of patients with complex intracranial aneurysms submitted to bypass. From January 2015 to May 2022, 23 patients were selected. We identified 11 cases (47.8%) of MCA, 6 cases (26.1%) of ACA and 6 cases (26.1%) of ICA aneurysms. The mean maximal diameter was 22.73 ± 12.16 mm, 8 were considered as giant, 9 were fusiform, 8 presented intraluminal thrombosis, 10 presented wall calcification, and 18 involved major branches or perforating arteries. Twenty-five bypass procedures were performed in 23 patients (two EC-IC bypasses with radial artery graft, seventeen single- or double-barrel STA-MCA bypasses and six IC-IC bypasses in anterior cerebral arteries). The long-term bypass patency rate was 94.5%, and the total aneurysm exclusion was 95.6%, with a mean follow-up of 28 months. Median KPS values at last follow-up was 90, and a favorable outcome (KPS ≥ 70 and mRS ≤ 2) was obtained in 87% of the cases. The use of bypass techniques represents, in selected cases, a valid therapeutic option in the management of complex anterior circulation aneurysms when a simpler direct approach, including the use of FD, is considered not feasible.
尽管血流导向装置（FDs）作为颅内动脉瘤的一种血管内治疗选择越来越受欢迎，但复杂动脉瘤的治疗仍然是一项挑战。在某些特定情况下，可以考虑采用保留血流的旁路联合策略。在本研究中，我们回顾性分析了接受旁路手术的复杂颅内动脉瘤患者系列。从2015年1月至2022年5月，共入选23例患者。我们确定其中11例（47.8%）为大脑中动脉（MCA）动脉瘤，6例（26.1%）为大脑前动脉（ACA）动脉瘤，6例（26.1%）为颈内动脉（ICA）动脉瘤。平均最大直径为22.73±12.16mm，8例被认为是巨大动脉瘤，9例为梭形动脉瘤，8例有腔内血栓形成，10例有壁钙化，18例累及主要分支或穿支动脉。23例患者共进行了25次旁路手术（2例采用桡动脉移植的颅外-颅内（EC-IC）旁路手术，17例单或双管颞浅动脉-大脑中动脉（STA-MCA）旁路手术，6例大脑前动脉的颅内-颅内（IC-IC）旁路手术）。长期旁路通畅率为94.5%，动脉瘤完全闭塞率为95.6%，平均随访28个月。末次随访时的KPS值中位数为90，87%的病例获得了良好结局（KPS≥70且改良Rankin量表（mRS）≤2）。当包括使用血流导向装置在内的更简单直接方法被认为不可行时，在某些特定情况下，旁路技术的应用是治疗复杂前循环动脉瘤的一种有效治疗选择。
