School of Medicine, Nankai University, 94 Weijin Road, 300071, Tianjin, China.
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Neurosurg Rev. 2023 Aug 4;46(1):192. doi: 10.1007/s10143-023-02101-5.
The purpose of this research was to demonstrate the effectiveness and clinical outcome of an external carotid artery-radial artery graft-posterior cerebral artery (ECA-RAG-PCA) bypass in the treatment of complex vertebrobasilar artery aneurysms (VBANs) in a single-center retrospective study. An ECA-RAG-PCA bypass may be a last and very important option in the treatment of complex VBANs when conventional surgical clipping or endovascular interventions fail to achieve the desired outcome. This study retrospectively analyzed the clinical presentation, case characteristics, aneurysm location, size and morphology, choice of surgical strategy, complications, clinical follow-up, and prognosis of the patients enrolled. The data involved were analyzed by the appropriate statistical methods. A total of 24 patients with complex VBANs who met the criteria were included in this study. Eighteen (75.0%) were male and the mean age was 54.1 ± 8.83 years. The aneurysms were located in the vertebral artery, the basilar artery, and in the vertebrobasilar artery with simultaneous involvement. All patients underwent ECA-RAG-PCA bypass surgery via an extended middle cranial fossa approach, with 8 (33.3%) undergoing ECA-RAG-PCA bypass only, 3 (12.5%) undergoing ECA-RAG-PCA bypass combined with aneurysm partial trapping, and 12 (50.0%) undergoing ECA-RAG-PCA bypass combined with proximal occlusion of the parent artery. The average clinical follow-up was 22.0 ± 13.35 months. The patency rate of the high-flow bypass was 100%. At the final follow-up, 15 (62.5%) patients had complete occlusion of the aneurysm, 7 (29.2%) patients had subtotal occlusion of the aneurysm, and 2 (8.3%) patients had stable aneurysms. The rate of complete and subtotal occlusion of the aneurysm at the final follow-up was 91.7%. The clinical prognosis was good in 21 (87.5%) patients and no procedure-related deaths occurred. Analysis of the good and poor prognosis groups revealed a statistically significant difference in aneurysm size (P = 0.034, t-test). Combining the results of this study and the clinical experience of our center, we propose a surgical algorithm and strategy for the treatment of complex VBANs.The technical approach of ECA-RAG-PCA bypass for complex VBANs remains important, even in an era of rapid advances in endovascular intervention. When conventional surgical clipping or endovascular intervention has failed, an ECA-RAG-PCA bypass plays a role that cannot be abandoned and is a very important treatment option of last resort.
本研究旨在通过单中心回顾性研究证明颈外动脉-桡动脉搭桥-脑后动脉（ECA-RAG-PCA）旁路在治疗复杂椎基底动脉动脉瘤（VBAN）中的有效性和临床结果。当传统的手术夹闭或血管内介入治疗无法达到预期效果时，ECA-RAG-PCA 旁路可能是治疗复杂 VBAN 的最后也是非常重要的选择。本研究回顾性分析了纳入患者的临床特征、病例特征、动脉瘤位置、大小和形态、手术策略选择、并发症、临床随访和预后。通过适当的统计方法对涉及的数据进行了分析。共纳入符合标准的 24 例复杂 VBAN 患者，其中男 18 例（75.0%），平均年龄 54.1±8.83 岁。动脉瘤位于椎动脉、基底动脉和椎基底动脉，同时累及。所有患者均经扩大中颅窝入路行 ECA-RAG-PCA 旁路手术，其中 8 例（33.3%）仅行 ECA-RAG-PCA 旁路，3 例（12.5%）行 ECA-RAG-PCA 旁路联合部分动脉瘤夹闭，12 例（50.0%）行 ECA-RAG-PCA 旁路联合近端母动脉闭塞。平均临床随访时间为 22.0±13.35 个月。高流量旁路的通畅率为 100%。末次随访时，15 例（62.5%）患者动脉瘤完全闭塞，7 例（29.2%）患者动脉瘤次全闭塞，2 例（8.3%）患者动脉瘤稳定。最终随访时，动脉瘤完全和次全闭塞率为 91.7%。21 例（87.5%）患者临床预后良好，无手术相关死亡。对预后良好和不良组进行分析，发现动脉瘤大小有统计学差异（P=0.034，t 检验）。结合本研究结果和本中心临床经验，提出了一种治疗复杂 VBAN 的手术算法和策略。在血管内介入治疗迅速发展的时代，ECA-RAG-PCA 旁路治疗复杂 VBAN 的技术方法仍然很重要。当传统的手术夹闭或血管内介入治疗失败时，ECA-RAG-PCA 旁路发挥着不可放弃的作用，是一种非常重要的治疗选择。
