Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Radiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
World Neurosurg. 2023 Dec;180:e494-e505. doi: 10.1016/j.wneu.2023.09.097. Epub 2023 Sep 27.
To discuss the treatment of intracranial fusiform and giant internal carotid artery (ICA) aneurysms via revascularization based on our institutional experience.
An institutional review board-approved retrospective analysis was performed of patients with unruptured fusiform and giant intracranial ICA aneurysms treated from November 1991 to May 2020. All patients were evaluated for extracranial-intracranial (EC-IC) bypass and ICA occlusion.
Thirty-eight patients were identified. Initially, patients failing preoperative balloon test occlusion were treated with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass and concurrent proximal ICA ligation. We then treated them with STA-MCA bypass, followed by staged balloon test occlusion, and, if they passed, endovascular ICA coil occlusion. We treat all surgical medically uncomplicated patients with double-barrel STA-MCA bypass and concurrent proximal ICA ligation. The mean length of follow-up was 99 months. Symptom stability or improvement was noted in 85% of patients. Bypass graft patency was 92.1%, and all surviving patients had patent bypasses at their last angiogram. Aneurysm occlusion was complete in 90.9% of patients completing proximal ICA ligation. Three patients experienced ischemic complications and 4 patients experienced hemorrhagic complications.
Not all fusiform intracranial ICA aneurysms require intervention, except when life-threatening rupture risk is high or symptomatic management is necessary to preserve function and quality of life. EC-IC bypass can augment the safety of proximal ICA occlusion. The rate of complete aneurysm occlusion with this treatment is 90.9%, and long-term bypass graft-related complications are rare. Perioperative stroke is a major risk, and continued evolution of treatment is required.
根据我们的机构经验，讨论基于血运重建的颅内梭形和巨大颈内动脉（ICA）动脉瘤的治疗方法。
对 1991 年 11 月至 2020 年 5 月期间接受未破裂梭形和巨大颅内 ICA 动脉瘤治疗的患者进行了机构审查委员会批准的回顾性分析。所有患者均接受了颅外-颅内（EC-IC）旁路和 ICA 闭塞的评估。
共确定了 38 例患者。最初，术前球囊试验闭塞失败的患者接受了颞浅动脉（STA）-大脑中动脉（MCA）旁路和同期近端 ICA 结扎治疗。然后，我们对其进行了 STA-MCA 旁路治疗，随后进行分期球囊试验闭塞，如果通过，则进行血管内 ICA 线圈闭塞。我们对所有手术治疗无并发症的患者采用双筒 STA-MCA 旁路和同期近端 ICA 结扎治疗。平均随访时间为 99 个月。85%的患者症状稳定或改善。旁路移植血管通畅率为 92.1%，所有存活患者的最后一次血管造影均显示旁路通畅。完成近端 ICA 结扎的 90.9%患者的动脉瘤闭塞完全。3 例患者发生缺血性并发症，4 例患者发生出血性并发症。
除了高破裂风险危及生命或为了保留功能和生活质量而有必要进行症状治疗外，并非所有颅内梭形 ICA 动脉瘤都需要干预。EC-IC 旁路可以提高近端 ICA 闭塞的安全性。这种治疗方法的动脉瘤完全闭塞率为 90.9%，长期旁路相关并发症罕见。围手术期卒中是一个主要风险，需要不断发展治疗方法。
