Yeh H, Tomsick T A
Department of Neurosurgery, University of Cincinnati College of Medicine, OH 45267-0515, USA.
Surg Neurol. 1997 Nov;48(5):473-6. doi: 10.1016/s0090-3019(96)00549-6.
Proximal arterial occlusion, with or without extracranial-to-intracranial (EC-IC) bypass, is frequently used as treatment for giant intracranial aneurysms that are unclippable. The authors report on a patient who had obliteration of a giant unruptured aneurysm of the right internal carotid terminus after undergoing an EC-IC bypass without proximal arterial ligation.
This 71-year-old woman presented with repeated right cerebral ischemia caused by a giant saccular aneurysm of the right internal carotid terminus. Direct surgical clipping of the aneurysm was not recommended because of the patient's age and because of the morphology of the aneurysm. She could not tolerate occlusion of the right internal carotid artery (ICA) and, therefore, first underwent an EC-IC bypass. Four weeks later, she returned to undergo a balloon occlusion of the right ICA proximal to the aneurysm.
The right distal ICA and aneurysm were found to be spontaneously thrombosed. At 2-year follow-up, the aneurysm was shown to be completely obliterated on the magnetic resonance imaging scans.
The authors conclude that hemodynamic changes in the blood flow of the parent artery after EC-IC bypass caused this occurrence.
近端动脉闭塞术，无论是否联合颅外-颅内（EC-IC）旁路手术，经常被用于治疗无法夹闭的巨大颅内动脉瘤。作者报道了1例患者，在接受了未进行近端动脉结扎的EC-IC旁路手术后，其右侧颈内动脉末端的巨大未破裂动脉瘤闭塞。
该71岁女性因右侧颈内动脉末端巨大囊状动脉瘤导致反复右侧脑缺血就诊。由于患者年龄及动脉瘤形态，不建议直接进行动脉瘤手术夹闭。她无法耐受右侧颈内动脉（ICA）闭塞，因此首先接受了EC-IC旁路手术。四周后，她再次接受手术，在动脉瘤近端对右侧ICA进行球囊闭塞。
发现右侧ICA远端及动脉瘤自发血栓形成。在2年的随访中，磁共振成像扫描显示动脉瘤完全闭塞。
作者得出结论，EC-IC旁路手术后供血动脉血流动力学变化导致了这一情况的发生。
