Indirect surgical technique for the treatment of giant internal carotid artery aneurysms:a single-center retrospective cohort study
10.3969/j.issn.1002-0152.2024.07.004
- VernacularTitle:间接手术技术治疗颈内动脉巨大动脉瘤:一项单中心、回顾性队列研究
- Author:
Maohua DING
1
;
Xiaoguang TONG
Author Information
1. 天津市环湖医院(天津市脑系科中心医院)神经外科,天津医科大学神经内外科及神经康复临床学院(天津 300350)
- Keywords:
Giant internal carotid aneurysms;
Internal carotid artery constriction;
Internal carotid artery ligation;
Cerebrovascular reconstruction surgery;
Retrospective study
- From:
Chinese Journal of Nervous and Mental Diseases
2024;50(7):415-422
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the single-center experience with indirect surgery(cerebrovascular bypass)for the treatment of giant internal carotid aneurysms(GICAs).Methods A retrospective analysis was conducted on the clinical outcomes of patients with GICAs treated using indirect surgical techniques at our center from May 2016 to May 2023.For patients who tested negative in the balloon occlusion test(BOT),internal carotid artery(ICA)constriction was performed with or without low-flow bypass from the superficial temporal artery(STA)to the middle cerebral artery(MCA).For patients who tested positive in the BOT,ICA ligation was combined with high-flow bypass(external carotid artery-radial artery-M2).Preoperative and postoperative O'Kelly-Marotta(OKM)grading and changes in the maximum diameter of the aneurysm were examined through cerebral angiography.The preoperative and postoperative modified Rankin Scale(mRS)scores and changes in clinical symptoms were followed up to evaluate the safety and efficacy of the indirect surgery.Results A total of 22 patients were included in this study.Sixteen patients underwent ICA constriction with or without STA-MCA bypass,while six patients underwent ICA ligation combined with high-flow bypass.Postoperative OKM grades reached C/D in 50% (11/22)of the patients,showing a statistically significant improvement compared to preoperative grades(P<0.0001).Postoperative or final imaging follow-up showed that the size of aneurysms was decreased in 19 patients,remained unchanged in 2 patients,and increased in 1 patient,which reached a statistically significant difference compared to preoperative measurements(t=5.439,P<0.001).Follow-up results indicated that the mRS scores of the 22 patients decreased significantly compared to preoperative scores(t=2.531,P=0.019).Conclusion In the era of neurointervention,indirect surgical techniques remain an important complementary approach for the treatment of refractory or recurrent GICAs.
