Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass
10.7461/jcen.2022.E2022.01.003
- Author:
Young Rak KIM
1
;
Sung Ho LEE
;
Jin Woo BAE
;
Young Hoon CHOI
;
Eun Jin HA
;
Kang Min KIM
;
Won-Sang CHO
;
Hyun-Seung KANG
;
Jeong Eun KIM
Author Information
1. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Publication Type:Case Report
- From:Journal of Cerebrovascular and Endovascular Neurosurgery
2023;25(1):62-68
- CountryRepublic of Korea
- Language:English
-
Abstract:
The treatment of complicated anterior cerebral artery aneurysms remains challenging. Here, the authors describe a case of ruptured complicated A3 aneurysm, which was treated with trapping and in-situ bypass. A 47-year-old man presented to the emergency department with severe headache and vomiting. Computed tomography illustrated acute intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) confirmed a ruptured fusiform A3 aneurysm with lobulation and a daughter sac. Trapping of the ruptured fusiform A3 aneurysm and distal end-toside A4 anastomosis was performed. DSA on postoperative day 7 showed mild vasospasm to the afferent artery. However, 2 months later, DSA demonstrated that the antegrade flow through the anastomosis site had recovered. Thus, surgeons should be aware of the possibility of postsurgical vasospasm of anastomosed arteries, especially in cases of ruptured aneurysms.
