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Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
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Bypass Surgery for Complex Internal Carotid Artery Aneurysms: 39 Consecutive Patients
Ville Nurminen1, Leena Kivipelto1, Riku Kivisaari1
1Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
World Neurosurgery
|March 3, 2019
Summary
Bypass surgery effectively treats complex internal carotid artery (ICA) aneurysms, achieving high occlusion rates with acceptable risks. Patient outcomes show good independence, though cranial nerve recovery varies.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Cerebrovascular Disease
Background:
- Complex internal carotid artery (ICA) aneurysms present significant treatment challenges.
- Bypass surgery is a specialized technique for managing these complex vascular lesions.
Purpose of the Study:
- To describe the treatment and outcomes of complex ICA aneurysms treated with bypass procedures.
- To analyze outcomes across different ICA segments: cavernous, supraclinoid, and bifurcation.
Main Methods:
- Retrospective review of 39 patients with 41 complex ICA aneurysms treated with 44 bypass procedures (1998-2016).
- Aneurysms categorized into three anatomic subgroups for strategy review.
- Comprehensive review of imaging and medical records.
Main Results:
- Successful aneurysm occlusion or flow modification achieved in 95% of cases.
- Long-term bypass patency rate was 68%.
- Minor complications (ischemia/hemorrhage) occurred in 51%, with rare major strokes (3%). Cranial nerve dysfunction showed limited improvement (20-50% for extraocular muscles, 22% for vision). 74% of patients were independent at follow-up (mRS ≤2).
Conclusions:
- Bypass surgery is a feasible and safe treatment for complex ICA aneurysms.
- Patients should be counseled regarding the uncertain prognosis for pre-existing cranial nerve deficits.
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