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Original research
Combined standard bypass and parent artery occlusion for management of giant and complex internal carotid artery aneurysms
  1. Philippe Dodier1,
  2. Wei-Te Wang1,
  3. Arthur Hosmann1,
  4. Dorian Hirschmann1,
  5. Wolfgang Marik2,
  6. Josa M Frischer1,
  7. Andreas Gruber3,
  8. Karl Rössler1,
  9. Gerhard Bavinzski1
  1. 1Department of Neurosurgery, Medical University of Vienna, Wien, Austria
  2. 2Department of Radiology, Medical University of Vienna, Wien, Austria
  3. 3Department of Neurosurgery, Kepler Universitätsklinikum GmbH, Linz, Oberösterreich, Austria
  1. Correspondence to Professor Gerhard Bavinzski, Department of Neurosurgery, Medical University of Vienna, Wien 1090, Austria; gerhard.bavinzski{at}meduniwien.ac.at

Abstract

Background Complex aneurysms do not have a standard protocol for treatment. In this study, we investigate the safety and efficacy of microsurgical revascularization combined with parent artery occlusion (PAO) in giant and complex internal carotid artery (ICA) aneurysms.

Methods Between 1998 and 2017, 41 patients with 47 giant and complex ICA aneurysms were treated by an a priori planned combined treatment strategy. Clinical and radiological outcomes were stratified according to mRS and Raymond classification. Bypass patency was assessed. Median follow-up time was 3.9 years.

Results After successful STA–MCA bypass, staged endovascular (n=37) or surgical (n=1) PAO was executed in 38 patients following a negative balloon occlusion test. Intolerance to PAO led to stent/coil treatments in two patients. Perioperative bypass patency was confirmed in 100% of completed STA–MCA bypass procedures. Long-term overall bypass patency rate was 99%. Raymond 1 occlusion and good outcome were achieved in 95% and 97% (mRS 0–2) of cases, respectively. No procedure-related mortality was encountered. Eighty-four percent of patients with preoperative cranial nerve compression syndromes improved during follow-up.

Conclusions The combined approach of STA-MCA bypass surgery followed by parent artery occlusion achieves high aneurysm occlusion and low morbidity rates in the management of giant and complex ICA aneurysms. This combined indirect approach represents a viable alternative to flow diversion in patients with cranial nerve compression syndromes or matricidal aneurysms, and may serve as a backup strategy in cases of peri-interventional complications or lack of suitable endovascular access.

  • aneurysm
  • balloon
  • technique
  • cranial nerve
  • intervention

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Individual de-identified participant data will not be shared due to the general Data Protection regulation which came into effect on May 25 2018 in Austria. The study protocol in the German language will be available on request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Individual de-identified participant data will not be shared due to the general Data Protection regulation which came into effect on May 25 2018 in Austria. The study protocol in the German language will be available on request.

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Footnotes

  • Presented at Preliminary data were presented at the Annual Meeting of the Austrian Neurosurgical Society 2018 (ÖGNC) and at the Congress of the European Association of Neurosurgical Societies 2019 (EANS).

  • Contributors Conception and design: PD, JMF, GB. Acquisition of data: PD. Analysis and interpretation of data: all authors. Drafting the article: all authors. Critically revising the article: all authors. Study supervision: JMF, KR, GB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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