Combined surgical revascularization and endovascular trapping of a large/giant thrombosed aneurysm of the distal anterior cerebral artery: A report of two cases

IF 0.5 Q4 CLINICAL NEUROLOGY

Interdisciplinary Neurosurgery: Advanced Techniques and Case Management Pub Date : 2025-07-25 DOI:10.1016/j.inat.2025.102102

Songhyon Lee, Michio Nakamura, Tadashi Miyazaki, Satoru Kurihara, Tomoko Yoneyama-Sarnecky

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Abstract

Background

Large and giant thrombosed aneurysms of the distal anterior cerebral artery (d-ACA), despite being rare, are associated with high mortality rates due to rupture. Direct clipping and endovascular embolization are often unfeasible due to the aneurysm’s morphology, necessitating trapping and bypass surgery. Recently, combined surgical revascularization and endovascular trapping have been found to be effective for complex vascular lesions.

Case Description

In Case 1, an 82-year-old woman underwent A3-A3 and STA-ACA bypass followed by endovascular embolization and internal trapping, resulting in significant shrinkage of the aneurysm and favorable recovery. In Case 2, a 76-year-old woman with an enlarging aneurysm underwent A3-A3 bypass with endovascular trapping but developed postoperative epidural hematoma.

Conclusions

Combined surgical revascularization and endovascular trapping is effective in protecting distal blood flow and reducing surgical invasiveness, though it predisposes patients to hemorrhagic complications.

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脑前远端大/巨血栓性动脉瘤联合手术重建术及血管内夹闭治疗2例报告

背景：大脑前动脉远端大而巨大的血栓性动脉瘤（d-ACA）尽管罕见，但因破裂而导致的死亡率很高。由于动脉瘤的形态，直接夹闭和血管内栓塞通常是不可行的，需要夹闭和搭桥手术。近年来，外科血管重建术和血管内诱捕术已被发现是治疗复杂血管病变的有效方法。病例描述：病例1，一名82岁女性接受了A3-A3和STA-ACA旁路手术，随后进行了血管内栓塞和内部夹闭，导致动脉瘤明显缩小，恢复良好。在病例2中，一名76岁的女性因动脉瘤增大，接受了A3-A3分流术并血管内夹闭，但术后出现硬膜外血肿。结论联合手术血管重建术可有效保护远端血流，减少手术创伤，但易引起出血性并发症。

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