[Double extra-intracranial microvascular anastomoses in deconstructive surgeries for giant aneurysms of internal carotid and middle cerebral arteries].

Abstract

Background: Deconstructive interventions with exclusion of the parent artery are one of the possible methods of treatment for giant and fusiform aneurysms of cerebral arteries if aneurysm occlusion with coils or insertion of flow-diverting stents are technically impossible. Such interventions are associated with high risks of stroke. In such cases, surgical revascularization with double barrel extra-intracranial bypass may be advisable to reduce the risks of ischemic complications, perioperative mortality and improve long-term neurological outcomes.

Material and methods: The study included 25 patients with large and giant aneurysms of internal carotid (ICA) and middle cerebral arteries (MCA). All ones underwent double barrel bypass surgery with subsequent exclusion of aneurysm by endovascular or open method between 2015 and 2025.

Results: The median follow-up was 11 [6; 25] months. Total exclusion of aneurysm was achieved in 24 (96%) patients. Ischemic complications occurred in 7 (28%) patients. The causes of ischemic complications were different: insufficient revascularization (n=3); EICMA thrombosis (n=1); ischemia in perforator basin (n=3). The risk of ischemic complications was higher in patients with aneurysms of MCA and supraclinoid segment of ICA compared to cavernous and paraclinoid localization.

Conclusion: Double barrel extracranial to intracranial bypass between superficial temporal artery and cortical M4 branches of MCA allows for sufficient revascularization and lower risks of ischemic complications following subsequent ICA occlusion for giant aneurysm. A personalized approach to choice of acceptor arteries taking into account localization of aneurysm and natural collateral circulation is necessary to achieve good functional outcomes.