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

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.