Abstract：
The purpose of this research was to demonstrate the effectiveness and clinical outcome of an external carotid artery-radial artery graft-posterior cerebral artery (ECA-RAG-PCA) bypass in the treatment of complex vertebrobasilar artery aneurysms (VBANs) in a single-center retrospective study. An ECA-RAG-PCA bypass may be a last and very important option in the treatment of complex VBANs when conventional surgical clipping or endovascular interventions fail to achieve the desired outcome. This study retrospectively analyzed the clinical presentation, case characteristics, aneurysm location, size and morphology, choice of surgical strategy, complications, clinical follow-up, and prognosis of the patients enrolled. The data involved were analyzed by the appropriate statistical methods. A total of 24 patients with complex VBANs who met the criteria were included in this study. Eighteen (75.0%) were male and the mean age was 54.1 ± 8.83 years. The aneurysms were located in the vertebral artery, the basilar artery, and in the vertebrobasilar artery with simultaneous involvement. All patients underwent ECA-RAG-PCA bypass surgery via an extended middle cranial fossa approach, with 8 (33.3%) undergoing ECA-RAG-PCA bypass only, 3 (12.5%) undergoing ECA-RAG-PCA bypass combined with aneurysm partial trapping, and 12 (50.0%) undergoing ECA-RAG-PCA bypass combined with proximal occlusion of the parent artery. The average clinical follow-up was 22.0 ± 13.35 months. The patency rate of the high-flow bypass was 100%. At the final follow-up, 15 (62.5%) patients had complete occlusion of the aneurysm, 7 (29.2%) patients had subtotal occlusion of the aneurysm, and 2 (8.3%) patients had stable aneurysms. The rate of complete and subtotal occlusion of the aneurysm at the final follow-up was 91.7%. The clinical prognosis was good in 21 (87.5%) patients and no procedure-related deaths occurred. Analysis of the good and poor prognosis groups revealed a statistically significant difference in aneurysm size (P = 0.034, t-test). Combining the results of this study and the clinical experience of our center, we propose a surgical algorithm and strategy for the treatment of complex VBANs.The technical approach of ECA-RAG-PCA bypass for complex VBANs remains important, even in an era of rapid advances in endovascular intervention. When conventional surgical clipping or endovascular intervention has failed, an ECA-RAG-PCA bypass plays a role that cannot be abandoned and is a very important treatment option of last resort.
摘要：
这项研究的目的是证明颈外动脉-桡动脉移植物-大脑后动脉（ECA-RAG-PCA）旁路术治疗复杂的椎基底动脉动脉瘤（VBAN）的有效性和临床结果。单中心回顾性研究。当常规手术夹闭或血管内介入无法达到预期结果时，ECA-RAG-PCA旁路可能是治疗复杂VBAN的最后且非常重要的选择。本研究回顾性分析患者的临床表现,案例特征,动脉瘤位置,大小和形态，手术策略的选择，并发症,临床随访,和入选患者的预后。所涉及的数据通过适当的统计方法进行分析。本研究共纳入24例符合标准的复杂VBAN患者。男性18名（75.0％），平均年龄为54.1±8.83岁。动脉瘤位于椎动脉,基底动脉,同时受累的椎基底动脉。所有患者通过扩展的中颅窝入路接受ECA-RAG-PCA搭桥手术，8人(33.3%)只接受ECA-RAG-PCA旁路手术，3（12.5％）接受ECA-RAG-PCA旁路术联合动脉瘤部分捕获，12例(50.0%)接受ECA-RAG-PCA旁路术联合其母动脉近端闭塞。平均临床随访22.0±13.35个月。高流量旁路的通畅率为100%。在最后的后续行动中，15例（62.5%）患者动脉瘤完全闭塞，7例(29.2%)患者出现动脉瘤次全闭塞,2例(8.3%)患者动脉瘤稳定。最终随访时动脉瘤完全和次全闭塞率为91.7％。21例（87.5%）患者临床预后良好，无手术相关死亡发生。对预后良好和预后不良组的分析显示，动脉瘤大小差异具有统计学意义（P=0.034，t检验）。结合本研究结果和本中心的临床经验,我们提出了一种治疗复杂VBAN的手术算法和策略。ECA-RAG-PCA旁路用于复杂VBAN的技术方法仍然很重要，即使是在血管内介入快速发展的时代。当常规手术夹闭或血管内介入治疗失败时，ECA-RAG-PCA旁路手术起着不可放弃的作用,是非常重要的最后选择.
