背景:建立颅外至颅内高流量旁路后捕获动脉瘤被认为是治疗颈内动脉(ICA)破裂血泡样动脉瘤(BBA)的最佳手术策略。对于高流量旁路手术,桡动脉移植物通常优于隐静脉移植物(SVG)。然而,SVG在急性期手术中可能是有利的,因为它们的长度更大,易于操作,作为高流量管道的能力,降低血管痉挛的风险.在这项研究中,作者介绍了5例破裂的BBAs,使用SVG进行高流量旁路治疗,然后进行BBA捕获,他们报告了可能有助于避免潜在陷阱的手术结果和手术细微差别。
方法:手术后,没有缺血或出血性并发症,包括有症状的血管痉挛.在五个案例中的三个,术后3个月随访时改良Rankin量表评分为0~2分.在一个案例中,手术后SVG自发闭塞,而保护颞浅动脉(STA)至大脑中动脉(MCA)旁路占优势,患者没有出现缺血症状。
结论:使用SVG和保护性STA-MCA旁路,然后进行BBA捕获的高流量旁路是一种安全有效的治疗策略。
BACKGROUND: Trapping an aneurysm after the establishment of an extracranial to intracranial high-flow bypass is considered the optimal surgical strategy for ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA). For high-flow bypass surgeries, a radial artery graft is generally preferred over a saphenous vein graft (SVG). However, SVGs can be advantageous in acute-phase surgeries because of their greater length, easy manipulability, ability to act as high-flow conduits, and reduced risk of vasospasms. In this study, the authors presented five cases of ruptured BBAs treated with high-flow bypass using an SVG followed by BBA trapping, and they reported on surgical outcomes and operative nuances that may help avoid potential pitfalls.
METHODS: After the surgeries, there were no ischemic or hemorrhagic complications, including symptomatic vasospasms. In three of the five cases, postoperative modified Rankin scale scores were between 0 and 2 at the 3-month follow-up. In one case, the SVG spontaneously occluded after surgery while the protective superficial temporal artery (STA) to middle cerebral artery (MCA) bypass became dominant, and the patient experienced no ischemic symptoms.
CONCLUSIONS: High-flow bypass using an SVG with a protective STA-MCA bypass followed by BBA trapping is a safe and effective treatment strategy.