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Emergency non-occlusive high capacity bypass surgery for ruptured giant internal carotid artery aneurysms


Burkhardt, Jan-Karl; Esposito, Giuseppe; Fierstra, Jorn; Bozinov, Oliver; Regli, Luca (2016). Emergency non-occlusive high capacity bypass surgery for ruptured giant internal carotid artery aneurysms. In: Burkhardt, Jan-Karl. Trends in Cerebrovascular Surgery. Switzerland: Springer, 77-81.

Abstract

AIM: Managing ruptured giant internal carotid artery (ICA) aneurysms in an emergency situation is very challenging. By reporting two cases, we discuss the role of the Excimer Laser-assisted Non-occlusive Anastomosis (ELANA) technique as an armamentarium for cerebrovascular surgeons dealing with giant ICA aneurysms presenting with subarachnoid hemorrhage (SAH).
MATERIALS AND METHODS: The management of two consecutive patients treated with ELANA bypass during a 6-month period (June- December 2013) for ruptured giant ICA aneurysms in an emergency setting is presented.
RESULTS: The two patients presented with SAH and newly diagnosed giant ICA aneurysms (both Fisher 3; WFNS scores 2 and 4, respectively). Both patients received an emergent high-capacity extra- to intracranial (EC-IC) bypass with interposition of a saphenous vein graft between the external carotid artery (ECA) and the ICA-termination. The intracranial anastomosis was performed by the use of the non-occlusive ELANA technique. The aneurysms were successfully trapped, and there were no major complications and no major persistent morbidity in either patient. A good clinical outcome was obtained with a modified Rankin scale of 2 at the last follow-up in both patients.
CONCLUSION: Emergency ELANA bypass surgery is a useful instrument for managing patients with giant ICA aneurysms presenting with SAH. In experienced hands, the technique does not seem to carry increased risk and may expand the surgical options due to its non-occlusive nature.

Abstract

AIM: Managing ruptured giant internal carotid artery (ICA) aneurysms in an emergency situation is very challenging. By reporting two cases, we discuss the role of the Excimer Laser-assisted Non-occlusive Anastomosis (ELANA) technique as an armamentarium for cerebrovascular surgeons dealing with giant ICA aneurysms presenting with subarachnoid hemorrhage (SAH).
MATERIALS AND METHODS: The management of two consecutive patients treated with ELANA bypass during a 6-month period (June- December 2013) for ruptured giant ICA aneurysms in an emergency setting is presented.
RESULTS: The two patients presented with SAH and newly diagnosed giant ICA aneurysms (both Fisher 3; WFNS scores 2 and 4, respectively). Both patients received an emergent high-capacity extra- to intracranial (EC-IC) bypass with interposition of a saphenous vein graft between the external carotid artery (ECA) and the ICA-termination. The intracranial anastomosis was performed by the use of the non-occlusive ELANA technique. The aneurysms were successfully trapped, and there were no major complications and no major persistent morbidity in either patient. A good clinical outcome was obtained with a modified Rankin scale of 2 at the last follow-up in both patients.
CONCLUSION: Emergency ELANA bypass surgery is a useful instrument for managing patients with giant ICA aneurysms presenting with SAH. In experienced hands, the technique does not seem to carry increased risk and may expand the surgical options due to its non-occlusive nature.

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Additional indexing

Item Type:Book Section, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Emergency bypass; Excimer laser-assisted non-occlusive anastomosis (ELANA); Giant aneurysm, ruptured aneurysm, complex aneurysm; Subarachnoid hemorrhage
Language:English
Date:2016
Deposited On:26 Jan 2017 10:30
Last Modified:28 Mar 2017 10:28
Publisher:Springer
Series Name:Acta Neurochirurgica. Supplementum
Number:123
ISSN:0065-1419
ISBN:978-3-319-02410-3
Publisher DOI:https://doi.org/10.1007/978-3-319-29887-0_11
PubMed ID:27637632

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