Long-term results and neuropathy of internal carotid artery aneurysms treated with high-flow bypass using saphenous vein graft and parent artery occlusion

Objectives: Giant internal carotid artery aneurysms require treatment owing to the risk of rupture, cranial nerve palsy in the cavernous sinus, and optic nerve symptoms. Among treatment options for internal carotid artery aneurysms, we compared the results of flow diverter stent with those of high-flow bypass.

Materials and methods: A total of 45 consecutive patients with large or giant internal carotid artery aneurysms underwent high-flow bypass using saphenous vein graft and double assist superficial temporal artery-middle cerebral artery bypass and proximal ligation of the internal carotid artery at the neck.

Results: The high-flow bypass patency rate was 96 %. Among the target aneurysms, 78 % and 96 % thrombosed within one and three years postoperatively, respectively. Neurological symptoms associated with aneurysms improved in 69 % of patients. The complication rate was 4 %. The thrombosis rate of aneurysms treated with high-flow bypass tended to be higher and faster than those treated with flow diverter stent.

Conclusions: Even in the era of flow diverter stenting, treatment with high-flow bypass should be considered for patients who have difficulty with flow diverter stent implantation or without thromboses. Therefore, the treatment of cerebral aneurysms with high-flow bypass requires high safety and efficacy.