論文

査読有り
2014年3月

Changing Treatment Strategy From Clipping to Radial Artery Graft Bypass and Parent Artery Sacrifice in Patients With Ruptured Blister-Like Internal Carotid Artery Aneurysms

NEUROSURGERY
  • Ken Kazumata
  • ,
  • Naoki Nakayama
  • ,
  • Toshitaka Nakamura
  • ,
  • Hiroyasu Kamiyama
  • ,
  • Shunsuke Terasaka
  • ,
  • Kiyohiro Houkin

10
1
開始ページ
66
終了ページ
72
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1227/NEU.0000000000000076
出版者・発行元
LIPPINCOTT WILLIAMS & WILKINS

BACKGROUND: Blood blister-like aneurysms (BBAs) are aneurysms with ill-defined fragile necks arising from an internal carotid artery (ICA) and associated with high mortality.
OBJECTIVE: To describe strategies and outcomes in patients in whom radial artery (RA) graft bypass with ICA sacrifice was considered as the primary treatment during the acute phase of subarachnoid hemorrhage.
METHODS: The authors analyzed the clinical records of 20 patients who were treated between 2004 and 2011 at their hospital and affiliate institutions.
RESULTS: A majority of the patients were treated during the acute phase (< 24 hours, n = 15). A favorable outcome was achieved in 18 (90%) patients. The treatment strategies used were as follows: (1) ICA trapping/external carotid artery (ECA)-RA-middle cerebral artery (MCA) bypass (n = 13), (2) ICA trapping/superficial temporal artery-MCA bypass (n = 2), (3) aneurysm clipping with RA-MCA temporary bypass (n = 3), (3) aneurysm clipping with proximal ICA ligation and ECA-RA-MCA bypass (n = 1), and (4) direct clipping (n = 1). Postoperative infarction was observed in 6 patients and was ascribed to vasospasm (n = 1), retrograde thrombosis associated with trapping (n = 2), and reasons unrelated to the surgical procedures (n = 3).
CONCLUSION: Trapping with RA graft bypass demonstrated favorable results in patients with internal carotid BBAs. Although trapping/RA graft bypass is a definitive treatment for BBAs located proximal to the origin of the posterior communicating artery, some distal BBAs preclude ICA trapping to spare the perforating arteries.


リンク情報
DOI
https://doi.org/10.1227/NEU.0000000000000076
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/23842547
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000339062500014&DestApp=WOS_CPL
ID情報
  • DOI : 10.1227/NEU.0000000000000076
  • ISSN : 0148-396X
  • eISSN : 1524-4040
  • PubMed ID : 23842547
  • Web of Science ID : WOS:000339062500014

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