くも膜下出血急性期にhigh flow bypassを行った破裂内頚動脈瘤の手術

We report our preliminary experience using radial artery graft bypass in patients with ruptured internal carotid artery aneurysm. The following types of 12 ruptured internal carotid artery aneurysms were treated: dorsomedial aneurysms with ill-defined necks (in 8 patients); tiny paraclinoid aneurysms projected in the superior (n=1) and ventral (n=1) direction; fusiform aneurysm (n=1) located between the C1 segment and M1 segment; and an IC-PC aneurysm (n=1) previously clipped 15 years before. Bypass procedures employed were EC-radial artery-M2 bypass in 6, and temporary using RA-M2 bypass (i.e., forearm vascular pedicle) in 6. Complete obliteration of aneurysms with no ischemic complication was achieved in all dorsomedial internal carotid aneurysms. Graft failure occurred in 1 case. Our experience emphasizes the importance of achieving vascular anastomosis in various clinical settings. We also describe a proposed strategy to obliterate blister aneurysm.