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Background <p>The management of ruptured, giant, fusiform aneurysms of the M1 segment of the middle cerebral artery (MCA) presents a significant therapeutic challenge. This difficulty is primarily due to their morphology, which lacks a distinct, clippable neck, and the involvement of critical lenticulostriate perforators.</p> Method <p>We describe a one-stage hybrid strategy that combines surgical revascularization with endovascular embolization. The procedure begins with a double-barrel superficial temporal artery (STA) to MCA bypass for flow replacement, followed by dual-microcatheter coil embolization of the aneurysm and its daughter sac, culminating in parent artery occlusion.</p> Conclusion <p>For ruptured giant M1 fusiform aneurysms with challenging proximal surgical exposure, a hybrid approach involving revascularization and subsequent parent artery occlusion represents a safe and effective treatment modality. The larger caliber of the STA in adult males allows for high-flow revascularization through a double-barrel bypass.</p>

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One-stage hybrid treatment of a ruptured M1 fusiform aneurysm with double-barrel STA–MCA bypass and endovascular embolization

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月20日

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  • Zhiqi Li,
  • Yuxin Cheng,
  • Bin Xu,
  • Feng Xu

摘要

Background

The management of ruptured, giant, fusiform aneurysms of the M1 segment of the middle cerebral artery (MCA) presents a significant therapeutic challenge. This difficulty is primarily due to their morphology, which lacks a distinct, clippable neck, and the involvement of critical lenticulostriate perforators.

Method

We describe a one-stage hybrid strategy that combines surgical revascularization with endovascular embolization. The procedure begins with a double-barrel superficial temporal artery (STA) to MCA bypass for flow replacement, followed by dual-microcatheter coil embolization of the aneurysm and its daughter sac, culminating in parent artery occlusion.

Conclusion

For ruptured giant M1 fusiform aneurysms with challenging proximal surgical exposure, a hybrid approach involving revascularization and subsequent parent artery occlusion represents a safe and effective treatment modality. The larger caliber of the STA in adult males allows for high-flow revascularization through a double-barrel bypass.