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<p>To present results of complex intracranial aneurysms (CIAs) underwent extracranial-intracranial (EC-IC) bypass with one-stage and two-stage aneurysm trapping in anterior circulation and share our experience. The author retrospectively reviewed 53 patients with CIAs underwent EC-IC bypass with different therapies of aneurysm trapping from Jan. 2018 to Dec 2020. Ballon occlusion testing (BOT) was performed to assess collateral circulation. In general, CIAs was operated by one-stage trapping, which was characterized by simultaneous implementation of aneurysm trapping and EC-IC bypass. However, CIAs failing to BOT or harboring important perforators was performed by two-stage trapping, which involved subsequent delay in performing aneurysm trapping based on CIAs change after EC-IC bypass. Clinical variables, postoperative complications, and follow-up outcomes were presented.&#xa0;Of the 53 patients, 28 patients completed the one-stage aneurysm trapping, and 25 patients completed two-stage aneurysm trapping. There was significant difference in patients experiencing new cerebral infarction between patients with one-stage and two-stage aneurysm trapping (21.4% vs. 4.0%, <i>P</i> = 0.049). When discharged, there was significant difference in CIAs disappeared between patients with one-stage and two-stage aneurysm trapping (100.0% vs. 24.0%, <i>P</i> &lt; 0.001). CIAs without one-stage aneurysm trapping achieved complex aneurysm changes after revascularization, including aneurysm disappeared, unchanged, and enlarged in 6 cases, 9 cases, and 10 cases. Out of 18 CIAs demanding two-staged aneurysm trapping, aneurysm disappeared in 17 cases and got smaller in 1 case. At the final follow-up with average of 58 months, there was no significant difference in aneurysm change between patients with one-stage and two-stage aneurysm trapping (<i>P</i> = 0.312). No new ischemic and hemorrhagic events developed. EC-IC bypass with one-stage aneurysm trapping was an effective option for CIAs although with high risk of operation-related infarction. EC-IC bypass with two-stage aneurysm trapping was an alternative treatment for selected CIAs. </p>

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Cerebral revascularization with one-stage and two-stage aneurysm trapping for complex intracranial aneurysms in anterior circulation: a single-center retrospective cohort study

  • 期刊论文

  • 发表日期：

    2025年10月23日

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  • Zhiyong Shi,
  • Zhongren Deng,
  • Le-Bao Yu,
  • Yi Wang,
  • Chunhua Hang,
  • Dong Zhang,
  • Yongbo Yang

摘要

To present results of complex intracranial aneurysms (CIAs) underwent extracranial-intracranial (EC-IC) bypass with one-stage and two-stage aneurysm trapping in anterior circulation and share our experience. The author retrospectively reviewed 53 patients with CIAs underwent EC-IC bypass with different therapies of aneurysm trapping from Jan. 2018 to Dec 2020. Ballon occlusion testing (BOT) was performed to assess collateral circulation. In general, CIAs was operated by one-stage trapping, which was characterized by simultaneous implementation of aneurysm trapping and EC-IC bypass. However, CIAs failing to BOT or harboring important perforators was performed by two-stage trapping, which involved subsequent delay in performing aneurysm trapping based on CIAs change after EC-IC bypass. Clinical variables, postoperative complications, and follow-up outcomes were presented. Of the 53 patients, 28 patients completed the one-stage aneurysm trapping, and 25 patients completed two-stage aneurysm trapping. There was significant difference in patients experiencing new cerebral infarction between patients with one-stage and two-stage aneurysm trapping (21.4% vs. 4.0%, P = 0.049). When discharged, there was significant difference in CIAs disappeared between patients with one-stage and two-stage aneurysm trapping (100.0% vs. 24.0%, P < 0.001). CIAs without one-stage aneurysm trapping achieved complex aneurysm changes after revascularization, including aneurysm disappeared, unchanged, and enlarged in 6 cases, 9 cases, and 10 cases. Out of 18 CIAs demanding two-staged aneurysm trapping, aneurysm disappeared in 17 cases and got smaller in 1 case. At the final follow-up with average of 58 months, there was no significant difference in aneurysm change between patients with one-stage and two-stage aneurysm trapping (P = 0.312). No new ischemic and hemorrhagic events developed. EC-IC bypass with one-stage aneurysm trapping was an effective option for CIAs although with high risk of operation-related infarction. EC-IC bypass with two-stage aneurysm trapping was an alternative treatment for selected CIAs.