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Trapping and A4-A4 end-to-side anastomosis for the treatment of a ruptured A3 fusiform aneurysm: Potential risk of in-situ bypass

Journal of Cerebrovascular and Endovascular Neurosurgery / Journal of Cerebrovascular and Endovascular Neurosurgery, (P)2234-8565; (E)2287-3139
2023, v.25 no.1, pp.62-68
https://doi.org/10.7461/jcen.2022.E2022.01.003
Young Rak Kim (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
Sung Ho Lee (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea)
Jin Woo Bae (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
Young Hoon Choi (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
Eun Jin Ha (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
Kang Min Kim (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
Won-Sang Cho (Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea)
Hyun-Seung Kang (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
Jeong Eun Kim (Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea)
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Abstract

The treatment of complicated anterior cerebral artery aneurysms remains challenging. Here, the authors describe a case of ruptured complicated A3 aneurysm, which was treated with trapping and in-situ bypass. A 47-year-old man presented to the emergency department with severe headache and vomiting. Computed tomography illustrated acute intracerebral hemorrhage in the right frontal lobe. Digital subtraction angiography (DSA) confirmed a ruptured fusiform A3 aneurysm with lobulation and a daughter sac. Trapping of the ruptured fusiform A3 aneurysm and distal end-toside A4 anastomosis was performed. DSA on postoperative day 7 showed mild vasospasm to the afferent artery. However, 2 months later, DSA demonstrated that the antegrade flow through the anastomosis site had recovered. Thus, surgeons should be aware of the possibility of postsurgical vasospasm of anastomosed arteries, especially in cases of ruptured aneurysms.

keywords
End-to-side anastomosis, In-situ bypass, Vasospasm, Complicated ACA aneurysm

Journal of Cerebrovascular and Endovascular Neurosurgery