Cerebrovascular bypass for ruptured aneurysms: A case series. (March 2021)

• Record Type: Journal Article
• Authors: Lam, Jordan; Ravina, Kristine; Rennert, Robert C.; Russin, Jonathan J
• Is Part Of: Journal of clinical neuroscience. Volume 85(2021)
• Page Start: 106
• Page End: 114
• Publication Date: 2021-03
• Subjects: Aneurysm -- Bypass -- Cerebral revascularization -- Complications -- Outcomes -- Subarachnoid hemorrhage; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.12.029
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Bypass is a viable option for complex ruptured aneurysms. In-hospital mortality is comparable to clipping and coiling. Strokes are common; attributable to surgery, vasospasm and endovascular treatments. Rates of other complications are comparable to clipping and coiling. Disability at discharge improves in the majority of patients. Abstract: In patients with aneurysmal subarachnoid hemorrhage (aSAH) unfavorable for endovascular or traditional open surgical techniques, surgical revascularization strategies comprise one of remaining limited options. There is nonetheless a paucity of data on the safety and efficacy of bypass in aSAH. In this study, we aimed to investigate complications and outcomes in a cohort of patients with aSAH treated with bypass. A prospective single-surgeon database of consecutive patients treated for aSAH between 2013 and 2018 was retrospectively analyzed. Complications and functional status at discharge were recorded and analyzed for the patients that underwent bypass surgery. Forty patients with aSAH were treated with bypass surgery (23 extracranial-intracranial; 17 intracranial-intracranial). All-cause perioperative mortality was 13% (6 patients). At discharge and at mean 14-month follow up, respectively, 16/40 (40%) and 16/25 (64%) of patients achieved a Glasgow Outcome Score of 4–5. All-cause, in-hospital complications occurred in 28 patients (70%), of which any ischemic complication occurred in 20 patients (50%), 7 (18%) being open surgical complications. This work represents the largest modern series of bypass for aSAH to date. In cases of aSAH unfavorable for endovascular intervention or traditional open surgical techniques, bypass remains a viable option in this complex group of patients.