Ischemic Complications after Radial Artery Grafting and Aneurysmal Trapping for Ruptured Internal Carotid Artery Anterior Wall Aneurysm

OBJECTIVE: Treatment of ruptured internal carotid artery anterior wall (ICAW) aneurysms presents a surgical challenge because limitations and difficulties are encountered with either clipping or endovascular treatment. The present study examined clinical outcomes after aneurysmal trapping followed by radial artery grafting for management of these difficult lesions. METHODS: Radial artery grafting was followed immediately by parent artery occlusion in five sides of five patients with acute ruptured ICAW aneurysm (3 men, 2 women; mean age 55.2 years). All patients underwent postoperative angiography and computerized tomography to assess graft patency and ischemic complications including vasospasm. RESULTS: Of the five patients, only one had a poor outcome. However, temporary ischemic complications due to vasospasm developed in four (80%) of the five patients. Long-term results of radial artery grafting and internal carotid trapping for acute stage ruptured ICAW were satisfactory, but detailed analysis indicated a high risk of ischemic complications. CONCLUSIONS: The long-term result was satisfactory, but there was a high rate of acute stage ischemic complications due to delayed vasospasm and low perfusion from the radial artery graft. Based on these results, the investigators recommend that, in addition to intraoperative anticoagulation therapy, in cases where the cerebral blood flow study in the early postoperative period indicates low cerebral perfusion or in cases with World Federation of Neurological Societies grade III-V, the patients should be placed under the highest level of intensive care to detect ischemic complications.