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Neurosurgery. 2008 Jun;62(6 Suppl 3):1411-8. doi: 10.1227/01.neu.0000333804.74832.e5.

Treatment of giant and large internal carotid artery aneurysms with a high-flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique.

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Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.



To define the clinical value of the high-flow replacement bypass using the excimer laser-assisted nonocclusive anastomosis technique in the treatment of patients with a noncoilable, nonclippable giant or large intracranial aneurysm of the internal carotid artery (ICA).


We studied 34 patients with a giant intracranial aneurysm of the ICA proximal to its bifurcation who were treated with an extracranial-intercranial high-flow replacement bypass in our hospital between 1999 and 2004. We retrospectively collected data for patient characteristics, operative aspects, complications, and functional health scores using the modified Rankin scale. Long-term data were updated by questionnaire and telephone survey. Mean long-term follow-up period was 3.3 years (range, 0.6-5.6 yr).


We were able to construct a patent bypass in 33 out of 34 patients (97%). In six patients (17%), we needed two bypass attempts. In one patient (3%), the bypass was technically impossible. After bypass construction, we occluded the ICA during or after surgery in 32 patients (94%), causing aneurysm thrombosis in all of these patients. A fatal complication occurred in two patients (6%) before we could occlude the ICA. A nonfatal complication occurred in seven patients (21%). In the long term, 25 patients (74%) had a favorable outcome and 27 patients (79%) were independent (modified Rankin scale, <3).


This study shows that the excimer laser-assisted nonocclusive anastomosis high-flow replacement bypass, which provides maximum brain protection because of its nonocclusive character, is a reliable and effective method to treat these otherwise untreatable patients.

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