Bypass and vascular reconstruction for anterior circulation aneurysms

Abstract

Complex aneurysms [ 2, 15, 23 ] are defi ned as those.14 mm, without a defi ned neck that have a major artery originating from the neck or sac, have considerable atherosclerotic changes in the neck, and have a signifi cant thrombus in the lumen, as well as fusiform aneurysms and blister aneurysms (Table 40.1). These aneurysms cannot be occluded by simple microsurgical clipping or standard endovascular coiling techniques without occluding the parent vessel or its major branches. Available strategies for preserving or reconstructing the parent vessel or major branches are microsurgical (clip reconstruction or bypass) or endovascular (balloon-assisted coiling or stent- assisted coiling, endovascular parent vessel occlusion) and the Pipeline Embolization Device (PED) (in case of ruptured paraclinoid and ophthalmic artery aneurysms) [ 1, 6, 9, 22 ].