Treatment strategy for ruptured aneurysms originating from the anterior wall of the internal carotid artery

The authors retrospectively reviewed their experience treating ruptured aneurysms originating from the anterior wall of the internal carotid artery in the acute stage after subarachnoid hemorrhage. Since 2002, there were 8 cases (mean age : 52 years old, three males) treated at our institution. Early in the study period, clipping was attempted in two cases, which were associated with intra- and post-operative rebleeding. Later, their strategy changed such that trapping of the aneurysms was the first choice of treatment, combined with STA-MCA bypass (4 cases) or high flow bypass using a radial artery graft (3 cases). Recently, the authors prefer to use high flow bypass more frequently, considering the possible occurrence of vasospasm on the collateral route shown at the initial angiograms. Specifically, vasospasm of the radial artery graft is another important issue to consider, even if pressure distension techniques are applied. If such vasospasm causes ischemic symptoms, percutaneous transluminal angioplasty should be performed in a timely fashion. Technical issues of surgical treatment of the anterior wall of the Internal carotid artery were discussed.