Excimer laser-assisted bypass in aneurysm treatment: short-term outcomes

J Neurosurg. 2002 Nov;97(5):1029-35. doi: 10.3171/jns.2002.97.5.1029.


Object: If clip application or coil placement for treatment of intracranial aneurysms is not feasible, the parent vessel can be occluded to induce thrombosis of the aneurysm. The Excimer laser-assisted anastomosis technique allows the construction of a high-flow bypass in patients who cannot tolerate such an occlusion. The authors assessed the complications of this procedure and clinical outcomes after the construction of high-flow bypasses in patients with intracranial aneurysms.

Methods: Data were retrospectively collected on patient and aneurysm characteristics, procedural complications, and functional outcomes in 77 patients in whom a high-flow bypass was constructed. Logistic regression analysis was used to quantify the relationships between patient and aneurysm characteristics on the one hand and outcome measures on the other. Fifty-one patients harbored a giant aneurysm, 24 patients suffered from a ruptured aneurysm, and 35 patients from an unruptured symptomatic aneurysm. In 22 patients (29%; 95% confidence interval [CI] 19-40%) a permanent deficit developed from an operative complication. At a median follow-up period of 2.5 months, 25 patients (32%; 95% CI 22-44%) were dependent or had died; in 10 of these patients (13% of all patients; 95% CI 6-23%) operative complications were the single cause of this poor outcome. Univariate analysis demonstrated that a poor clinical condition before treatment (odds ratio [OR] 4.7; 95% CI 1.7-13.3) and a history of cardiovascular disease (OR 4.1; 95% CI 1-16.2) increased the risk of poor outcome. Multivariate analysis demonstrated that only the clinical condition before treatment was significantly related to outcome (OR 4; 95% CI 1.3-11.9).

Conclusions: In patients with an intracranial aneurysm that cannot be treated by clip application or coil placement, and in whom occlusion of the parent artery cannot be tolerated, the construction of a high-flow bypass should be considered. This procedure carries a considerable risk of complications, but this should be weighed against the disabling or life-threatening effects of compression, the high risk of rupture, and the substantial chance of poor outcome after the rupture of such aneurysms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arterial Occlusive Diseases / etiology
  • Blood Vessel Prosthesis Implantation
  • Brain Ischemia / etiology
  • Cerebral Arteries
  • Cerebral Revascularization* / adverse effects
  • Cerebrovascular Circulation
  • Constriction
  • Feasibility Studies
  • Female
  • Humans
  • Intracranial Aneurysm / physiopathology
  • Intracranial Aneurysm / surgery*
  • Laser Therapy*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome