Revascularization of the anterior cerebral artery by Y-shaped superficial temporal artery interposition graft for the treatment of a de novo aneurysm arising at the site of A3-A3 bypass: Technical case report

Hidenori Endo, Shin Ichiro Sugiyama, Toshiki Endo, Miki Fujimura, Hiroaki Shimizu, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

The most frequently used option to reconstruct the anterior cerebral artery (ACA) is an ACA-ACA side-to-side anastomosis. The long-term outcome and complications of this technique are unclear. The authors report a case of a de novo aneurysm arising at the site of A3-A3 anastomosis. A 53-year-old woman underwent A3-A3 side-to-side anastomosis for the treatment of a ruptured right A2 dissecting aneurysm. At 44 months after surgery, a de novo aneurysm developed at the site of anastomosis. The aneurysm developed in the front wall of the anastomosis site, and projected to the anterosuperior direction. A computational fluid dynamics (CFD) study showed the localized region with high wall shear stress coincident with the pulsation in the front wall of the anastomosis site, where the aneurysm developed. A Y-shaped superficial temporal artery (STA) interposition graft was used successfully to reconstruct both ACAs, and then the aneurysm was trapped. To the authors' knowledge, this is the first case of a de novo aneurysm that developed at the site of an ACA-ACA side-to-side anastomosis. A CFD study showed that hemodynamic stress might be an underlying cause of the aneurysm formation. A Y-shaped STA interposition graft is a useful option to treat this aneurysm. Long-term follow-up is necessary to detect this rare complication after ACA-ACA anastomosis.

Original languageEnglish
Pages (from-to)1120-1124
Number of pages5
JournalJournal of neurosurgery
Volume129
Issue number5
DOIs
Publication statusPublished - 2018 Nov

Keywords

  • Anterior cerebral artery
  • Bypass surgery
  • De novo aneurysm
  • Interposition graft
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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