抄録
A case of fatal rupture of a giant internal carotid aneurysm is reported, which occurred after an extracranial to intracranial (EC-IC) bypass surgery combined with occlusion of the proximal internal carotid artery (ICA) by detachable balloons. A 65-year-old woman presented with progressive visual deterioration due to an unruptured giant aneurysm at the supraclinoid segment of the ICA. Since the patient did not tolerate a balloon occlusion test of the ICA, saphenous vein graft was undertaken between the proximal external caroid artery and the middle cerebral artery (MCA). Three balloons were placed in the proximal ICA to occlude the ICA six days after the surgery. Although no retrograde filling of the aneurysm from the MCA was seen on the postembolization angiography, a massive subarachnoid hemorrhage (SAH) occurred two days after the embolization. Changes of pressure and/or flow dynamics within the aneurysm induced by the high-flow bypass, and accompanying intramural hemorrhage might cause rupture of the giant aneurysm. It is believed that this complication may be avoided by using a normal-flow bypass with the graft diameter similar to that of the distal recipient artery. The aneurysm should be trapped immediately to prevent rupture, if there is any evidence of retrograde filling of the aneurysm following proximal occlusion.
