Anterior cerebral artery bypass for complex aneurysms: advances in intracranial-intracranial bypass techniques.



Document Type



BACKGROUND: Anterior cerebral artery (ACA) bypasses for complex aneurysms are infrequently performed, yet previous experience demonstrates the importance of intracranial-intracranial (IC-IC) bypasses. Here we describe the technical advances in IC-IC bypass techniques and their clinical results.

METHODS: Twenty-three patients with complex aneurysms requiring ACA bypasses were retrospectively studied. Ten patients were treated in period 1 (1997-2013) and 13 in period 2 (2014-2018).

RESULTS: There were 3 precommunicating, 8 communicating, and 8 postcommunicating, ACA aneurysms, plus 4 middle cerebral artery aneurysms. ACA in situ bypass was the most commonly performed (9 patients; 39%). The classic left A3 ACA-right A3 ACA in situ bypass was performed in 5 patients, but 3 new in situ variations emerged in period 2: left pericallosal artery (PcaA)-right PcaA (n=1), left callosomarginal artery (CmaA)-right CmaA (n=2), and left CmaA-right A3 ACA (n=1). The sole reimplantation in period 1 was the ipsilateral and vertical PcaA-CmaA reimplantation, whereas reimplantations in period 2 were contralateral and horizontal (left PcaA-right PcaA and right A3 ACA-left anterior internal frontal artery). The A1 ACA was used as a donor only in period 2 in 4 patients with middle cerebral artery bifurcation aneurysms. Bypass patency was 91%, and 21 patients (91%) improved or remained at neurological baseline (mean [SD] follow-up duration, 26 [8.2] months).

CONCLUSIONS: ACA bypass techniques continue to evolve with the addition of several variations. These variations push bypass techniques beyond the standard constructs and add important alternatives to our bypass arsenal.

Publication Date


Publication Title

World Neurosurg



PubMed ID


Digital Object Identifier (DOI)


This document is currently not available here.