Acta Neurochirurgica

, Volume 161, Issue 6, pp 1207–1214 | Cite as

Protective STA-MCA bypass to prevent brain ischemia during high-flow bypass surgery: case series of 10 patients

  • Rabih AboukaisEmail author
  • Barbara Verbraeken
  • Xavier Leclerc
  • Corinne Gautier
  • Maximilien Vermandel
  • Nicolas Bricout
  • Jean-Paul Lejeune
  • Tomas Menovsky
Original Article - Vascular Neurosurgery - Aneurysm
Part of the following topical collections:
  1. Vascular Neurosurgery – Aneurysm



High-flow extracranial-intracranial bypass is associated with a significant risk of ischemic stroke. The goal of this study is to evaluate the effectiveness of STA-MCA bypass preceding a high-flow bypass as a means of protecting the brain from ischemia during the high-flow bypass anastomosis in patients with otherwise untreatable aneurysms.

Materials and method

This prospective study included 10 consecutive patients treated for complex/giant aneurysm using a previous combined STA-MCA bypass and high-flow EC-IC bypass between June 2016 and January 2018 when classical endovascular or microsurgical exclusion was estimated too risky. Early cranial Doppler, MRI, CT scan, and conventional angiography were performed in each patient to confirm patency of bypasses, measure flow in the anastomoses, detect any ischemic lesions, and evaluate exclusion of the aneurysm.


The mean age at treatment was 55 years (range 34 to 67). The mean time of microsurgical procedure was 11 h (range 9 to 12). In all patients, the high-flow bypass was patent intraoperatively and complete occlusion of aneurysm was obtained. No ischemic lesions were noted on early MRI. One patient died from a large hemispheric infarction related to a common carotid artery dissection 10 days after the microsurgical procedure and immediate postoperative epidural hematoma was noted in one other patient.


In this study, we described the use of a protective STA-MCA bypass, performed prior to the high-flow bypass, in order to reduce the risk of perioperative ischemic lesions without increasing the morbidity of the surgical procedure. This treatment paradigm was feasible in all ten patients without complications related to the STA-MCA anastomosis.


Aneurysm High-flow Protective bypass Sta-mca anastomosis Ischemia 


Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Lille University Hospital/ Ethic committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Rabih Aboukais
    • 1
    • 2
    Email author
  • Barbara Verbraeken
    • 3
  • Xavier Leclerc
    • 4
  • Corinne Gautier
    • 4
  • Maximilien Vermandel
    • 2
  • Nicolas Bricout
    • 4
  • Jean-Paul Lejeune
    • 1
    • 2
  • Tomas Menovsky
    • 3
  1. 1.Department of Neurosurgery, Hospital NordLille University HospitalLille cedexFrance
  2. 2.INSERM, CHU Lille, U1189-ONCO-THAI-Image Assisted Laser Therapy for OncologyUniversity of LilleLilleFrance
  3. 3.Department of Neurosurgery, Antwerp University HospitalUniversity of AntwerpAntwerpBelgium
  4. 4.Department of Neuroradiology, Hospital NordLille University HospitalLilleFrance

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