The intraoperative arterial thrombosis in the surgery of partially thrombosed large and giant aneurysms of middle cerebral artery

Objective. To study the frequency of intraoperative arterial thrombosis (IAT) during microsurgical treatment of large and giant partially thrombosed aneurysms of middle cerebral arteries (MCA) and to assess various options to treat this complication. Materials. The consecutive series of 53 patients operated on for partially thrombosed MCA aneurysms in Burdenko Neurosurgical Institute from January 2005 to September 2014 were analyzed. The large aneurysms (15-25 mm) were seen at 32 patients, giant (> 25 mm) aneurysms - at 21 patients. Results. The aneurysm clipping was performed at 47 patients, trapping - at 3, wrapping with surgical gauze - at 3. IAT was diagnosed at 10 (18.9%) patients. The injection of modified human recombinant prourokinase (mr-proUK) in the thrombosed artery was performed at 7 patients, among them 5 (71.4%) patients were discharged without any changes in the neurological status, one (14.3%) patient - with moderate deterioration (MRS 2) and one (14.3%) patient - with severe deterioration (MRS 4). Among patients without injection of mr-proUK (3 persons) two patients suffered from severe (MRS 3 and 4) and one - from moderate deterioration (MRS 2). Conclusion. The main risk factor for thrombosis of MCA branches is thrombectomy under condition of temporary trapping. The injection of fibrinolytic drugs in thrombosed MCA branch is an effective method to treat IAT. The revascularization operation (bypass) should be considered in the case of fibrinolytic agent fails to solve the problem.

частично тромбированные аневризмы, большие и гигантские аневризмы, тромбэктомия, тромбоз мозговых артерий, фибринолиз, проурокиназа, аневризмы средних мозговых артерий, partially thrombosed aneurysms, large and giant aneurysms, thrombectomy, thrombosis of cerebral arteries, fibrinolysis, r-proUK, aneurysms of middle cerebral artery

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