• Maohua Ding, Xu Wang, Haijun Zhao, Minggang Shi, Yanguo Shang, Hu Wang, Xuan Wang, and Xiaoguang Tong.
• Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
• World Neurosurg. 2022 Aug 1; 164: e662-e670.

BackgroundThe optimal management of giant internal carotid aneurysms (GICAs) is disputed owing to their low incidence. The aim of this study was to describe the use of internal carotid artery (ICA) constriction as therapeutic management of GICAs.MethodsThis retrospective cohort study analyzed data from medical histories and follow-up of 14 patients with GICAs. Before surgery, the patients underwent balloon test occlusion and magnetic resonance perfusion evaluation. ICA constriction was considered only for patients with negative balloon test occlusion. A transverse incision of about 50% of the initial part of the ICA was done, and the free margins on both sides were sutured, causing 70%-90% stenosis. ICA constriction alone was selected (11 cases) if both anterior communicating artery and posterior communicating artery compensatory blood flow existed and magnetic resonance perfusion was ≤II1 on the affected side. If there was only 1 compensatory vessel from the anterior communicating artery and posterior communicating artery, and/or magnetic resonance perfusion was >II1, ICA constriction was combined with low-flow bypass (3 cases).ResultsThe mean follow-up time of the 14 patients was 43.5 months (interquartile range: 38.8-51.3 months). Of these 14 patients, 5 achieved O'Kelly-Marotta grades C and D. Clinical improvement occurred in 12 of 14 patients. No patients experienced new-onset stroke.ConclusionsICA constriction exhibits a perforator protective effect. This procedure could be a promising alternative to ICA ligation in patients with GICAs and negative balloon test occlusion.Copyright © 2022 Elsevier Inc. All rights reserved.

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