Double-barrel STA-MCA bypass with endovascular parent artery occlusion for complex anterior circulation aneurysms: indications and outcomes.

All patients achieved confirmed aneurysm exclusion and preserved perfusion following the double-barrel STA-MCA bypass with endovascular parent artery occlusion.

• Seven patients were included in the analysis with a mean age of 44.7 ± 27.5 years; 57.1% were male.
• Postoperative DSA confirmed aneurysm exclusion and preserved perfusion in all 7 cases.
• At long-term follow-up, all aneurysms remained completely occluded and bypass patency was maintained in all patients.
• Follow-up was conducted at 1-, 3-, and 6-month post-procedure and annually thereafter, including clinical assessment and imaging with MRI/MRA or DSA.

No permanent neurological deficits or bypass failures were observed in the study cohort.

• One patient developed transient hemiparesis, which resolved spontaneously without intervention.
• One emergency case involved a double-barrel bypass performed following coil prolapse and occlusion of both M2 segments during endovascular embolization; this patient was discharged with mild residual contralateral paresis.
• No permanent neurological deficits were recorded across all 7 patients.
• No bypass failures were observed at any follow-up time point.

The majority of aneurysms treated were fusiform and located in the middle cerebral artery.

• 85.7% of aneurysms were fusiform in morphology.
• 71.4% of aneurysms were located in the MCA.
• The study focused on giant or fusiform intracranial aneurysms treated between January 2019 and January 2025.
• All 7 patients underwent both double-barrel bypass and endovascular occlusion of the parent artery.

The hybrid approach was feasible in an emergency setting following iatrogenic endovascular complication.

• One patient required emergency double-barrel bypass after coil prolapse caused occlusion of both M2 segments during endovascular embolization.
• The patient in the emergency case was discharged with only mild residual contralateral paresis.
• This case demonstrated the utility of performing the procedure in a hybrid operating setting.

The hybrid operating setting was identified as a key factor in enabling the combined surgical and endovascular approach for complex intracranial aneurysms.

• The procedure involved double-barrel STA-MCA bypass followed by endovascular occlusion of the parent artery.
• The authors concluded this strategy is particularly effective 'when performed in a hybrid operating setting.'
• The study period spanned January 2019 to January 2025, representing a retrospective observational design.