Extracranial internal carotid artery (ICA) aneurysms located at the entrance of the skull are a rare pathology. Surgical treatment is indicated for this pathology because of the risk of arterio-arterial embolism and the development of cerebrovascular disease. The domestic and international literature reports single cases or small group cases of successful surgical treatment of patients with distal internal carotid artery aneurysms associated with pathological kinking of the artery. Open surgery for aneurysms of this localization is complicated because of a high injury risk associated with the approach. Endovascular interventions are not always possible due to the presence of degenerative changes in the vascular wall and pathological artery kinking. We propose a surgical option for creating a high-flow ec-ic bypass between the external carotid artery and the M2 segment of the middle cerebral artery. The article describes the results of successful application of this technique in three patients with distal extracranial internal carotid artery aneurysms associated with pathological kinking of the artery.
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