Radial Artery Graft for Giant Common Carotid Artery Pseudoaneurysm After Carotid Artery Stenting

Abstract BACKGROUND AND IMPORTANCE Conventional microsurgical treatment for symptomatic internal carotid artery (ICA) occlusion is revascularization with superficial temporal artery (STA) to middle cerebral artery bypass. However, in rare cases where the common carotid artery, external carotid artery (ECA), or both are also occluded, other microsurgical treatment options must be considered. CLINICAL PRESENTATION We present the case of a 52-yr-old woman with common carotid artery occlusion and weak ICA flow from collateral connections between the vertebral artery, occipital artery, and ECA. She had ischemic symptoms and a history of stroke. The patient's STA was unsuitable as a donor vessel due to its small caliber and poor flow, and we instead performed an interpositional bypass from the subclavian artery to the ICA using a radial artery graft. CONCLUSION This case illustrates the successful use of the subclavian artery to ICA bypass technique with an interpositional radial artery graft. The surgical anatomy of the subclavian arteries is reviewed, and the technical details of subclavian artery to radial artery graft to ICA interpositional bypass are presented.

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High flow bypass for right giant cavernous internal carotid artery aneurysm with fibromuscular dysplasia of cervical internal carotid artery: microsurgical 2-D video

Surgical Neurology International ◽

10.25259/sni_141_2020 ◽

2020 ◽

Vol 11 ◽

pp. 177

Author(s):

Miguel Angel Lopez-Gonzalez ◽

Xiaochun Zhao ◽

Dinesh Ramanathan ◽

Timothy Marc Eastin ◽

Song Minwoo

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Radial Artery ◽

Fibromuscular Dysplasia ◽

Internal Carotid ◽

High Flow ◽

Oculomotor Nerve Palsy ◽

Radial Artery Graft ◽

Artery Graft ◽

Cervical Internal Carotid Artery

Background: It is well known that intracranial aneurysms can be associated to fibromuscular dysplasia (FMD). Nevertheless, it is not clear the best treatment strategy when there is an association of giant symptomatic cavernous carotid aneurysm with extensive cervical internal carotid artery (ICA) FMD. Case Description: We present the case of 63 year-old right-handed female with hypothyroidism, 1 month history of right-sided pulsatile headache and visual disturbances with feeling of fullness sensation and blurry vision. Her neurological exam showed partial right oculomotor nerve palsy with mild ptosis, asymmetric pupils (right 5 mm and left 3mm, both reactive), and mild exotropia, normal visual acuity. Computed tomography angiogram and conventional angiogram showed 2.5 × 2.6 × 2.6 cm non-ruptured aneurysm arising from cavernous segment of the right ICA. She had right hypoplastic posterior communicant artery, and collateral flow through anterior communicant artery during balloon test occlusion and the presence of right cervical ICA FMD. The patient was started on aspirin. After lengthy discussion of treatment options in our neurovascular department, between observations, endovascular treatment with flow diverter device, or high flow bypass, recommendation was to perform high flow bypass and patient consented for the procedure. We performed right-sided pterional trans-sylvian microsurgical approach and right neck dissection at common carotid bifurcation under electrophysiology monitoring (somatosensory evoked potentials and electroencephalography); while vascular surgery department assisted with the radial artery graft harvesting. The radial artery graft was passed through preauricular tunnel, cranially was anastomosed at superior trunk of middle cerebral artery, and caudally at external carotid artery (Video). Intraoperative angiogram showed adequate bypass patency and lack of flow within aneurysm. The patient was extubated postoperatively and discharged home with aspirin in postoperative day 5. Improvement on oculomotor deficit was complete 3 weeks after surgery. Conclusion: Nowadays, endovascular therapy can manage small to large cavernous ICA aneurysms even if associated to FMD, although giant symptomatic cavernous carotid aneurysms impose a different challenge. Here, we present the management for the association of symptomatic giant cavernous ICA aneurysm and cervical ICA FMD with high flow bypass. We consider important to keep the skills in the cerebrovascular neurosurgeon armamentarium for the safe management of these lesions.

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Creation of a Middle Communicating Artery With External Carotid Artery-Radial Artery Graft-M2 Middle Cerebral Artery Interpositional Bypass and M2 Middle Cerebral Artery-M2 Middle Cerebral Artery Reimplantation for a Recurrent Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa244 ◽

2020 ◽

Vol 20 (1) ◽

pp. E44-E45

Author(s):

Fabio A Frisoli ◽

Joshua S Catapano ◽

Dimitri Benner ◽

Michael T Lawton

Keyword(s):

Carotid Artery ◽

Middle Cerebral Artery ◽

Radial Artery ◽

Cerebral Artery ◽

Artery Aneurysm ◽

External Carotid Artery ◽

External Carotid ◽

Radial Artery Graft ◽

Lenticulostriate Arteries ◽

Artery Graft

Abstract Dolichoectatic aneurysms of the middle cerebral artery (MCA) bifurcation pose unique treatment challenges.1 One treatment consists of an extracranial-intracranial (EC-IC) interpositional bypass and double-reimplantation of the M2 divisions.2-8 We present a variation of this construct in which an M2 MCA-M2 MCA end-to-side reimplantation was performed, creating a middle communicating artery (MCoA). The patient, a 61-yr-old woman, had previously undergone a “picket fence” clip reconstruction of an unruptured, giant left MCA bifurcation aneurysm in 2014.9 After the patient provided informed written consent for treatment, a 5-yr surveillance angiogram revealed substantial aneurysm regrowth opposite the clips. A pterional craniotomy was performed, and the aneurysm was exposed through a transsylvian approach. Proximal external carotid artery-radial artery graft (ECA-RAG) anastomosis was performed to arterialize the graft. The distal RAG was anastomosed end-to-side to the temporal division of the M2 segment, and the vessel proximal to the bypass inflow was transected from the aneurysm. We repurposed this “dead-end” as an MCoA by end-to-side reimplantation onto a branch of the frontal M2 trunk. The superior trunk was then clip occluded at its origin at the aneurysm. The aneurysm could not be proximally occluded due to lenticulostriate arteries arising from the back of the bifurcation. Postoperative angiography confirmed patency of the MCoA and its donor bypasses. The aneurysm no longer filled, and the lenticulostriate arteries were preserved. The patient was discharged on postoperative day 3 and made an excellent recovery (3-mo modified Rankin Scale [mRS] = 1). The MCoA is a novel construct that redistributed flow from the interpositional graft into the superior trunk, without the need for additional ischemia time while working with the inferior trunk. Used with permission from Barrow Neurological Institute.

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Posttraumatic Carotid-Cavernous Fistulae Treated by Internal Carotid Artery Trapping and High-Flow Bypass Using a Radial Artery Graft

Neurologia medico-chirurgica ◽

10.2176/nmc.51.113 ◽

2011 ◽

Vol 51 (2) ◽

pp. 113-116 ◽

Cited By ~ 6

Author(s):

Takayuki MIZUNARI ◽

Yasuo MURAI ◽

Kyongsong KIM ◽

Shiro KOBAYASHI ◽

Hiroyasu KAMIYAMA ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Radial Artery ◽

Internal Carotid ◽

High Flow ◽

Radial Artery Graft ◽

Artery Graft

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Left External Carotid Artery to the Middle Cerebral Artery Bypass with Radial Artery Graft and Clip Reconstruction of a Large Middle Cerebral Artery Fusiform Aneurysm: 3-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy406 ◽

2019 ◽

Vol 17 (4) ◽

pp. E159-E160 ◽

Cited By ~ 1

Author(s):

Chun-Yu Cheng ◽

Zeeshan Qazi ◽

Laligam N Sekhar

Keyword(s):

Carotid Artery ◽

Middle Cerebral Artery ◽

Radial Artery ◽

Cerebral Artery ◽

Temporal Artery ◽

External Carotid Artery ◽

External Carotid ◽

Fusiform Aneurysm ◽

Radial Artery Graft ◽

Artery Graft

Abstract This 16-yr-old boy presented with episodes of severe headaches, blurred vision, dizziness, and muffled hearing and was discovered to have a large fusiform aneurysm of the left middle cerebral artery (MCA), M1 segment, 20 × 12 mm in dimension. The lenticulostriate arteries were arising proximal and distal to the aneurysm, but the anterior temporal artery was arising from the aneurysm. The aneurysm culminated in the distal M1 segment, and M1 immediately branched into 3 M2 vessels, the lower one being the larger. Due to origin of the lenticulostriate arteries and the anterior temporal artery and patient's age, a bypass was preferred to a flow diversion stent. He underwent left frontotemporal craniotomy and orbital osteotomy, left cervical external carotid artery exposure followed by radial artery graft extraction. The Sylvian fissure was opened and intracranial ICA was exposed for proximal control. The distal M2 vessels traced back toward the aneurysm. The aneurysm was not clippable and a bypass to the larger inferior M2 branch was performed followed by aneurysm trapping. The radial artery graft bypass was placed from the left external carotid artery to the M2 segment of left MCA, followed by clip reconstruction and occlusion of the MCA aneurysm with the preservation of the anterior temporal branch and the lenticulostriate vessels. The patient had no postoperative complications. At the follow-up, one month after surgery, he was doing well, and his angiogram demonstrated patency of the bypass. This video shows the management of a complex fusiform M1 aneurysm with bypass and trapping. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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Long-term patency of radial artery graft bypass for reconstruction of the internal carotid artery

Journal of Neurosurgery ◽

10.3171/jns.1999.90.4.0786 ◽

1999 ◽

Vol 90 (4) ◽

pp. 786-790 ◽

Cited By ~ 71

Author(s):

Kiyohiro Houkin ◽

Hiroyasu Kamiyama ◽

Satoshi Kuroda ◽

Tatsuya Ishikawa ◽

Akihiro Takahashi ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Radial Artery ◽

Internal Carotid ◽

Radial Artery Graft ◽

Conventional Angiography ◽

Content Type ◽

Artery Graft ◽

Fine Print

✓ Reconstruction of the carotid artery by using a radial artery graft is a useful option that can produce reliable long-term patency for the surgical treatment of giant and/or large aneurysms of the cavernous and paraclinoid internal carotid artery (ICA).During the past 10 years, 43 patients with intracavernous and paraclinoid giant aneurysms of the ICA have been treated by reconstruction of the ICA with radial artery grafts after ligation of the cervical ICA. The long-term patency of the grafted radial artery was evaluated over more than a 5-year period (mean 7.2 years) in 20 of these patients by using magnetic resonance angiography or conventional angiography. There was no late occlusion of the graft in any of these cases. Stenotic graft changes were observed in two cases.

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Large Aneurysm in a Nonbifurcating Cervical Carotid Artery: An Aneurysm Associated With a Rare Anomaly Treated With Radial Artery Graft Bypass: Case Report

Operative Neurosurgery ◽

10.1227/neu.0b013e318207b221 ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. onsE250-onsE253 ◽

Cited By ~ 1

Author(s):

Joji Tokugawa ◽

Kensaku Yoshida ◽

Munetaka Yamamoto ◽

Hiroyasu Kamiyama ◽

Hidenori Oishi ◽

...

Keyword(s):

Magnetic Resonance ◽

Carotid Artery ◽

Radial Artery ◽

Relevant Literature ◽

Parent Artery ◽

Radial Artery Graft ◽

Conventional Angiography ◽

Artery Graft ◽

Parent Artery Occlusion ◽

Large Aneurysm

Abstract BACKGROUND AND IMPORTANCE: A nonbifurcating cervical carotid artery is an extremely rare type of carotid artery anomaly. We present a patient with a nonbifurcating cervical carotid artery and a large aneurysm of the cavernous internal carotid artery (ICA). The patient was successfully treated with combined microsurgical and endovascular techniques. We describe this case with reference to the relevant literature. CLINICAL PRESENTATION: A 66-year-old woman with progressive left external ocular movement dysfunction was found to have a large left cavernous ICA aneurysm. Serial magnetic resonance angiography revealed progressive growth of the lesion. In addition, conventional angiography showed a nonbifurcating cervical carotid artery and a persistent primitive trigeminal artery. The aneurysm was found unsuitable for direct surgery because of its size and location and for endovascular intervention because of extreme tortuosity of both carotid and right vertebral arteries. Surgery was performed in 2 stages. First, we performed an extracranial-intracranial high-flow bypass using radial artery graft, followed by proximal occlusion of the carotid artery. As the second stage, the patient underwent intravascular parent artery occlusion via the radial artery graft bypass to approach the intracranial carotid artery. The carotid artery was successfully coil embolized, and the aneurysm was undetectable on a postprocedure angiogram. Serial follow-up magnetic resonance imaging revealed thrombosis of the aneurysm. CONCLUSION: We report a rare case that involves the novel use of the radial artery graft bypass as an approach for parent vessel occlusion.

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Use of “Bonnet” Bypass with Radial Artery Interposition Graft in a Patient with Recurrent Cranial Base Carcinoma: Technical Report of Two Cases and Review of the Literature

Operative Neurosurgery ◽

10.1227/01.neu.0000144492.42325.34 ◽

2005 ◽

Vol 56 (suppl_1) ◽

pp. ONS-E202-ONS-E202 ◽

Cited By ~ 8

Author(s):

Vivek R. Deshmukh ◽

Randall W. Porter ◽

Robert F. Spetzler

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Middle Cerebral Artery ◽

Radial Artery ◽

Internal Carotid ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Cranial Base ◽

Radial Artery Graft ◽

Artery Graft

Abstract OBJECTIVE AND IMPORTANCE: Two patients with recurrent cranial base carcinomas involving the carotid artery received a “bonnet” bypass using the contralateral superficial temporal artery as the donor vessel because the ipsilateral common and external carotid arteries were unavailable. The radial artery was used as the graft. CLINICAL PRESENTATION: A 58-year-old man with ear pain and an enlarging mass involving the left cranial base and neck had undergone a right partial glossectomy and modified neck dissection followed by radiotherapy for squamous cell carcinoma. Recurrent carcinoma extensively involved the left internal carotid artery. A 46-year-old man with jaw pain and hoarseness had undergone multiple resections and radiation therapy for medullary thyroid carcinoma. Magnetic resonance imaging showed recurrent tumor on the right. INTERVENTION: Both patients underwent a pterional craniotomy. The supraclinoid internal carotid artery was exposed. The radial artery was harvested. The contralateral superficial temporal artery was dissected at its bifurcation into the frontal and parietal branches. The radial artery graft was anastomosed to the superficial temporal artery and a recipient ipsilateral branch of the middle cerebral artery. The internal carotid artery was clip-ligated. After surgery, both patients remained neurologically stable. Angiography confirmed that the bypasses were patent and that the middle cerebral artery territory filled. The patients’ carcinomas were resected aggressively. CONCLUSION: When aggressive resection of cranial base tumors is needed and the ipsilateral carotid artery is unavailable as a donor vessel, a “bonnet” bypass with carotid artery sacrifice may be performed. Compared with vein grafts, microsurgical anastomosis is easier and the patency rate is higher with a radial artery graft.

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