scholarly journals High flow EC–IC bypass for a giant left MCA aneurysm

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video9
Author(s):  
Eric J. Arias ◽  
Gregory J. Zipfel
Keyword(s):  
Artery Bypass ◽  
Bypass Graft ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
High Flow ◽  
External Carotid ◽  
Left Middle Cerebral Artery ◽  
Mca Aneurysm ◽  
Cerebral Artery Aneurysm

Giant cerebral aneurysms may be treated through a variety of options, including aneurysm trapping with concurrent bypass. This video describes the case of a large, recurrent, left middle cerebral artery aneurysm that was treated using a high flow, radial artery bypass graft, from the external carotid artery to the left temporal M2 branch. A step-by-step operative description, with emphasis on proper microsurgical technique, is included.The video can be found here: http://youtu.be/9xTMC6InivQ.

External Carotid Artery-to-Middle Cerebral Artery Bypass Using a Saphenous Vein Graft With 3-Vessel Anastomosis for the Treatment of a Large, Ruptured Middle Cerebral Artery Aneurysm: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Kristine Ravina ◽  
Joshua Bakhsheshian ◽  
Joseph N Carey ◽  
Jonathan J Russin
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
External Carotid ◽  
Bifurcation Aneurysm

Abstract Cerebral revascularization is the treatment of choice for select complex intracranial aneurysms unamenable to traditional approaches.1 Complex middle cerebral artery (MCA) bifurcation aneurysms can include the origins of 1 or both M2 branches and may benefit from a revascularization strategy.2,3 A novel 3-vessel anastomosis technique combining side-to-side and end-to-side anastomoses, allowing for bihemispheric anterior cerebral artery revascularization, was recently reported.4  This 2-dimensional operative video presents the case of a 73-yr-old woman who presented as a Hunt-Hess grade 4 subarachnoid hemorrhage due to the rupture of a large right MCA bifurcation aneurysm. The aneurysm incorporated the origins of the frontal and temporal M2 branches and was deemed unfavorable for endovascular treatment. A strategy using a high-flow bypass from the external carotid artery to the MCA with a saphenous vein (SV) graft was planned to revascularize both M2 branches simultaneously, followed by clip-trapping of the aneurysm. Intraoperatively, the back walls of both M2 segments distal to the aneurysm were connected with a standard running suture, and the SV graft was then attached to the side-to-side construct in an end-to-side fashion. Catheter angiograms on postoperative days 1 and 6 demonstrated sustained patency of the anastomosis and good filling through the bypass. The patient's clinical course was complicated by vasospasm-related right MCA territory strokes, resulting in left-sided weakness, which significantly improved upon 3-mo follow-up with no new ischemia.  The patient consented for inclusion in a prospective Institutional Review Board (IRB)-approved database from which this IRB-approved retrospective report was created.

Subclavian-External Carotid Artery Bypass Graft

AORN Journal ◽  
1989 ◽  
Vol 50 (2) ◽  
pp. 361-368
Author(s):  
Jon Senkowsky ◽  
Florence L. Smith ◽  
Morris D. Kerstein
Keyword(s):  
Carotid Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
External Carotid Artery ◽  
External Carotid ◽  
Artery Bypass Graft

Basilar Trunk Aneurysm Surgically Treated with Anterior Petrosectomy and External Carotid Artery-to-Posterior Cerebral Artery Bypass: Technical Note

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 1083-1088 ◽  
Author(s):  
Shunsuke Terasaka ◽  
Koji Itamoto ◽  
Kiyohiro Houkin
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Artery Bypass ◽  
Vascular Reconstruction ◽  
External Carotid Artery ◽  
Technical Note ◽  
High Flow ◽  
External Carotid ◽  
Anterior Petrosectomy

Abstract OBJECTIVE We discuss a detailed surgical technique, its indications, and potential pitfalls in its use. METHODS A surgical procedure combining Kawase's anterior petrosectomy and external carotid artery-to-posterior cerebral artery high-flow bypass was performed for the treatment of a patient with a fusiform basilar trunk aneurysm. RESULTS Follow-up angiography revealed the successful obliteration of the aneurysm and that the graft was functioning well. Late ischemic complications, however, occurred 5 weeks after surgery. CONCLUSION Kawase's approach is a versatile option for safe vascular reconstruction of the posterior cerebral artery and exposure of a basilar trunk aneurysm in the upper clival region. Although, theoretically, a high-flow bypass might decrease the risk of hemodynamic ischemia, it does not prevent thromboembolic complications.

Republished: Thrombectomy for late occlusion of high flow extracranial–intracranial saphenous vein bypass graft after 27 years of patency

2018 ◽  
Vol 10 (11) ◽  
pp. e27-e27
Author(s):  
Michael A Silva ◽  
Rodolfo E Alcedo Guardia ◽  
Mohammad Ali Aziz-Sultan ◽  
Nirav J Patel
Keyword(s):  
Saphenous Vein ◽  
Saphenous Vein Graft ◽  
Bypass Graft ◽  
External Carotid Artery ◽  
High Flow ◽  
Posterior Circulation ◽  
External Carotid ◽  
Vein Bypass ◽  
Basilar Occlusion

High flow extracranial–intracranial (EC-IC) bypass with a saphenous vein graft (SVG) has been used for more than 40 years in patients with giant aneurysms of the posterior circulation refractory to medical management, and has demonstrated high long term patency rates. We report the case of a patient treated with external carotid artery (ECA)–posterior cerebral artery SVG bypass in 1989 who presented 27 years later with paresthesias and confusion, and was found to have partial occlusion of her SVG bypass graft and a basilar occlusion. She was treated with mechanical thrombectomy of the basilar occlusion via the partially thrombosed graft, the first report of such a procedure through a high flow posterior circulation EC-IC SVG, resulting in improvement of the patient’s neurologic examination. At 27 years, this is the longest reported delay in thrombosis of a high flow SVG bypass graft, highlighting the long term patency of these grafts and the feasibility of thrombectomy through occluded bypass grafts.

Spontaneous thrombosis in agiant middle cerebral artery aneurysm

1972 ◽  
Vol 37 (3) ◽  
pp. 361-363 ◽  
Author(s):  
R. Michael Scott ◽  
H. Thomas Ballantine
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Cerebral Aneurysms ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Content Type ◽  
Complete Thrombosis ◽  
Cerebral Artery Aneurysm

✓ Five-year follow-up angiography in a woman with an untreated giant aneurysm of the left middle cerebral artery revealed complete thrombosis of the aneurysm. Her case suggests that certain asymptomatic giant cerebral aneurysms may be treated without surgery.

Giant thrombosed vertebral artery aneurysm managed with extracranial-intracranial bypass surgery and aneurysmectomy

1992 ◽  
Vol 77 (4) ◽  
pp. 624-627 ◽  
Author(s):  
Kenji Wakui ◽  
Shigeaki Kobayashi ◽  
Toshiki Takemae ◽  
Yukihiro Kamijoh ◽  
Hisashi Nagashima ◽  
...  
Keyword(s):  
Vertebral Artery ◽  
Bypass Surgery ◽  
Posterior Cerebral Artery ◽  
Clinical Course ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
External Carotid Artery ◽  
External Carotid ◽  
Arterial Graft ◽  
Content Type

✓ A case is presented of a left giant thrombosed vertebral artery aneurysm in a 46-year-old man. The giant thrombosed aneurysm was successfully resected with trapping of the affected artery after right external carotid artery-posterior cerebral artery bypass surgery using a radial arterial graft. The clinical course is reported, and the details of the operative approach and techniques are discussed.

Giant Intracranial Aneurysms Presenting with Massive Cerebral Edema

Neurosurgery ◽  
1984 ◽  
Vol 15 (4) ◽  
pp. 572-577 ◽  
Author(s):  
Roberto C. Heros ◽  
Sastry Kolluri
Keyword(s):  
Cerebral Hemisphere ◽  
Intracranial Aneurysms ◽  
Artery Aneurysm ◽  
Left Middle Cerebral Artery ◽  
Brain Swelling ◽  
Middle Cerebral Artery Aneurysm ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
Cerebral Artery Aneurysm ◽  
Left Middle

Abstract Two cases of giant left middle cerebral artery aneurysm presenting with rapidly progressing hemiparesis and aphasia are presented. In both, the computed tomographic scan showed recent intraaneurysmal thrombosis and massive edema and swelling of the cerebral hemisphere. There was no evidence of recent hemorrhage in either case. In both patients, surgical resection of the aneurysm was accomplished, but the outcome was disastrous. The literature is reviewed and the possible mechanisms responsible for brain swelling in these cases are discussed.

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