Contralateral external carotid-to-middle cerebral artery graft using the saphenous vein

1993 ◽  
Vol 78 (2) ◽  
pp. 290-293 ◽  
Author(s):  
Kazushi Kinugasa ◽  
Masaru Sakurai ◽  
Takashi Ohmoto
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Saphenous Vein Graft ◽  
External Carotid ◽  
The Common ◽  
Internal Carotid Arteries

✓ A variation of the extracranial-intracranial arterial bypass, using a long saphenous vein graft, is presented. The saphenous vein graft was inserted from the contralateral external carotid artery to the distal middle cerebral artery to replace the common and internal carotid arteries in a patient with a large neck tumor that invaded the common and internal carotid arteries, the esophagus, and the trachea. The patient had a positive balloon Matas' test. The saphenous vein was covered with an artificial vascular graft so that turning of the head or movement of the mandible did not displace or compress the graft. A large volume of flow began immediately after anastomosis. A description of the case and the operative technique is presented herein.

EXTERNAL CAROTID ARTERY TO MIDDLE CEREBRAL ARTERY BYPASS WITH THE SAPHENOUS VEIN GRAFT

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_3) ◽  
pp. ONS134-ONS140 ◽  
Author(s):  
Erica F. Bisson ◽  
Agostino J. Visioni ◽  
Bruce Tranmer ◽  
Michael A. Horgan
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Artery Bypass ◽  
External Carotid Artery ◽  
External Carotid

Cerebral revascularization to a main limb of the middle cerebral artery in the Sylvian fissure

1985 ◽  
Vol 63 (1) ◽  
pp. 21-29 ◽  
Author(s):  
Fernando G. Diaz ◽  
Felix Umansky ◽  
Bharat Mehta ◽  
Salvador Montoya ◽  
Manuel Dujovny ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Saphenous Vein ◽  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Sylvian Fissure ◽  
External Carotid ◽  
Content Type ◽  
Fine Print

✓ Thirteen patients underwent an anastomosis of the superficial temporal artery (STA) or a saphenous vein graft to one of the secondary trunks of the middle cerebral artery (MCA). They included five patients with giant MCA trifurcation aneurysms, four patients in whom an earlier conventional STA-MCA anastomosis had become occluded, two patients who had stenosis of one of the secondary limbs of the MCA, and one patient who had a carotid-cavernous fistula. One patient had a saphenous vein graft from the common carotid artery to a secondary trunk of the MCA to bypass an occluded internal carotid artery and severely stenosed external carotid artery. The primary advantages of this procedure are that a large-caliber anastomosis to one of the secondary limbs of the MCA immediately restores flow into the MCA tree with a larger amount of vessel filling than with a standard cortical bypass, and large vessels can be used for the anastomosis. The disadvantages are that one of the secondary branches of the MCA must be occluded, the cerebral hemisphere around the Sylvian fissure must be retracted, a lumbar subarachnoid drain is needed, and the anastomosis must be performed deep within the Sylvian fissure. The procedure is a satisfactory alternative in cases in which a conventional STA-MCA anastomosis has either failed or would be less likely to succeed.

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.

scholarly journals Unusual position of external carotid artery: a case report

2005 ◽  
Vol 38 (02) ◽  
pp. 170-171
Author(s):  
S B Rao ◽  
V R Vollala ◽  
M Rao ◽  
V P Samuel ◽  
D Deepthinath ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Clinical Importance ◽  
Lateral Position ◽  
External Carotid Artery ◽  
External Carotid ◽  
Unusual Position ◽  
The Common ◽  
Internal Carotid Arteries

AbstractThe arterial pattern of the human body is one of the systems that show a large number of variations. Many reports are available regarding variations of common carotid, external and internal carotid arteries and branches of external carotid artery. We describe a very rare case of lateral position of external carotid artery. The external carotid artery was lateral to the internal carotid artery at the bifurcation of the common carotid artery. The clinical importance of this variation is discussed.

scholarly journals An Endovascular Primate Model for the Production of a Middle Cerebral Artery Ischemic Infarction

2001 ◽  
Vol 7 (3) ◽  
pp. 223-228 ◽  
Author(s):  
M. Horowitz ◽  
A. Kassam ◽  
E. Nemoto ◽  
J. Arimoto ◽  
C. Jungreis
Keyword(s):  
Blood Flow ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Primate Model ◽  
Xenon Ct ◽  
Open Surgical Approach ◽  
Internal Carotid Arteries ◽  
Flow Study

An endovascular model for producing and studying middle cerebral artery acute ischemic strokes was developed to avoid the need for an open surgical approach to the middle cerebral, anterior cerebral, posterior cerebral and internal carotid arteries. Endovascular occlusion of these vessels followed by Xenon-CT cerebral blood flow study confirmed the production of a middle cerebral artery distribution infarct in two primates. The methodology, advantages and drawbacks of this model are discussed.

Embolization of a Superficial Temporal Artery to Middle Cerebral Artery Bypass: Case Report

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 342-345 ◽  
Author(s):  
Frances K. Conley
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Internal Carotid ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Bilateral Carotid ◽  
History Of ◽  
Internal Carotid Arteries ◽  
Bilateral Carotid Artery

Abstract This case history of a man with bilateral carotid artery occlusions presents angiographic documentation of the embolization of a superficial temporal-middle cerebral artery bypass. The embolic source was thrombotic and/or atheromatous debris that had collected in the persistent stump of one of the occluded internal carotid arteries.

Blister Aneurysms of the Internal Carotid Artery: Microsurgical Results and Management Strategy

Neurosurgery ◽  
2017 ◽  
Vol 80 (2) ◽  
pp. 235-247 ◽  
Author(s):  
Christopher M. Owen ◽  
Nicola Montemurro ◽  
Michael T. Lawton
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Artery Bypass ◽  
External Carotid ◽  
Parent Artery ◽  
Intraoperative Rupture

Abstract BACKGROUND: Blister aneurysms of the supraclinoid internal carotid artery (ICA) are challenging lesions with high intraoperative rupture rates and significant morbidity. An optimal treatment strategy for these aneurysms has not been established. OBJECTIVE: To analyze treatment strategy, operative techniques, and outcomes in a consecutive 17-year series of ICA blister aneurysms treated microsurgically. METHODS: Seventeen patients underwent blister aneurysm treatment with direct clipping, bypass and trapping, or clip-reinforced wrapping. RESULTS: Twelve aneurysms (71%) were treated with direct surgical clipping. Three patients required bypass: 1 superficial temporal artery to middle cerebral artery bypass, 1 external carotid artery to middle cerebral artery bypass, and 1 ICA to middle cerebral artery bypass. One patient was treated with clip-reinforced wrapping. Initial treatment strategy was enacted 71% of the time. Intraoperative rupture occurred in 7 patients (41%), doubling the rate of a poor outcome (57% vs 30% for patients with and without intraoperative rupture, respectively). Severe vasospasm developed in 9 of 16 patients (56%). Twelve patients (65%) were improved or unchanged after treatment, and 10 patients (59%) had good outcomes (modified Rankin Scale scores of 1 or 2). CONCLUSION: ICA blister aneurysms can be cautiously explored and treated with direct clipping as the first-line technique in the majority of cases. Complete trapping of the parent artery with temporary clips and placing permanent clip blades along normal arterial walls enables clipping that avoids intraoperative aneurysm rupture. Trapping/bypass is used as the second-line treatment, maintaining a low threshold for bypass with extensive or friable pathology of the carotid wall and in patients with incomplete circles of Willis.

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