High-flow bypass using the nonocclusive excimer laser—assisted end-to-side anastomosis of the external carotid artery to the P1 segment of the posterior cerebral artery via the sylvian route

1998 ◽  
Vol 88 (5) ◽  
pp. 925-927 ◽  
Author(s):  
Cornelis A. F. Tulleken ◽  
Albert van der Zwan ◽  
Willem Jan van Rooij ◽  
Lino Moreira Pereira Ramos
Keyword(s):  
Carotid Artery ◽  
Excimer Laser ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Giant Aneurysm ◽  
External Carotid Artery ◽  
Balloon Occlusion ◽  
External Carotid ◽  
Content Type ◽  
Grafting Procedure

✓ In a patient with a giant aneurysm of the basilar artery trunk, a vein graft was interposed between the external carotid artery in the neck and the P1 segment of the posterior cerebral artery. Balloon occlusion of both vertebral arteries was performed 3 days later. The sylvian route was used for the grafting procedure and the connection to the posterior cerebral artery was made by using the excimer laser—assisted nonocclusive anastomosis technique.

Distal Basilar Artery “Umbrella Aneurysm” Treated by Radial Artery Graft Bypass From the External Carotid Artery to Posterior Cerebral Artery and Clip Trapping: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Varadaraya S Shenoy ◽  
Pascal Lavergne ◽  
Zeeshan Qazi ◽  
Basavaraj V Ghodke ◽  
Laligam N Sekhar
Keyword(s):  
Carotid Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Basilar Artery ◽  
Posterior Cerebral Artery ◽  
Video Recording ◽  
Memory Loss ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ct Angiogram

Abstract A 71-yr-old woman was discovered to have an incidental distal basilar artery (BA) fusiform aneurysm 7 × 5 mm in dimension, shaped like an “umbrella handle” with critical stenosis distal to the aneurysm. The right posterior cerebral artery (PCA) P1 segment was small; the left posterior communicating artery (PComA) was miniscule. Because the natural history of fusiform BA aneurysms is poorly defined, this was equated to a saccular aneurysm, with an estimated 10-yr rupture rate of 29%.1-8 After discussion of alternative treatments, the patient decided upon surgery. Because of inadequate collateral circulation, a bypass to the left PCA was deemed necessary.  The aneurysm was exposed by an extended trans-sylvian approach, and the left PCA P2 segment was visualized subtemporally. The left radial artery (RAG) was extracted, and pressure distended to prevent vasospasm. The RAG bypass was sutured first to the P2, and then to the cervical external carotid artery (ECA); the BA aneurysm was then clipped. The proximal anastomosis of the bypass needed revision because of poor flow; a 4-mm punch hole was made to widen the arteriotomy on the ECA. The patient was discharged home with mild memory loss and partial left cranial nerve III palsy. After discharge, she developed a severe left hemicrania, resolved with gabapentin. At 6-wk follow-up, she was asymptomatic, and computed tomography (CT) angiogram demonstrated patency of the bypass.  The patient gave informed consent for surgery and video recording. All relevant patient identifiers have been removed from the video and accompanying radiology slides.

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.

Endovascular middle cerebral artery embolic stroke model: a novel approach

2021 ◽  
pp. neurintsurg-2021-017370
Author(s):  
L Fernando Gonzalez ◽  
David S Warner ◽  
Huaxing Sheng ◽  
Eduardo Chaparro
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
External Carotid Artery ◽  
Embolic Stroke ◽  
Therapeutic Interventions ◽  
External Carotid ◽  
Stroke Model ◽  
Content Type ◽  
Proximal Internal Carotid Artery

A video (video 1) describing a novel murine endovascular embolic stroke model is presented. Traditional middle cerebral artery (MCA) occlusion models include a blind insertion of a monofilament string12 into the common or external carotid artery with the expectation to selectively occlude the MCA. However, significant mortality occurs due to subarachnoid hemorrhage and variability in stroke size, possibly related to the filament’s malposition—for example, external carotid or proximal internal carotid artery (ICA). Additionally, while the string is in place, it occludes the entire extracranial ICA affecting also the collateral pial circulation.Video 1Our model includes tail artery access, which tolerates several procedures facilitating survival studies. This model uses autologous blood3 4 clot deployed directly into the MCA, resembling what occurs in clinical practice. Autologous thrombi could be lysed with IA/IV tissue plasminogen activator.In summary, we describe a novel model that resembles real practice, permits multiple catheterizations, results in reliable embolization under fluoroscopic guidance and allows therapeutic interventions not available with traditional models.

A modified technique for bypass of the external carotid artery to the proximal posterior cerebral artery: An anatomical and technical study

2006 ◽  
Vol 126 (5) ◽  
pp. 526-529 ◽  
Author(s):  
Kayhan Ozturk ◽  
Ilknur Ismihan Uysal ◽  
Hamdi Arbag ◽  
Mustafa Buyukmumcu ◽  
Mehmet Erkan Ustun ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Modified Technique ◽  
Technical Study

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.

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

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.

External carotid-cavernous fistula treated by arterial embolization

1974 ◽  
Vol 40 (1) ◽  
pp. 110-114 ◽  
Author(s):  
M. Stephen Mahalley ◽  
Stephan C. Boone
Keyword(s):  
Carotid Artery ◽  
Successful Treatment ◽  
Arterial Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Unusual Occurrence ◽  
Fine Print

✓ The unusual occurrence of a carotid-cavernous fistula supplied entirely by branches of the external carotid artery is presented, and its successful treatment by arterial embolization described.

Arteriovenous malformation in the posterior fossa supplied by the external carotid circulation

1974 ◽  
Vol 41 (4) ◽  
pp. 502-507 ◽  
Author(s):  
Carl J. Graf ◽  
Arnold H. Menezes
Keyword(s):  
Carotid Artery ◽  
Arteriovenous Malformation ◽  
Posterior Fossa ◽  
Blood Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Content Type ◽  
Carotid Circulation ◽  
Fine Print

✓ The authors report a case in which the blood supply of a posterior fossa arteriovenous malformation was derived entirely from the external carotid artery.

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