Extracranial-intracranial bypass surgery using a radial artery interposition graft for cerebrovascular diseases

Abstract

Objective: To investigate the efficacy of extracranial-intracranial (EC-IC) bypass surgery using a radial artery interposition graft (RAIG) for surgical management of cerebrovascular diseases.

Methods: The study involved a retrospective analysis of 13 patients who underwent EC-IC bypass surgery using RAIG at a single neurosurgical institute between 2003 and 2009. The diseases comprised intracranial aneurysm (n=10), carotid artery occlusive disease (n=2), and delayed stenosis in the donor superficial temporal artery (STA) following previous STA-middle cerebral artery bypass surgery (n=1). Patients were followed clinically and radiographically.

Results: Bypass surgery was successful in all patients. At a mean follow-up of 53.4 months, the short-term patency rate was 100%, and the long-term rate was 92.3%. Twelve patients had an excellent clinical outcome of Glasgow Outcome Scale (GOS) 5, and one case had GOS 3. Procedure-related complications were a temporary dysthesia on the graft harvest hand (n=1) and a hematoma at the graft harvest site (n=1), and these were treated successfully with no permanent sequelae. In one case, spasm occurred which was relieved with the introduction of mechanical dilators.

Conclusion: EC-IC bypass using a RAIG appears to be an effective treatment for a variety of cerebrovascular diseases requiring proximal occlusion or trapping of the parent artery.

Keywords: EC-IC arterial bypass; Radial artery interposition graft; Revascularization.

Fig. 1

Illustrations depicting long- and short-segment bypassing using a radial artery interposition graft (RAIG). A : Long-segment bypass. One end of the RAIG (green color) is anastomosed to the M2 segment of the middle cerebral artery and the other end is anastomosed the cervical external carotid artery in an end-to-side fashion. B : Short-segment bypass. The RAIG is anastomosed to the proximal superficial temporal artery in an end-to-end fashion at a site just anterior to the tragus.

Fig. 2

A : Intraoperative photo shows anastomosis from radial artery to M2 segment of the middle cerebral artery in and end-to-side fashion. B : It shows anastomosis from cervical external carotid artery to radial artery in an end-to-side fashion.

Fig. 3

A 61-year-old woman presented with a headache, and was found to have a huge aneurysm of the right cavernous internal carotid artery. A and B : Preoperative conventional angiography showing a giant aneurysm measuring 2×4 cm. C : Postoperative angiography revealed good patency of the bypass graft. D : After endovascular occlusion of the proximal ICA, the aneurysm is no longer filled. Angiography shows blood flow through the RAIG supplying the whole middle cerebral territory and the supraclinoid portion of the ICA. ICA : internal carotid artery, RAIG : radial artery interposition graft.

Fig. 4

A 60-year-old man presented with headache and neck pain, and was found to have a huge dissection aneurysm on basilar artery. A, B and C : Preoperative conventional angiography show a giant dissection aneurysm measuring 1.6×3.2 cm. D : Post-bypass surgery angiography reveal good patency of the bypass graft. E and F : After endovascular occlusion of the proximal right vertebra artery, the aneurysm is no longer filled.