External Carotid Artery to Middle Cerebral Artery Bypass With the Saphenous Vein Graft

Abstract

Patients with occlusive cerebrovascular disease who have failed maximal medical therapy, which consists of antiplatelet agents as well as maximizing modifiable risk factors such as blood pressure, cholesterol, smoking cessation, and obesity, and whose lesions are not amenable or have not responded to the more common vascular procedures (i.e., carotid endarterectomy or stenting) are considered candidates for an extracranial-intracranial bypass. Additionally, for a patient to be a candidate, he/she must have an adequate graft vessel. Typically, this vessel is the superficial temporal artery. However, oftentimes, the superficial temporal artery is an inadequate vessel or the patient requires a high-flow conduit. It is in these patients that use of the saphenous vein should be considered. In this report, we detail the technical aspects of performing an extracranial-intracranial bypass by using a saphenous vein graft.

Watertight Dural Closure Constructed With DuraSeal^TM for Bypass Surgery

“…Pericranium, temporal fascia, temporal muscle, 1) and gelatin foam discs have been placed around the STA to reduce the space around the donor artery and to prevent CSF leakage after bypass surgery, 2,11) but this approach is not necessarily reliable. In the present study, the occurrence of CSF leakage did not differ with the use of hydrogel sealant from the temporal muscle cohort.…”

“…2,5,[9][10][11][12] Harvesting of the STAs, and the procedure for anastomosis are well established, 5,7,11,12) but there is little discussion about dural closure. 3) After establishing the patency of the bypass, the dura is usually just loosely reapproximated so as not to compromise the STA.…”

“…3) After establishing the patency of the bypass, the dura is usually just loosely reapproximated so as not to compromise the STA. 2,5,11,12) Alternatively, a small strip of the temporal muscle or fascia is employed around the STA and sutured to the dura to minimize the extent of the dural defect around the STA. The bandage tends to be loose so as not to compress and occlude the STA.…”

Tratamiento de un aneurisma serpentino gigante de arteria cerebral media con bypass de alto flujo desde la arteria carótida interna petrosa

“…Algunos aneurismas cerebrales gigantes sólo pueden ser tratados mediante bypass, seguido o no de la exclusión y de la exéresis quirúrgica del aneurisma 1,3,4,6,8,10,13 . Las características del aneurisma gigante tratado se corresponden con las de los aneurismas serpentinos, término descriptivo que sirve para designar a los aneurismas trombosados que poseen un canal vascular tortuoso no endotelizado en su seno que conecta la entrada y salida del vaso a través de la lesión.…”

“…El bypass es una técnica alternativa a la exclusión directa con clipaje microquirúrgico de los aneurismas cerebrales gigantes 1,3,4,6,8,10,13 …”