A2 Anterior Cerebral Artery-to-A3 Anterior Cerebral Artery Interpositional Bypass with Radial Artery Graft for a Ruptured Mycotic Fusiform Aneurysm: 2-Dimensional Operative Video

2018 ◽  
Vol 15 (5) ◽  
pp. 601-601 ◽  
Author(s):  
Jan-Karl Burkhardt ◽  
Ethan Winkler ◽  
Halima Tabani ◽  
Sirin Gandhi ◽  
Arnau Benet ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Fusiform Aneurysm ◽  
Radial Artery Graft ◽  
Artery Graft

The azygos anterior cerebral artery bypass: double reimplantation technique for giant anterior communicating artery aneurysms

2011 ◽  
Vol 114 (4) ◽  
pp. 1154-1158 ◽  
Author(s):  
Zaman Mirzadeh ◽  
Nader Sanai ◽  
Michael T. Lawton
Keyword(s):  
Radial Artery ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Artery Bypass ◽  
Anterior Communicating Artery ◽  
Retrograde Flow ◽  
Radial Artery Graft ◽  
Pterional Craniotomy ◽  
Artery Graft ◽  
Interhemispheric Fissure

The authors introduce the azygos anterior cerebral artery (ACA) bypass as an option for revascularizing distal ACA territories, as part of a strategy to trap giant anterior communicating artery (ACoA) aneurysms. In this procedure, the aneurysm is exposed with an orbitozygomatic-pterional craniotomy and distal ACA vessels are exposed with a bifrontal craniotomy. The uninvolved contralateral A2 segment of the ACA serves as a donor vessel for a short radial artery graft. The contralateral pericallosal artery (PcaA) and the callosomarginal artery (CmaA) are connected to the graft in the interhemispheric fissure using the double reimplantation technique. Three anastomoses create an azygos system supplying the entire ACA territory, enabling the surgeon to trap the aneurysm incompletely. Retrograde flow from the CmaA supplies the ipsilateral recurrent artery of Heubner, and the aneurysm lumen thromboses. The azygos bypass was successfully performed to treat a 47-year-old woman with a giant, thrombotic ACoA aneurysm supplied by the A1 segment of the left ACA, with left PcaA and CmaA originating from the aneurysm base. The authors conclude that the azygos ACA bypass is a novel option for revascularizing PcaA and CmaA, as part of the overall treatment of giant ACoA aneurysms.

Left External Carotid Artery to the Middle Cerebral Artery Bypass with Radial Artery Graft and Clip Reconstruction of a Large Middle Cerebral Artery Fusiform Aneurysm: 3-Dimensional Operative Video

2019 ◽  
Vol 17 (4) ◽  
pp. E159-E160 ◽  
Author(s):  
Chun-Yu Cheng ◽  
Zeeshan Qazi ◽  
Laligam N Sekhar
Keyword(s):  
Carotid Artery ◽  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Temporal Artery ◽  
External Carotid Artery ◽  
External Carotid ◽  
Fusiform Aneurysm ◽  
Radial Artery Graft ◽  
Artery Graft

Abstract This 16-yr-old boy presented with episodes of severe headaches, blurred vision, dizziness, and muffled hearing and was discovered to have a large fusiform aneurysm of the left middle cerebral artery (MCA), M1 segment, 20 × 12 mm in dimension. The lenticulostriate arteries were arising proximal and distal to the aneurysm, but the anterior temporal artery was arising from the aneurysm. The aneurysm culminated in the distal M1 segment, and M1 immediately branched into 3 M2 vessels, the lower one being the larger. Due to origin of the lenticulostriate arteries and the anterior temporal artery and patient's age, a bypass was preferred to a flow diversion stent.  He underwent left frontotemporal craniotomy and orbital osteotomy, left cervical external carotid artery exposure followed by radial artery graft extraction. The Sylvian fissure was opened and intracranial ICA was exposed for proximal control. The distal M2 vessels traced back toward the aneurysm. The aneurysm was not clippable and a bypass to the larger inferior M2 branch was performed followed by aneurysm trapping. The radial artery graft bypass was placed from the left external carotid artery to the M2 segment of left MCA, followed by clip reconstruction and occlusion of the MCA aneurysm with the preservation of the anterior temporal branch and the lenticulostriate vessels. The patient had no postoperative complications. At the follow-up, one month after surgery, he was doing well, and his angiogram demonstrated patency of the bypass.  This video shows the management of a complex fusiform M1 aneurysm with bypass and trapping.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

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.

Radial Artery Graft for Bypass of the Maxillary to Proximal Middle Cerebral Artery: An Anatomic and Technical Study

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 667-671 ◽  
Author(s):  
Mehmet Erkan Üstün ◽  
Mustafa Büyükmumcu ◽  
Cagatay Han Ulku ◽  
Aynur Emine Cicekcibasi ◽  
Hamdi Arbag
Keyword(s):  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Proximal Middle Cerebral Artery ◽  
The Mean ◽  
Artery Branch

Abstract OBJECTIVE In this study, we aimed to investigate the use of a radial artery graft for bypass of the maxillary artery (MA) to the proximal middle cerebral artery (MCA) as an alternative to superficial temporal artery-to-MCA anastomosis or extracranial carotid-to-MCA bypass using long grafts. METHODS Five adult cadavers were used bilaterally. After a frontotemporal craniotomy and a zygomatic arch osteotomy, the MA was found easily 1 to 2 cm inferior to the infratemporal crest. A hole was created with a 4-mm-tip drill in the sphenoid bone 2 to 3 mm lateral to the foramen rotundum extradurally, and the dura over the hole was opened. After the carotid and sylvian cisterns had been opened, the M2 segment of the MCA was exposed. The graft was passed through the hole to reach the M2 segment. Then, the MA was freed from the surrounding tissue and was transected before the infraorbital artery branch. The radial artery graft was anastomosed end-to-end to the MA proximally and end-to-side to the M2 segment of the MCA distally. RESULTS The mean thickness of the MA before the infraorbital artery branch was 2.6 ± 0.3 mm. The mean thickness of the largest trunk of the MCA was 2.3 ± 0.3 mm. The average length of the graft was 36 ± 5.5 mm. CONCLUSION MA-to-MCA bypass is as feasible as proximal MCA revascularization using long vein grafts. The thickness of the MA provides sufficient flow; the length of the graft is short, and it has a straight course. MA-to-proximal MCA bypass may be an alternative to superficial temporal artery-to-MCA as well as extracranial carotid-to-MCA bypasses.

Bypass of the maxillary to proximal middle cerebral artery or proximal posterior cerebral artery with radial artery graft

2011 ◽  
Vol 153 (8) ◽  
pp. 1649-1655 ◽  
Author(s):  
Xiang’en Shi ◽  
Hai Qian ◽  
K I Singh K.C. ◽  
Yongli Zhang ◽  
Zhongqing Zhou ◽  
...  
Keyword(s):  
Middle Cerebral Artery ◽  
Radial Artery ◽  
Cerebral Artery ◽  
Posterior Cerebral Artery ◽  
Radial Artery Graft ◽  
Artery Graft ◽  
Proximal Middle Cerebral Artery

Revascularization of the Anterior Cerebral Artery with an A3–A3 Anastomosis and a Superficial Temporal Artery Bypass Using an A3-Radial Artery Graft to Trap a Giant Anterior Communicating Artery Aneurysm: Technical Case Report

2005 ◽  
Vol 57 (suppl_1) ◽  
pp. E207-E207 ◽  
Author(s):  
Tomohiro Inoue ◽  
Kazuo Tsutsumi ◽  
Hiroyasu Ohno ◽  
Munehisa Shinozaki
Keyword(s):  
Radial Artery ◽  
Anterior Cerebral Artery ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Artery Aneurysm ◽  
Temporal Artery ◽  
Anterior Communicating Artery ◽  
Radial Artery Graft ◽  
Anterior Communicating Artery Aneurysm ◽  
Artery Graft

Abstract OBJECTIVE AND IMPORTANCE: How to manage the distal anterior cerebral artery (ACA) circulation in the treatment of a giant anterior communicating artery aneurysm or a giant azygous A2 aneurysm is still controversial. CLINICAL PRESENTATION: We are reporting the case of a 70-year-old man who presented with an evolving giant thrombosed anterior communicating artery aneurysm. INTERVENTION: He was successfully treated by trapping the aneurysm in conjunction with an A3–A3 side-to-side anastomosis and a superficial temporal artery bypass using an A3-radial artery graft. The postoperative angiography showed an excellent filling of all the bilateral distal ACA area through the bypass. CONCLUSION: In cases in which direct clipping to preserve distal ACA flow is quite difficult, the bilateral ACA revascularization described here should be considered as another possibility.

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