THE MODIFIED EXCIMER LASER-ASSISTED HIGH-FLOW BYPASS OPERATION

BACKGROUND To make high-now revascularization of the brain possible, w e developed an anastomosis technique that obviates temporary occlusion of the recipient artery. After connecting donor and recipient vessels , an Excimer laser catheter, introduced by way of an artificial side b ranch, creates a hole at the anastomosis site. Because of the inconsis tency of the diameter of the hole produced by the closed laser tip, we developed an extensive modification of the procedure. METHODS A new t ype of laser tip was developed, consisting of two layers of 60 mu lase r fibers in a circular configuration with a diameter of 2.2 mm. The la ser tip is fixed to the vessel wall at the anastomosis site by suction with a high-vacuum suction device, and a round piece of recipient ves sel wall inside the anastomosis is cut out. RESULTS Using the aorta as the recipient vessel in 30 rabbits, the modified technique was develo ped and, in the end, produced anastomoses with a high patency fate. In 25 patients, high-flow bypasses for different indications were made u sing a venous transplant interposed between the external carotid arter y or one of its branches and the intracranial internal carotid artery, utilizing the modified Excimer laser technique for the intracranial a nastomosis. Complications related to the new anastomosis technique wer e minimal, and a satisfactory patency rate was obtained. CONCLUSIONS T he modified Excimer laser-assisted anastomosis technique makes high-fl ow revascularization of the brain a safe procedure, since temporary oc clusion of the recipient proximal brain artery during the making of th e anastomosis is obviated. (C) 1996 by Elsevier Science Inc.