Ln. Sekhar et al., Cerebral revascularization using radial artery grafts for the treatment ofcomplex intracranial aneurysms: Techniques and outcomes for 17 patients, NEUROSURGER, 49(3), 2001, pp. 646-658
OBJECTIVE: The goal of this report is to illustrate the use of radial arter
y grafts as bypass conduits in the management of complex intracranial aneur
ysms and to describe a new "pressure distension technique" to eliminate pos
toperative vasospasm, which was a common problem early in our experience.
METHODS: This study included a series of 17 patients who were surgically tr
eated between 1994 and January 2001 for complex intracranial aneurysms. Fiv
e patients were surgically treated without the pressure distension techniqu
e; for 12 patients, the technique was used to reduce postoperative vasospas
m. Fourteen of the patients had anterior circulation aneurysms, and three h
ad posterior circulation aneurysms. Five of the patients had undergone prev
ious attempts at direct clipping or excision and reconstruction of the aneu
rysm in question, and embolization had been performed for one patient with
a carotid-cavernous fistula. Thirteen patients underwent permanent revascul
arization combined with proximal occlusion, trapping, or clipping, and four
patients underwent temporary revascularization for cerebral protection dur
ing anticipated prolonged occlusion of the parent vessel during aneurysm di
ssection. Surgical techniques are described, with particular reference to v
essel collection and bypass techniques.
RESULTS: The outcomes for this group of patients, considering the complexit
y of the aneurysms and their "inoperability," with respect to direct clippi
ng, were satisfactory. The aneurysms were completely obliterated for all pa
tients, and the grafts were patent for all except one patient on postoperat
ive angiograms. There were two deaths, one attributable to systemic sepsis
and the other attributable to cardiac arrest during a transbronchial biopsy
. The postoperative Glasgow Outcome Scale scores were either better or the
same for all other patients, compared with their preoperative scores. Three
of the five patients treated before the institution of the pressure disten
sion technique experienced vasospasm of the graft, with two of those patien
ts requiring angioplasty. For one of those patients, angioplasty led to rup
ture of the graft. Vasospasm was not observed for any of the 12 patients fo
r whom the pressure distension technique was used. We observed no morbidity
related to radial artery collection.
CONCLUSION: Revascularization techniques are occasionally necessary for the
surgical treatment of complicated intracranial aneurysms. The merits of th
e use of the radial artery as a bypass conduit are discussed. Radial artery
grafts should be considered as alternatives to saphenous vein and superfic
ial temporal artery grafts. The problem of vasospasm of the artery has been
solved with the pressure distention technique.