Cerebral revascularization using radial artery grafts for the treatment ofcomplex intracranial aneurysms: Techniques and outcomes for 17 patients

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.