Endoscopic Radial Artery Harvesting for U-Clip EC-IC Bypass in the Treatment of a Giant Petrous Internal Carotid Artery Aneurysm: Technical Case Report

Abstract

Introduction: High-flow extracranial-intracranial (EC-IC) bypass and aneurysm trapping constitutes a well-known surgical solution for internal carotid artery (ICA) aneurysms that are not amenable to clip ligation or endovascular therapy. The advantages of the radial artery (RA) as a conduit for myocardial revascularization have become widely accepted, with a better patency rate than that of the saphenous vein.

Case Report: A 66-year-old woman was found to harbour a right giant, partially thrombosed aneurysm of the intrapetrous segment of the internal carotid artery. Endoscopic harvesting of the RA was achieved combining a resterilizable retractor and a vessel sealing system. After neck dissection, the main trunk of the middle cerebral artery (MCA), its branches, and part of the aneurysm were isolated through a right fronto-orbito-zygomatic craniotomy. The external carotid artery, distal to the origin of the facial artery, was chosen in the neck for an end-to-end microanastomosis. The temporal branch of the MCA was selected for an end-to-side microanastomosis with the radial graft using ten U-clips. The total temporary occlusion time was 13 min. The post-operative course was uneventful.

Conclusion: Endoscopic technique provides improved patient satisfaction, especially in terms of length of the surgical incision, when compared to the conventional approach. Combined with the innovative use of U-clips, this case illustrates how new technologies can simplify ECA-ICA bypass surgery while yielding a better cosmetic and functional outcome.

Key words

extracranial-intracranial (EC-IC) bypass - cerebral aneurysms - radial artery

References

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