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Natarajan SK, Hauck EF, Hopkins LN, Levy EI, Siddiqui AH. Endovascular Management of Symptomatic Spasm of Radial Artery Bypass Graft. Neurosurgery 2010; 67:794-8; discussion 798. [PMID: 20657319 DOI: 10.1227/01.neu.0000374724.78276.a6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
To describe the technique of endovascular access for treatment of vasospasm of a radial artery bypass graft from the occipital artery to the M3 branch of the middle cerebral artery (MCA) in a patient with moyamoya disease.
CLINICAL PRESENTATION
A 32-year-old woman presented with recurrent right-sided ischemic symptoms in the territory of a previous stroke. Angiographic findings were consistent with moyamoya disease, and a perfusion deficit was identified on computed tomography (CT) perfusion imaging.
TECHNIQUE
The patient underwent a left MCA bypass graft for flow augmentation. She returned with an occluded bypass graft, collateralization of the anterior MCA territory through a spontaneous synangiosis, and a severe perfusion deficit in the posterior MCA territory. She underwent a revision bypass graft procedure with the radial artery from the occipital artery stump to the MCA-M3 branch. She developed repeated symptomatic vasospasm of the radial artery graft postoperatively. After systemic anticoagulation, the graft was accessed through the occipital artery, and intra-arterial verapamil was injected. When this failed to resolve the graft spasm, the radial artery graft was accessed with a 0.14-inch Synchro-2 microwire (Boston Scientific, Natick Massachusetts), and sequential angioplasties were performed using over-the-wire balloons from the proximal to distal anastomosis and in the occipital artery stump. A nitroglycerin patch was applied cutaneously over the graft to relieve the vasospasm.
RESULTS
No complications occurred. Graft patency with robust flow was observed on the 5-month follow-up angiogram.
CONCLUSION
Endovascular techniques can be safely used for salvage of spastic extracranial-intracranial grafts.
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Affiliation(s)
- Sabareesh K. Natarajan
- Department of Neurosurgery, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Erik F. Hauck
- Department of Neurosurgery, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - L. Nelson Hopkins
- Departments of Neurosurgery and Radiology, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Elad I. Levy
- Departments of Neurosurgery and Radiology, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
| | - Adnan H. Siddiqui
- Departments of Neurosurgery and Radiology, Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Department of Neurosurgery, Millard Fillmore Gates Hospital, Kaleida Health, Buffalo, New York
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Beloscar A, Guarinos J, Gutiérrez L, Lechuga Í, Bardají A, Ridao C. Intervencionismo coronario percutáneo a injerto de arteria radial. Resultado inicial y seguimiento. Rev Esp Cardiol (Engl Ed) 2005. [DOI: 10.1157/13072480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sharma AK, Ajani AE, Garg N, GebreEyesus A, Varghese J, Pinnow E, Waksman R, Pichard AD, Lindsay J. Percutaneous interventions in radial artery grafts: clinical and angiographic outcomes. Catheter Cardiovasc Interv 2003; 59:172-5. [PMID: 12772234 DOI: 10.1002/ccd.10527] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the modern era, radial artery graft is being used with increasing frequency to replace saphenous vein as a conduit for coronary artery bypass surgery. Several reports have shown encouraging early results of radial grafts compared to saphenous grafts. Despite these advantages, radial artery graft failure requiring revascularization does occur. We report on the clinical, angiographic, and technical characteristics and the follow-up results of 22 patients who underwent percutaneous intervention of radial grafts.
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Affiliation(s)
- Arvind K Sharma
- Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA.
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