Basic Techniques and Perioperative Care of Radial Artery Graft: Lessons Learned from 130 Cases

Murai, Yasuo; Morita, Akio; Mizunari, Takayuki; Tateyama, Kojiro; Koketsu, Kenta; Matano, Fumihiro; Igarashi, Yutaka; Baba, Eiichi; Tsukiyama, Atsushi

doi:10.2335/scs.47.6

Cited by 1 publication

(1 citation statement)

References 12 publications

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“… 3 , 18 , 19 ) Murai et al reported that in their high-flow bypass with RA grafting, the 5-year or longer patency rate of the graft was 94%, and the symptomatic ischemic complication rate was 4.9%. 20 , 21 ) It can be safely performed even in patients with intracranial hemorrhage or multiple trauma because dual antiplatelet therapy is not required, and there is no possibility of postoperative rupture. Even in emergency operations under conditions that do not allow preoperative cerebral blood flow testing, the risk of postoperative complications, including hyperperfusion and ischemic complications, has been determined to be reduced by intraoperative maneuvers such as MCA pressure measurements, additional STA-MCA bypass, and indocyanine green fluorescence.…”

Section: Discussionmentioning

confidence: 99%

A Case of Ruptured Carotid Traumatic Blood Blister-like Aneurysm

MATSUMOTO,

NAKAE,

MATANO

et al. 2023

NMC Case Report Journal

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Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.

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