Radial artery graft for bypass of internal maxillary artery to intracranial artery: a wise choice for complex intracranial aneurysms

Abstract

Objective To report results of the internal maxillary artery bypass (MA)to the intracranial arteries with radial artery (RA) graft for complex aneurysms.Methods 22 patients with complex aneurysms underwent MA bypass with radial artery graft.Aneurysms were located in the cavernous segment of the internal carotid artery (C3) in 8 cases,middle cerebral artery (MCA) in 6 cases,ophthalmic segment in 4 cases,supraclinoid segment (C4) in 1 case,vertebrobasilar junction in 2 cases,and low basilar trunk in 1 case.Vital branches or perforating arteries arose at the origin of aneurysm bodies in 9 cases.4 patients had recurrent filling aneurysms or migration after coiling treatment.A 7 cm RA harvest was gathered from the forearm.An end-to-end anastomosis was first performed between the proximal radial artery graft and the proximal MA.In internal carotid aneurysms,the distal end of the RA graft was then anastomosed to the side of the temporal-occipital branch of the MCA,while the distal end of the RA graft was anastomosed to the side of the P2 segment of the PCA for vertebrobasilar aneurysms.After the completion of all anastomosis,the aneurysms were trapped in 16 cases,and proximal artery patent arteries was occluded only for creating reversal flow bypasses to aneurysms related to the small perforating arteries in 6 cases.Results 20 patients obtained excellent recovery; furthermore,patency of the bypass graft with elimination of aneurysms was confirmed in 20 patients.Patency of the bypass was unidentifiable in the remaining 2 patients,however,both patients did not have any symptoms without patent bypass in spite of the occlusion.22(100％)patients were followed-up between 3 months and 3 years after surgery.21 patients recovered their normal lives,while 1 patient still needed assistance for daily life for a disease unrelated to the surgery.Conclusion The selection of maxillary artery bypass to the intracranial artery distal to the aneurysm with subsequent reversal flow to the aneurysm body or trapping of the aneurysm should be an effective management in patients with unclipped giant aneurysm. Key words: Intracranial aneurysm; Cerebral revascularization; Vascular grafting; Maxillary artery; Radial artery