Use of the excimer laser in high-flow bypass surgery of the brain

Abstract

The technique of laser-assisted anastomosis for high-flow bypass surgery using the excimer laser is described in 15 rabbits and in one patient. The left common carotid artery of the rabbits was excised and, with two anastomoses, connected to the right common carotid artery. An end-to-side anastomosis technique was used that obviated the temporary occlusion of the recipient artery. The end of the donor artery was connected for its full circumference with the exterior of the recipient artery and, with the aid of an excimer laser catheter (introduced via an artificial side branch of the donor artery), the wall of the recipient artery was evaporated. In two animals only, occlusion of the anastomosis sites occurred. In the remaining 13 animals both anastomosis sites were proven to be patent by inspection at different times, followed by scanning electron microscopy in six animals. In a patient with hypoperfusion of the brain caused by bilateral internal carotid artery occlusion, revascularization of the right hemisphere was obtained by placing a shunt between the proximal superficial temporal artery and the intracranial portion of the internal carotid artery, using a free transplant of the right inferior epigastric artery. The anastomosis with the internal carotid artery was created using the excimer laser-assisted technique without occlusion of the recipient artery.