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Botulinum toxin to improve vessel graft patency in cerebral revascularization surgery: report of 3 cases

Ben A Strickland1, Robert C Rennert2, Joshua Bakhsheshian1

  • 1Departments of1Neurosurgery.

Journal of Neurosurgery
|March 3, 2018
PubMed

Insights

Botulinum toxin was used ex vivo to prevent graft spasm in three extracranial-intracranial bypass surgeries. This novel approach successfully maintained graft patency and avoided spasm, offering a new option for cerebral revascularization.

Area of Science:

  • Neurosurgery
  • Vascular Surgery
  • Pharmacology

Background:

  • Surgical revascularization is crucial for complex intracranial aneurysms and ischemic cerebrovascular disease.
  • Graft spasm is a frequent complication of bypass procedures, potentially leading to ischemia or thrombosis.

Observation:

  • Botulinum toxin was clinically used for the first time to prevent graft spasm in extracranial-intracranial (EC-IC) bypass.
  • The technique involved ex vivo treatment of harvested grafts with botulinum toxin prior to anastomosis in 3 EC-IC bypass surgeries.

Findings:

  • Post-bypass vascular imaging confirmed graft patency and absence of spasm in all three cases.
  • Histopathological analysis revealed no immediate endothelial or vessel wall damage from the botulinum toxin treatment.
  • Postoperative angiograms showed no instances of graft spasm.

Implications:

  • Botulinum toxin presents a potential new method for preventing graft spasm in cerebral revascularization.
  • This technique may improve graft patency and reduce ischemic complications following EC-IC bypass procedures.

Keywords:
EC-IC bypassbotulinum toxingraft patencyrevascularizationvascular disorders

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