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External Carotid Artery-Related Adverse Events at Extra-Intra Cranial High Flow Bypass Surgery Using a Radial Artery
Masahiro Yamaguchi1, Kyongsong Kim1, Takayuki Mizunari1
1Department of Neurological Surgery, Chiba Hokuso Hospital, Nippon Medical School, Chiba, Japan.
Insights
Extracranial-intracranial (EC-IC) high-flow bypass using a radial artery graft poses risks, particularly for male patients with shorter external carotid artery (ECA) length (<17.5 mm). Careful consideration of ECA length is crucial for patient safety during this procedure.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Surgical Complications
Background:
- Extracranial-intracranial (EC-IC) high-flow bypass with radial artery (RA) grafts is an option for patients at high risk from direct internal carotid artery (ICA) treatment.
- Focus is on the external carotid artery (ECA) to RA graft anastomosis, a critical juncture for potential adverse events.
Purpose of the Study:
- To identify and analyze adverse events occurring during the ECA-RA anastomosis in EC-IC high-flow bypass procedures.
- To determine risk factors associated with these adverse events, specifically focusing on patient demographics and anatomical measurements.
Main Methods:
- Review of surgical records and intraoperative videos for 87 consecutive patients undergoing EC-IC high-flow bypass with RA grafts.
- Measurement of ECA diameter and non-branched length from preoperative angiograms to assess anastomosis site characteristics.
Main Results:
- Adverse events occurred in 12.6% of patients during ECA-RA anastomosis.
- Higher rates of ECA dissection were observed in male patients (23.5%) compared to female patients (4.3%).
- Male sex, diabetes mellitus, and shorter non-branching ECA length (<17.5 mm) were identified as significant risk factors for adverse events.
Conclusions:
- Male patients undergoing EC-IC high-flow bypass with RA grafts are at increased risk of adverse events.
- An ECA length shorter than 17.5 mm at the planned anastomosis site is a key predictor of complications.
- Preoperative assessment of ECA length is vital for risk stratification and patient management.
Objective:
Placing an extracranial-intracranial (EC-IC) high-flow bypass using a radial artery (RA) graft plus internal carotid artery (ICA) trapping or ligation is an option for treating patients expected to be at high risk for complications by direct surgical treatment of the ICA. We focused on the anastomosis between the external carotid artery (ECA) and the RA graft in the cervical region and present adverse events and salvage procedures.
Methods:
EC-IC high-flow bypass procedures using an RA graft were performed to treat 87 consecutive patients. The ECA diameter at the midpoint of the planned ECA-RA anastomosis and the non-branched length of the ECA were measured on preoperative angiograms. To study adverse events related to ECA-RA anastomoses, we reviewed the patients' surgical records and intraoperative videos.
Results:
In 11 patients (12.6%) we encountered adverse events during anastomosis between the ECA and RA. The rate of ECA dissection was significantly higher in male patients (4 of 17; 23.5%) than female patients (3 of 70; 4.3%) (P = 0.012). Logistic regression analysis revealed that male sex, individuals with diabetes mellitus, and patients whose non-branching length of the ECA was short (16.1 ± 6.7 mm) were at high risk of ECA problems. We set the cutoff point at 17.5 mm (the area under the receiver operator characteristic curve was 0.72).
Conclusions:
Our findings indicate that patients, especially male patients, treated by EC-IC high-flow bypass using an RA graft are at increased risk for adverse events when the ECA length at the site of the planned anastomosis is shorter than 17.5 mm.
