Salvage Maneuvers for Occluded Bypass in Cerebral Revascularization Procedures

Area of Science:

• Neurosurgery
• Vascular Surgery
• Interventional Neurology

Background:

• Cerebral revascularization effectively treats complex intracranial aneurysms and ischemic cerebrovascular disease.
• Intraoperative thrombosis leading to bypass occlusion is a critical complication with severe consequences.

Purpose of the Study:

• To report experiences and salvage maneuvers for intraoperative thrombosis during cerebral revascularization.
• To discuss the characteristics and causes of intraoperative thrombosis in these procedures.

Main Methods:

• A retrospective review of 720 patients undergoing cerebral revascularization (STA-MCA and ECA-RA-MCA bypass) from 2013-2021.
• Analysis of clinical data, imaging, and neurological outcomes for patients experiencing intraoperative thrombosis.
• Confirmation of bypass patency using intraoperative Doppler ultrasonography and ICG videoangiography.

Main Results:

• Seven cases of intraoperative thrombosis occurred in 720 patients (0.97%).
• Six of seven thromboses were successfully salvaged using various maneuvers, including gelfoam application and thrombectomy.
• All salvaged patients achieved favorable outcomes at discharge and 6-month follow-up.

Conclusions:

• Intraoperative thrombosis is a rare but significant complication in cerebral revascularization.
• Salvage maneuvers, particularly relieving donor vessel compression with gelfoam, can restore bypass patency and lead to good outcomes.
• Further investigation into the specific culprits of thrombosis is warranted.